Treatment of amenorrhea as a pathology, and when the absence of menstruation is the absolute norm

The hormonal system and functions of the ovaries clearly respond not only to significant diseases of the body, but also to the psycho-emotional state of the woman. Stress, malnutrition, overload also often cause amenorrhea, especially among teenage girls. The reason for the absence of menstruation should always be established, as sometimes this is the first sign of serious illness.

What is amenorrhea and why is it dangerous

What does amenorrhea mean and how to cure it? According to the classification of ICD-10 (international classification of diseases from 2010 revision) amenorrhea is encoded as N 91. Pathology is established in two cases:

• in the absence of menstruation, the girl is 16-18 years old;
• with a delay of menstruation for six months or more.

The coordinated work of the structures of the brain (pituitary, hypothalamus), endocrine organs, as well as the uterus and ovaries provides cyclical changes in the body and menstruation. A malfunction or mechanical obstruction causes amenorrhea.

Depending on the cause and mechanism of development, varieties are distinguished.

• True amenorrhea. The cyclic secretion of hormones is disturbed, so the endometrium does not mature and there is no menstruation. It happens with many diseases. Depending on the place of occurrence of the problem, suprahypothalamic, pituitary-hypothalamic amenorrhea, ovarian (sometimes incorrectly called egg), uterine amenorrhea are distinguished.
• False amenorrhea. If there is a mechanical obstruction at the level of the cavity, cervix and vagina, there is no menstruation due to the fact that the discharge cannot exit the genitals.
• Physiological. This is a temporary or permanent absence of menstruation, which is not accompanied by pathology. It happens during pregnancy, breastfeeding, during menopause and puberty.
• Primary. If the girl has never had her period. This is the pathology of adolescent development.
• Secondary. If a woman had at least one menstruation.

When can you suspect

The main symptom in amenorrhea is the absence of any menstrual-like discharge. This is the main criterion, all other signs vary depending on the cause.

Amenorrhea is established in the couple in the event that she has reached 16 years of age and she has never had menstruation. This is the primary form. If menstruation was at least once, to establish a diagnosis, their absence is required for six or more months.

Often, pathology is combined with other symptoms:

• additional signs of primary amenorrhea - stunted teenage girls, the absence of other sexual characteristics (hair growth, breast growth);
• conditions characteristic of secondary amenorrhea - infertility, irregular periods, established polycystosis, previous ovarian surgery, signs of hyperandrogenemia (male type hair).

Possible reasons

All causes of amenorrhea can be divided into several groups. The tactics of management and treatment, as well as the prognosis in each case are different.

Functional nature

They occur with eating disorders, psycho-emotional stress, stress. They are based on changes in the functioning of the central nervous system, in which the cyclic secretion of the hormones of the hypothalamus, and subsequently the pituitary gland and ovaries, is disturbed. The regulation of the genital organs is being sorted out; as a result, cyclic changes in the endometrium and ovaries do not occur.

When examining such women on the hormonal panel, there are not always obvious changes. The mechanism of functional amenorrhea is not fully understood, so it is not always treatable.

The main forms are as follows.

• Psychogenic. It occurs against the background of prolonged emotional stress, at the same time, most often subclinical (latent) depression occurs. At the same time, the connections between the individual brain structures are disrupted, and the secretion of stress hormones (adrenaline, adrenal norepinephrine) increases. All this leads to a change in the synthesis of FSH and LH by the pituitary gland, the sensitivity of the reproductive organs to sex hormones decreases. The consequence of all these processes is the absence of menstruation.
• Food amenorrhea. It is typical for poor countries in Africa, as well as for girls who are fond of losing weight and even fasting. It has been established that a decrease in body weight of more than 15% from ideal will certainly lead to disruption of the menstrual cycle. In some cases, after weight recovery, amenorrhea passes without a trace, but in about 30% it does not respond to treatment even against the background of normalization of all other indications of the body. Prevention of this - normalization of nutrition.
• Against the background of physical exertion. Girls who exhaust themselves with training also put themselves at risk for developing amenorrhea. This is due to a special low-calorie diet, a decrease in the mass of adipose tissue in the body, and stresses, experiences associated with competitions play a significant role.
• After taking contraceptives. It is known that in 5-7% of women after prolonged use of birth control pills, functional amenorrhea is associated with impaired secretion of the pituitary hormones. It can last up to a year and sometimes longer. The latter is a poor prognostic sign for the subsequent restoration of menstrual function.

Pituitary pathology

The range of diseases associated with the pituitary gland is wide. It can be inflammatory, autoimmune diseases, functional, tumors, hemorrhages. A thorough examination using modern technologies such as CT, MRI helps to establish the true cause. The most common include the following.

• Pituitary tumors. The most common is the pituitary adenoma, which causes hyperprolactinemia - an increase in the level of prolactin in the blood during examination. This leads to an imbalance of sex hormones, a violation of the synthesis of FSH and LH and the absence of menstruation. An increase in prolactin in the blood can also develop against the background of diseases of the thyroid gland and adrenal glands.
• Sheehan syndrome. It occurs in women after childbirth if they are accompanied by large blood loss. There is necrosis (death) of the pituitary gland against the background of thrombosis of its vessels. Subsequently, the organ does not function at all.
• "Empty Turkish Saddle". The Turkish saddle is a place on the bones of the skull where the pituitary gland is located. If for some reason he is not there, panhypopituitarism develops - a deficiency of hormones that regulate the function of the genitals, adrenal glands, and thyroid gland. The condition requires lifelong administration of synthetic analogues.

Genetic abnormalities

At the same time, external sexual characteristics may not correspond to the chromosome set or there is sexual underdevelopment. For example, at first glance, the girl in structure has male genital organs inside.

• Kalman's syndrome. This is a genetic mutation associated with pituitary dysfunction and a simultaneous lack of smell.
• Lawrence's Syndrome. This leads to obesity, delayed sexual development and mental disability. Such obvious symptoms become noticeable in childhood or in adolescents, therefore, diagnosis occurs at this time.
• Shereshevsky-Turner Syndrome. It develops in girls who have not two X chromosomes in their genetic material, but one. They have obvious external symptoms of pathology - short stature, short neck with special pterygoid folds. Sexual development is practically absent, since their ovaries are completely composed of normal, and not ovarian, tissue.
• Swyer Syndrome. It is characterized by the presence of female sexual characteristics, but with the onset of puberty, developmental delays become noticeable. In the study of genetic material, a male set is determined - XU.
• True polycystic ovary. Also called Stein-Leventhal Syndrome. At the same time, they are covered with a dense shell, hormonal disorders join, the consequence of which is amenorrhea.
• Aromatase enzyme deficiency. Estrogens are partially formed from the male. With a deficiency of the aromatase enzyme, the amount of androgens is increased, "male signs" appear - hair growth, an increase in the size of the clitoris and amenorrhea.
• Depleted ovary syndrome. A condition in which the ovaries are not sensitive to the hormones formed. Along with normal external signs of puberty, there are no periods, infertility develops.

Genital anatomy disorder

In this case, obstacles are formed in the way of menstrual blood, resulting in a condition of false amenorrhea. Most often, one has to face the following causes of amenorrhea, acquired and congenital.

• Congenital malformations. They are detected in adolescence after the girl does not begin menstruation. This may be the underdevelopment of the uterus and the upper third of the vagina. In this case, the middle and lower third allows you to maintain normal intimate relationships, but there is no menstruation with normal ovaries. Such girls in the future may have children only with the use of ART, in particular, surrogacy.
• Asherman's Syndrome. It is characterized by the appearance of adhesions in the uterine cavity after inflammation, curettage. In this case, the outflow of secretions is also mechanically disturbed.
• Cervical narrowing. It can be acquired (after a difficult birth, curettage, abortion and trauma) or congenital. In this case, menstrual flow in the uterine cavity is formed, but can not go outside. As they accumulate, there are pulling pains in the lower abdomen that do not stop with anything. Elementary examination and ultrasound helps to find out the cause.
• Thick hymen. Normally, menstrual blood easily leaves through small pores in the film, which separates the vestibule and the vaginal cavity. In rare cases, problems arise with its exit from the vagina, as well as with defloration (during first sexual contact), with the onset of puberty and the onset of menstruation.

How to identify and confirm

Independently determine the causes of the absence of menstruation is possible only in the case of physiological processes - postpartum (with breastfeeding) amenorrhea, during pregnancy, menopause or even childhood. Otherwise, only a specialist can figure it out and only after a serious and often expensive examination. The following is almost always the case.

• Hormone tests for amenorrhea. First of all, sexual (estrogens, gestagens, androgens, as well as pituitary and hypothalamic hormones (LH, FSH, prolactin), thyroid gland (TSH, T3, T4), adrenal glands (cortisol, DHEA) are determined.You can explore the anti-Muller hormone, which reflects the "stock" of eggs.
• Pelvic ultrasound. The study helps to identify malformations, fluid accumulation in the uterine cavity (for example, with narrowing of the cervical canal), I also have ovarian function in amenorrhea.
• CT or MRI. It is performed to determine the structure of the pituitary gland, to identify its tumors.
• Karyotyping. A method for determining human genetic data, for example, which set in the cells is XX, XU, or only one chromosome X.
• Laparoscopy. It is performed less frequently for diagnostic purposes, as this is an invasive procedure. When carrying out, it is possible to take part of the tissue for subsequent examination.
• Hysteroscopy. It is performed to eliminate mechanical obstruction in the way of menstrual blood, for example, with adhesions in the uterine cavity (Asherman's syndrome), narrowing or overgrowth of the cervix.
• Functional Tests. Their essence lies in the fact that a concentrate of hormones (FSH, LH or estrogen) is injected into the blood and then the body's reaction is monitored, by which one can judge the level of damage.
• Other specialists. For additional diagnosis, examinations of an ophthalmologist, neurologist, endocrinologist, and general practitioner are often necessary.

With secondary amenorrhea, general tests are important - blood, urine, biochemical. So you can exclude metabolic diseases (for example, diabetes mellitus), chronic inflammatory processes.

Effects

First of all, the consequences of amenorrhea affect the possibility of pregnancy. If there is no menstruation, most likely there is no ovulation, which means that it is impossible to become pregnant with amenorrhea naturally. The earlier a pathology is identified and treatment is started, the less negative consequences for a woman’s body, and the probability of a favorable outcome is higher. The absence of menstruation threatens the following:

• infertility - you have to apply auxiliary methods (IVF, surrogacy);
• other gynecological problems - increases the likelihood of endometrial hyperplasia, the formation of polyps and cancerous degeneration of cells;
• imbalance of sex hormones - virilization may occur ("male hair growth");
• early menopause - as well as the ensuing consequences, osteoporosis, withering of the skin, early aging;
• the development of other diseases - Many genetic abnormalities combine or increase the risk of pathologies of other systems and organs.

How to cause menstruation

The treatment of amenorrhea depends entirely on its type and degree of impairment. The prognosis for the secondary is more favorable, since the previous menstrual function suggests that the violation occurred recently and this is not a pathology of a genetic nature. The treatment options are as follows.

• Operations. Classic laparotomic interventions, laparoscopy, hysteroscopy are used - it all depends on what is supposed to be done with amenorrhea. This can be just the removal of adhesions in the uterine cavity, resection (excision of a part) of the ovary or plastic of the vagina (with underdevelopment), cervix. If the cause of amenorrhea is a pituitary tumor, it may be necessary to remove them.
• Hormone therapy. This is the most popular option for treating secondary and even primary amenorrhea. Used drugs of different directions. The principle of hormone therapy is described in more detail in the table below.
• Psychological help. With food and psychogenic amenorrhea, a qualified consultation of a psychologist or even a psychotherapist is necessary, with the help of which nutrition is established or other problems are solved.
• Normalization of the work-rest regime. With functional amenorrhea, vitamin therapy is important (groups B, A, E, C), herbs, dietary supplements, homeopathy and other non-traditional methods can also be used. In the case of mild violations, they can also have a significant effect. It is necessary to normalize physical activity, sleep, rest and reduce mental work.

Table - Treatment of amenorrhea with hormones

Folk recipes

In addition to the main treatment, you can use folk remedies - herbal recipes that improve the functioning of the central nervous system, regulate the production of hormones. As an isolated treatment for amenorrhea, such methods are ineffective, but can be used as a supplement. The duration of any course should be at least one to two weeks.

• Parsley and dill. Grind 10 g of parsley leaves and dill and pour 200 hot water, let it brew for two to three hours. Take five to six times a day for half a glass with amenorrhea.
• Root elecampane. Erase 10 g of dried root or chop finely and finely. Pour 400 ml of boiling water and let stand for several hours. Take three to four tablespoons before each meal.
• Bay leaf. It is necessary to take fifty medium dried leaves, add water (1000 ml), bring to a boil and hold over low heat for 15-20 minutes. Then divide the resulting broth into three parts and drink during the day.
• Chamomile and mint with valerian. It is necessary to take 50 g of chamomile flowers, the same amount of mint leaves and 20 g of dry Valerian plant. Pour a liter of hot water and let stand for 30 minutes. The resulting solution should be taken 100 g three times a day with amenorrhea.

The reviews of women confirm that, despite the fact that all recipes of traditional medicine are easy to reproduce at home, such treatment is effective only in simple cases of functional amenorrhea, and it is impossible to cause menstruation in case of serious problems.

Amenorrhea is a serious disease that indicates a functional or organic disease in a woman’s body. She threatens not only infertility, but also other health problems. The treatment of amenorrhea should be carried out only by a specialist after a thorough examination and the establishment of the cause.