AMENORRHEA

AMENORRHEA - absence of menstruation for 6 months or more. There are physiological and pathological amenorrhea. Physiological amenorrhea occurs in childhood, during pregnancy, lactation, post-menopausal. There are false and the true pathological amenorrhea. When false amenorrhea occur in the body for a typical menstrual cycle changes, but no menstrual bleeding. Misleading pathological amenorrhea due to a violation of the outflow of menstrual blood and observed in malformations of sexual organs (for example, in the absence of the vagina or a portion thereof, a solid hymen), as well as acquired imperforate (atresia) of the cervical canal, the vagina, the hymen.

True amenorrhea is associated with disorders of the reproductive system as a result of the impact of unfavorable factors (ionizing radiation, infection ,, stress, hunger, etc.); It also occurs when genetic disorders, diseases of the central nervous and endocrine systems, congenital absence (aplasia) of the uterus and endometrium is damaged. Pathologic amenorrhea is primary if menstruation was never in his life, or secondary, if in the past was at least one self-menstruation. Depending on the level of destruction of the reproductive system of conditional release cerebral, hypothalamic, pituitary, ovarian and uterine form of amenorrhea. In all forms of amenorrhea observed infertility .

Cerebral or psychogenic amenorrhea occurs when severe mental shocks (eg, amenorrhea wartime) or mental illness. This form also include amenorrhea during false pregnancy.

Hypothalamic amenorrhea develops due to the defeat of the hypothalamus (most functional nature) and secondary reduction of gonadotropic pituitary function. It can be caused by intoxication (for example, frequent angina), stress, neyroinfektsy, pathological course of pregnancy and childbirth, as well as hypothalamic tumor. At the same time, in addition to amenorrhea and infertility patients often observed headaches, loss of memory and health, obesity , hirsutism, hypertension . To also include hypothalamic amenorrhea occurs in women after a significant loss of body weight due to the use of different diets; amenorrhea syndrome with pituitary gipertormozheniya, growing sometimes combined with the abolition of estrogengestagennyh drugs (bisekurin, marvelon et al.) after long-term use; the syndrome of amenorrhea galactorrhea - amenorrhea due to increased secretion of prolactin. In the last two forms of amenorrhea, in addition to violations of the hypothalamic regulation, possible tumor of the pituitary (adenoma), which allows us to consider these forms as the pituitary amenorrhea.

Pituitary amenorrhea occurs in lesions of the pituitary gland, accompanied by decreased production of gonadotropins. Most often it develops in tumors of the pituitary gland.

Ovarian amenorrhea associated with ovarian hormone deficiency functions. It is observed in Shereshevskii syndrome - Turner - congenital malformations of the sex glands (the absence of a functional tissue), caused by chromosomal abnormalities. Ovarian amenorrhea also occurs when ovarian depletion syndrome in women younger than 35 years, previously had a normal menstrual cycle. This syndrome, in addition to amenorrhea and infertility, manifested "tides", sweating; when ovarian biopsy and laparoscopy detect the absence of follicles in the ovary. Amenorrhea observed in resistant ovarian syndrome - macro- and microscopically unchanged ovarian insensitive to endogenous gonadotropin-releasing hormone, as well as ovarian syndrome sclerocystic. In addition, amenorrhea occurs after the removal of the ovaries (castration), and hormone-masculinizing ovarian tumors, sometimes with purulent inflammation of the ovaries.

Uterine amenorrhea due to congenital absence of the uterus, as well as damage to the endometrium of abortion, complicated delivery, tuberculous endometritis, when the endometrium loses its ability to respond to hormonal stimulation.

In the presence of amenorrhea, the patient must be referred to a gynecologist for a thorough gynecological examination in order to identify the causes of disease. In addition to vaginal and bimanual (two-handed) research, conducted tests of functional diagnostics:. Measurement of basal (rectal) temperature, cytological examination of vaginal smears, the definition of the phenomenon of "pupil", etc. For in-depth study of the reproductive system of the state is used histological examination of scrapings of the endometrium, determine the content in the blood gonadotropin, sex and adrenal hormones is carried out functional tests with hormones. According to testimony carried ultrasound examination of the uterus and ovaries, hysteroscopy, hysterosalpingography, laparoscopy. In order to eliminate a tumor of the pituitary examined fundus, the color of the field of view, perform craniography, a CT scan of the skull.

The prognosis depends on the cause and duration of amenorrhea. In functional disorders of the reproductive system forecast is generally favorable.

Prevention is aimed at ensuring a healthy inheritance (with the exception of closely related marriages, etc.), Abortion prevention, reproductive organs diseases, effects of unfavorable factors (stress, ionizing radiation, infections, etc.), Timely and adequate treatment of diseases of the central nervous system and the endocrine system.