Amenorrhea. Causes and consequences of lack of menstruation

The following types of amenorrhea are distinguished:

• true amenorrhea - no menstruation due to the absence of changes in the uterus and ovaries characteristic of a normal menstrual cycle. All this happens against the background of hormonal imbalance;
• false - cyclical changes in the uterus and ovaries occur, but due to abnormalities in the development of the genital organs (for example, vaginal occlusion), no bleeding is observed;
• physiological amenorrhea is a normal state of the body that is observed in teenage girls in the first two years of menstruation, as well as in women during pregnancy, lactation and menopause;
• pathological amenorrhea - can be primary (you have never had a period in your life) or secondary (you used to have periods, but for some reason they disappeared).

In addition, depending on the mechanism of development, amenorrhea can be:

• Lactational amenorrhea is one example of the physiological cessation of menstruation. Occurs with exclusive breastfeeding. The mechanism of development is similar to that of hyperprolactinemia.
• Uterine amenorrhea occurs as a complication of gynecological manipulations - curettage, cauterization, or as a consequence of childbirth. The absence of menstruation in such cases is due to the intensive growth of adhesions in the uterine cavity.
• The diagnosis of “primary amenorrhea” is given to girls who have not had a single menstruation before the age of 16, provided that the patient has secondary sexual characteristics. If a girl’s breasts do not grow, there is no pubic or armpit hair, and there has been no characteristic weight gain, a gynecologist should be consulted no later than 14 years of age.
• Secondary amenorrhea is the absence of menstruation in previously menstruating women for six months or longer. According to statistics, it accounts for up to 80% of all types of amenorrhea.

In clinical practice, secondary true amenorrhea is most common. It can occur for various reasons (for example, deficiency or excess weight, constant stress). The absence of menstruation can be a consequence of diseases of the endocrine organs, complicated abortions, tumors and the use of a number of psychotropic drugs.

Causes of primary and secondary amenorrhea

Types of amenorrhea: norm and pathology

• Physiological
  . Typical for women during pregnancy and breastfeeding, it is not a pathology. After cessation of lactation, the menstrual cycle returns to normal.
• False
  . A form of amenorrhea in which no endocrine, hormonal or gynecological disorders are observed, but menstruation is absent for 3 months or more.
• Primary
  . This diagnosis is given to girls if they have not started menstruating before the age of 16.
• Secondary
  . A pathological form of amenorrhea, which occurs due to exposure to stress, the development of endocrine and gynecological diseases.
• Uterine
  . A pathological form of amenorrhea resulting from destruction of the endometrium.

Bibliography

1. Vikhlyaeva E.M. Hyperprolactinemia and reproductive system disorders. Guide to Endocrine Gynecology
2. Gurkin Yu.A. Adolescent gynecology / guide for doctors
3. Berek J., Adasi I., Hillard P. Gynecology according to Emil Novak
4. Manusharova R.A., Cherkezova E.I. Gynecological endocrinology / guide for doctors
5. Bogdanova E.A. Gynecology of children and adolescents
6. Smetnik V.P. Non-operative gynecology / Smetnik V.P., Tumilovich L.G. – 3rd edition. – M.: MIA, 2003.
7. Heffner L. The human reproductive system in normal and pathological conditions: A visual textbook // Trans. from English – 2003. – 128 p.
8. Gordner D., Shobek D. Basic and clinical endocrinology. – M.: Publishing house. "Binom", 2010.

Symptoms

Depending on the type of amenorrhea, it may be accompanied by different symptoms, but the most important and obvious one is, of course, the absence of menstruation for more than 3 cycles in a row without pregnancy.

False amenorrhea is accompanied by pain in the lower abdomen and breast swelling.

Secondary amenorrhea also manifests itself as endocrine and mental disorders - excessive growth of body hair, sudden changes in body weight, malfunction of the thyroid gland, disturbances in the functioning of the ovaries, irritability and anxiety.

Central form

Damage to the hypothalamic-pituitary region of the brain is accompanied by a characteristic appearance for patients: overweight, a rounded moon-shaped face, a fat apron, purple-red stripes on the skin of the abdomen and thighs. However, excessive thinness is also possible with weakly expressed secondary sexual characteristics. Pituitary tumors may cause progressive headaches, symptoms associated with excessive secretion of tropical hormones - acromegaly (sudden growth of the feet, hands, nose in adulthood), increased irritability and swelling. Hyperprolactinemia is manifested by discharge from the mammary glands, their pain and engorgement, and decreased libido.

Possible causes of amenorrhea

Each type of amenorrhea has its own causes of development

:

• In the case of false amenorrhea, it is most often atresia (lack of a natural canal) of the vagina, cervix or hymen. In second place are inflammatory processes in the uterus and the consequences of medical abortions.
• Primary amenorrhea is most often caused by hereditary, psychological and anatomical reasons - underdevelopment of the gonads, occlusion of the vaginal canal and hymen, severe stress and shock.
• Secondary amenorrhea occurs in approximately 8–10% of women aged 16 to 45 years due to the development of anorexia or obesity, early menopause, increased levels of the hormone prolactin in the blood, and polycystic ovaries.
• The main reasons for the development of uterine amenorrhea are gonorrheal and tuberculous endometritis, difficult childbirth, abortion and other surgical interventions.

Medicines

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Treatment with drugs

Primary amenorrhea is most often treated with hormonal pills and a special diet that promotes weight gain through muscle mass. Vitamins for amenorrhea in the primary form are a mandatory form of treatment. In addition to special vitamin complexes for amenorrhea (vitamin E, vitamin B1 in solution, folic acid), it is recommended to introduce into the diet foods containing vitamin E, estrogen, folic acid, vitamins that provide significant assistance for amenorrhea.

Estrogen is found in:

• legumes;
• bran;
• apricots;
• coffee.

The following foods contain folic acid:

• spinach;
• salad;
• dark greens;
• celery;
• berries;
• peas;
• carrot;
• pumpkin;
• corn.

Vitamin E for amenorrhea is replenished by:

• sea ​​fish;
• greenery;
• berries;
• porridge;
• nuts.

Taking vitamins during amenorrhea strengthens the nervous system and creates the prerequisites for restoring reproductive function naturally. Treatment of amenorrhea with vitamin preparations reduces nervous tension and improves tone. If this is the primary form, then pills for amenorrhea may not be needed, the function of the ovaries will recover on its own. Drugs for amenorrhea for girls are prescribed only in severe cases.

Vitamins, hormones, drugs (Folliculin, Cyclovita) and physical exercise eliminate health problems in teenage girls. Vitamin complex Cyclovita is a drug that replenishes the lack of minerals and vitamins and restores the tone of a weakened body.

Treatment with hormonal drugs is prescribed when a special diet and vitamin complexes do not help.

Primary amenorrhea caused by infectious diseases or intrauterine infections is treated with special medications.

In case of secondary type amenorrhea, in addition to hormones, they are treated with special diets, physiotherapy and vitamins necessary for patients of any age.

For secondary amenorrhea, specialists may prescribe the hormonal drug Duphaston. This is a progestogenic hormonal drug that includes dihydrogesterone. Duphaston is used for primary and secondary amenorrhea as hormone replacement therapy. Treatment of amenorrhea with Duphaston allows for effective therapy for patients of reproductive age.

Treatment of amenorrhea with Duphaston can be replaced with its analogue Utrozhestan. The drug is natural progesterone. Utrozhestan compensates for the deficiency of endogenous progesterone and replaces several drugs prescribed for the treatment of amenorrhea. Utrozhestan has no side effects and is quickly eliminated from the body.

Also, patients with amenorrhea are prescribed hormonal drugs to restore ovarian function in tablets.

Treatment of amenorrhea with replacement therapy drugs:

• Progestin drugs: Utrozhestan, Duphaston, Pregnin, Norkolut. For amenorrhea, these drugs are widely used to treat primary and secondary forms.
• Estrogens: Femoston, Femoston 210, Rigevidon.
• GnRH hormones: Cyclomate. Used to treat amenorrhea caused by polycystic ovary syndrome.
• Non-steroidal synthetic drugs: Clomiphene. These tablets stimulate ovarian function.

Cyclodinone (an analogue of Utrozhestan) is prescribed for amenorrhea to restore the cycle and prevent early menopause. Cyclodinone contains twig berry extract.

For amenorrhea, Femoston, like Cyclodinone, is used in case of insufficient hormone production.

Femoston helps restore the cycle against the background of stressful situations and sudden weight loss. It is prescribed to women after 40 years of age to delay early menopause, which is based on a deficiency of female sex hormones associated with women reaching a certain age. Femaston helps prevent hot flashes, emotional breakdowns, bone depletion, headaches, and dry mucous membranes.

Femoston lowers blood cholesterol levels, lowers LDL and increases HDL, prevents the risk of carcinogenesis and endometrial diseases.

Diagnostics

The diagnosis is made by
a gynecologist after an examination, which includes
:

• Gynecological and vaginal examination
• Ultrasound of the pelvic organs
• MRI
• Hematological studies (clinical, biochemical blood tests, analysis for tumor markers)
• Hormonal research
• Radiography
• Treatment

In the case of amenorrhea, self-medication is completely excluded, since pathological forms of this disorder are treated with a complex of physiotherapeutic procedures and medications prescribed by a doctor.

Treatment methods used in gynecology

:

• Hormonal therapy (including the use of COCs and steroid hormones)
• Stimulation of ovulation (medical and surgical)
• Infusion therapy
• Surgical removal of adhesions and neoplasms
• Anti-adhesive drug therapy
• Antibacterial therapy in the postoperative period
• Correction of mental health in case of development of anxiety, panic and other disorders

Folk remedies

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Treating amenorrhea with folk remedies is a common practice, but this approach is safe only in consultation with a doctor. This is necessary due to possible individual intolerance to medications.

Herbs for primary amenorrhea

It is impossible to induce menstruation with such a deviation using homeopathy, but improving hormonal levels and general well-being is a solvable task. Applicable:

• infusion of oregano. Has a calming effect;
• sage extract is a phytohormone with properties similar to female sex hormones.

Folk remedies in the case of primary amenorrhea usually provide only maintenance therapy; this form of the disease requires a more radical approach.

Consequences

Amenorrhea does not threaten a woman’s life, but can cause infertility and pathological changes in the pelvic organs, such as:

• Reduction and atrophy of the uterus
• Destruction of the endometrium with the formation of adhesions
• Complete blockage of the uterus
• Osteoporosis (increased bone fragility)

Unfortunately, if a woman does not consult a gynecologist on time, the consequences of amenorrhea can be irreversible. The listed pathologies are extremely difficult to treat, and in some cases a woman is forever deprived of the opportunity to become a mother.

Don't be afraid to see a doctor. If menstruation is absent for more than 2 months in a row, you need to make an appointment with a gynecologist and find out the reasons for this phenomenon. Only a specialist can conduct a full examination and prescribe treatment.

Gynecologists from the network of Moscow MCs “Zdorovye” are always ready to help patients with any problems related to sexual and reproductive health. We guarantee complete confidentiality, professional approach and tact of the medical staff. Make an appointment with a gynecologist on the website medcentr.biz

Treatment

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Amenorrhea is a complex disease, so its treatment is usually lengthy and varied. The treatment tactics for this pathology should be selected by a gynecologist depending on the cause of the disease.

So, if the cause of the disease is infantilism of the reproductive system, then the emphasis in treatment is on a special diet and taking hormonal drugs. This leads to the woman rapidly gaining the missing fat and muscle tissue over the course of several months.

If amenorrhea is caused by developmental defects, doctors may prescribe surgical treatment.

If a woman has a secondary form of the disease, treatment of amenorrhea must necessarily include eliminating the cause that caused it. This often requires changing your diet or avoiding stressful situations.

For ovarian pathologies, doctors prescribe hormone replacement therapy. It is carried out only under the careful supervision of a specialist. During the entire treatment period, a woman should undergo hormone tests from time to time.

All types of amenorrhea, regardless of the reasons that caused it, require treatment. The only exception in this case may be lactational amenorrhea, since six months after childbirth the menstrual cycle begins to improve. Until this time, a woman can use the lactational amenorrhea method (if used correctly, its reliability can reach 98%).

In general, treatment for amenorrhea almost always includes:

• hydro- and physiotherapy;
• massage;
• physical therapy;
• performing hardening procedures;
• treatment with folk remedies;
• diet correction;
• taking vitamin and mineral complexes.

The best results are usually achieved by combining several treatment methods.

If a patient’s amenorrhea is a consequence of unfavorable psychogenic factors, doctors may additionally prescribe:

• psychotherapy sessions;
• oxygen therapy or yoga;
• general strengthening procedures.

It is worth noting that amenorrhea can only be cured by knowing the causes of its occurrence. And this can take a lot of time even for experienced doctors. That is why treating amenorrhea at home is unacceptable.

Homeopathy

Homeopathic medicines have a completely natural composition, but they are much more effective than conventional herbs. Doctors often prescribe them in addition to medications.

Treatment of amenorrhea with homeopathy is most often used if the disease was caused by chronic stress or severe emotional stress. For this purpose, homeopathic preparations with a sedative effect are used.

However, homeopathic remedies can be helpful for all types of amenorrhea. This is especially true for homeopathic remedies with hormonal effects. They bring the greatest benefit in the treatment of hypogonadotropic amenorrhea.

However, only a doctor should choose these drugs and prescribe their dosage based on the patient’s indications and contraindications.

Massage

Today, to eliminate the disease, many reputable doctors recommend that patients undergo massage for amenorrhea. The essence of this massage is to create vibrations in the area of ​​the lumbar vertebrae. In this way, the nerve endings in this area are irritated, which ultimately has a stimulating effect on the reproductive organs.

Such a massage can help normalize menstrual function and ripen the genital organs.

To improve blood circulation in the pelvic organs, doctors may also perform tapping movements on either side of the lower spine.

Numerous positive reviews from patients about this procedure indicate its high effectiveness.

Diet

Diet for amenorrhea is of great importance. However, it should directly depend on the causes of the disease. So, if the cause of amenorrhea in a patient is fasting, then a high-calorie diet is indicated for her, and if the pathology is caused by Itsenko-Cushing's disease, the amount of food consumed, on the contrary, should be reduced.

However, no matter what the diet, nutrition during amenorrhea should always be complete, that is, a woman should not consume vitamins, fats, proteins, carbohydrates in quantities less than the daily norm.

With amenorrhea, it is very important to normalize the patient’s weight, since menstruation cannot proceed normally both with excess weight and with underweight.

To restore the functioning of the reproductive organs, it is also necessary to stop drinking alcohol and cigarettes, and normalize work and rest patterns.

Operating principle

Elevated levels of prolactin inhibit the pulsatile secretion of gonadotropin, a hormone releasing hormone from the hypothalamus (a group of cells that regulate neurogenic activity in the brain).

This in turn interferes with the hypothalamic-pituitary-ovarian axis, preventing estrogen secretion and ovulation. As the baby is weaned, prolactin levels decrease and ovulation resumes within 14–30 days.