Amenorrhea is a disorder of menstrual function, in which women of childbearing age (16 – 45 years old) do not have menstruation for six months or more. Amenorrhea, as a rule, is not an independent disease, but is a symptom of genetic, biochemical, physiological, psycho-emotional disorders in the body.
This is not an emergency, but postponing the solution to this problem promises extremely negative consequences.
The following types of amenorrhea are distinguished:
- primary (such a diagnosis is made if by the age of 16 the girl has never had independent periods);
- secondary (occurs in the case of a delay in menstruation for six months or more with previously existing independent or drug-induced menstruation);
- physiological (in the prepubertal period, during pregnancy, during lactation and in the postmenopausal period).
If there is a delay in menstruation, but is less than six months, and in total they occur up to 9 times a year, this condition is called oligomenorrhea. In the case of regular (monthly), but scanty in terms of the volume of menstruation, they are denoted by the term “opsomenorrhea”.
In fact, amenorrhea is hypogonadism, that is, a condition associated with insufficient function of the gonads. Depending on the level of gonadotropic hormones in the blood, the following forms are distinguished:
- hypogonadotropic (the concentration of follicle-stimulating hormone (FSH) is less than 1.6 U / l);
- hypergonadotropic (FSH level more than 30 U / l);
- normogonadotropic (FSH content is in the range from 1.6 to 30 U / l).
Primary amenorrhea can be caused by:
- dysgenesis of the gonads (underdevelopment of the sex glands);
- Shereshevsky-Turner syndrome (leads to the development of amenorrhea in 1 in 2500 newborn girls);
- congenital hypopituitarism;
- malformations of intrauterine development of the organs of the reproductive system (for example, an infection of the vaginal canal);
- tumors of the central nervous system, in particular, the hypothalamic-pituitary region;
- psychoemotional severe stress;
- improper, insufficient nutrition of a teenager;
- excessive physical exertion.
Secondary amenorrhea is usually caused by:
- resistant wasted ovary syndrome;
- polycystic ovary syndrome;
- acquired hypopituitarism;
- emaciation (underweight) or, on the contrary, obesity of a woman;
- diseases of the organs of the endocrine system in the stage of decompensation.
As a result of one reason or another, the processes of synthesis and release of female sex hormones into the blood are disrupted in a woman’s body, and therefore the menstrual cycle is disrupted up to the absolute absence of menstruation.
The main symptoms of any type of amenorrhea are the complete absence of menstruation and the inability to get pregnant, that is, infertility.
Secondary amenorrhea in 4 out of 5 patients is accompanied by vasomotor disorders, disorders of the nervous system (irritability, bad mood), decreased libido, soreness in the genital area during intercourse. For the primary form of this pathology, such symptoms are not typical.
In some diseases, there are specific clinical signs characteristic of them. In particular:
- tumors that produce a large amount of male sex hormones are manifested by hirsutism (excessive hair growth of the female body);
- hyperprolactinemia (increased concentration of prolactin in the blood) is accompanied by the outflow of milk from the mammary glands (this is called “galactorrhea”);
- Shereshevsky-Turner syndrome is characterized by the special appearance of the patient, her low stature, etc.
Conducting an objective examination of the patient, the doctor will pay attention to the severity of her secondary sexual characteristics, the correspondence of sexual development to age, assess the height and body weight. At the previous, initial stage of diagnosis – in the process of collecting complaints and anamnesis – he will clarify the characteristics of the patient’s eating behavior, take an interest in concomitant diseases, menstrual function, etc.
In order to detect the fact of an irregularity on the part of the menstrual cycle, a woman will be recommended daily in the morning, without getting out of bed, to measure the basal temperature (temperature in the rectum). Normally, its increase indicates the onset of ovulation, and if such a peak is absent, then ovulation does not occur, and the woman does not have the opportunity to become pregnant.
From laboratory diagnostics, the doctor can prescribe:
- determination of the level of hCG in the blood serum – for the absolute exclusion of pregnancy;
- determination of the level of prolactin in the blood plasma (an increased amount indicates the need to examine the pituitary gland for prolactinoma);
- determination of the level of FSH (follicle-stimulating hormone) and LH (luteinizing hormone) – an imbalance in the ratio indicates the likelihood of developing polycystic ovaries, increased FSH indicates gonadal dysgenesis, and decreased FSH indicates pituitary or hypothalamic dysfunction;
- determination of the level of T4 and TSH (thyroid-stimulating hormone) – a deviation from the norm indicates hypo- or hyperthyroidism and thyroid dysfunction;
- glucose tolerance test – will diagnose diabetes mellitus;
- progesterone test – negative indicates pathological changes in the endometrium, and positive indicates hypo- or hypergonadotropic amenorrhea.
For diagnostic purposes, to establish the causes of amenorrhea and further eliminate them, the following is used:
- ultrasound examination of the pelvic organs;
- X-ray examination of the Turkish saddle (if prolactinoma is suspected);
- computed tomography and MRI if necessary.
Therapeutic measures directly depend on what pathology underlies amenorrhea.
- With primary amenorrhea associated with genetic diseases, the patient is shown a lifelong intake of hormones missing in the body – estrogens. This method of treatment is called hormone replacement therapy.
- If a girl has developmental disorders (both physical and sexual), the doctor recommends her a high-calorie diet (for the purpose of muscle and fat mass growth), as well as taking hormones that stimulate menstrual function.
- In the case of emotional instability of the patient and the associated amenorrhea, the girl is shown observation not only by a gynecologist-endocrinologist, but also by a neuropathologist with the intake of prescribed drugs.
- Sometimes it is impossible to do without surgical intervention. In particular, this concerns the anatomical features of the development of the genital organs, in which the outflow of blood from the uterus is disturbed during menstruation. The task of the operating doctor is to restore the normal outflow, thereby eliminating the cause of the disease.
- If amenorrhea is the result of a significant decrease in body weight in a short time or has arisen due to intense physical exertion, the main direction of treatment is to normalize the lifestyle, work and rest, nutrition.
- Polycystic ovary syndrome is treated with medication or by laparoscopic diathermocoagulation.
- To eliminate hyperprolactinemia, the patient is recommended to take medications that reduce the concentration of prolactin in the blood. In order to track the effectiveness of treatment, a woman is recommended to control the basal temperature – as mentioned above, its growth is a sign of ovulation.
A correct lifestyle in combination with a balanced diet, as well as a woman’s attentive attitude to her health – timely diagnosis and adequate treatment of diseases, positive thinking and joy in every moment are fundamental points in the prevention of menstrual irregularities.