Amenorrhea Primary And Secondary - What To Do? Causes And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Amenorrhea primary and secondary: causes and treatment

Amenorrhea is the absence of menstruation in a woman of childbearing age. Normally, menstruation should come at certain dates, without delays or failures. They begin at the age of 12-16 and persist until the end of menopause. Of course, menstruation somewhat worsens a woman's quality of life. She does not have the opportunity to engage in active sports or visit the pool. At the same time, the absence of menstruation for no apparent reason may indicate a serious disorder in the body. Amenorrhea is a common problem that affects about 3.5% of women.

Content:

• When is amenorrhea the norm?
• Degree of amenorrhea
• Primary amenorrhea
• Secondary amenorrhea
• Other types of amenorrhea
• Diagnosis of amenorrhea
• Treatment of amenorrhea

When is amenorrhea the norm?

Menstruation begins at the age of 12-16, up to this point, its absence is normal. The girl's reproductive system is at rest.

During menopause, the absence of menstruation is also a variant of the norm. Menopause occurs in the period 49-52 years. These are average values. You should focus on the age at which menopause occurred in women in the family.

Breastfeeding and amenorrhea are two normal phenomena that must be combined with each other. When a woman breastfeeds her baby, she produces hormones that prevent the maturation of the egg. A similar situation is observed during pregnancy. The ovum fulfilled its main purpose - the woman conceived a child. Until the moment of his birth, other eggs will not be needed, so they are at rest, which means that a woman's periods do not come.

Degree of amenorrhea

There are 3 degrees of amenorrhea:

1. Mild amenorrhea. Menses are absent throughout the year. During this period, it will not be difficult to find the right treatment.
2. Moderate amenorrhea. Menstruation does not occur within 1-3 years.
3. Severe amenorrhea. Menses have been absent for more than 3 years.

Amenorrhea can be primary and secondary. It is very important to determine which disorder is developing in the patient, since the features of the treatment depend on this.

Primary amenorrhea

If a woman or girl has never had a period before, and it does not come on time, then they talk about primary amenorrhea. Normally, your period should begin before age 16. Their absence before this age should alert parents.

Primary amenorrhea with delayed puberty

Primary amenorrhea with delayed puberty can occur for the following reasons:

Malformations of the organs of the reproductive system. Genetic disorders. Dysgenesis of the gonads is a chromosomal abnormality that a child has from birth. They lead to the fact that the girl's genitals are not fully developed. Normally, a female child has a set of chromosomes presented as "46 XX". However, mutations sometimes occur, for example, "46 XO" and others. This is due to incorrect division of chromosomes during intrauterine development.

Such pathologies are manifested by the absence of menstruation, disturbances in the structure and work of internal organs, and external developmental anomalies. Girls are short (less than 150 cm), their neck is short, covered with folds, bite is often disturbed, squint, deformity of the elbow and knee joints occurs. Ultrasound examination allows visualization of small ovaries, which lack glandular tissue. They do not contain oocytes, and their structure is represented by compounds that resemble scar tissue. The uterus in such patients is underdeveloped, often the organ does not have a cavity.

In women with such irregularities, menstruation is absent, they cannot become pregnant. There is an anomaly in 1 girl out of 12 thousand newborns.

To accurately establish the diagnosis, you will need a consultation with a geneticist. In the future, a woman will need lifelong treatment with drugs that replace her own hormones. Most often, patients are prescribed Femoston. Since long-term hormonal therapy can cause damage to liver cells, patients are prescribed hepatoprotectors every 6 months (Heptor, Heptral, Essentiale).

STF is a testicular feminization syndrome. The disorder is characterized by a failure in the exchange and production of testosterone during the intrauterine development of the fetus. The girl who was born has all the female characteristics. However, there is no area of pigmentation around the nipples, hair does not grow under the armpits and on the pubis.

Examination of the internal genital organs reveals a short vagina that ends blindly. The patient has no uterus, cervix or ovaries. Instead, a woman grows testes (male reproductive organs), but they do not produce sex hormones. The absence of female genital organs leads to the fact that menstruation, and therefore pregnancy, is impossible. This malformation occurs in 1 out of 15,000 newborn girls.

Therapy is reduced to the removal of the testes by surgery. This must be done for the reason that these organs often become the basis for the development of a cancerous tumor. The operation is performed after the girl reaches 16 years old, when her chest and body have formed. After that, the patient is prescribed femosterone for the rest of her life. Vaginal surgery allows a woman to have a normal sex life.

Violations in the work of the SHS. The hypothalamic-pituitary system is responsible for the production of hormones and other substances that are needed for the onset of menstruation and the normal course of metabolic processes in general.

Disturbances in work - these systems can occur due to poor-quality nutrition that a child receives, with chronic infectious and non-infectious diseases, against the background of prolonged intoxication of the body. Low hemoglobin levels are also often the reason for the absence of menstruation in girls during puberty.

If a teenager starts eating right, gains the missing body weight, or loses weight, then menstruation will stabilize on its own, without any therapy.

In some cases, delayed sexual development occurs due to the peculiarities of the girl's constitution. Often a similar situation is observed among the people of Karelia, the Nenets Autonomous District, and among the women of Chukotka. In this case, the absence of menstruation before the age of 16 and older is a variant of the norm, but on condition that other causes of amenorrhea have been excluded. For girls with such a problem, an ultrasound scan of the genitals is shown, as well as an x-ray of the bones of the hand, forearm and wrist. If the growth zones in them are normal, then there is no cause for concern, and menstruation will begin soon.

Diseases of the hypothalamic-pituitary system with its organic lesion. Amenorrhea and other malfunctions in the functioning of the reproductive system occur due to congenital tumors that are located in the pituitary gland. It is not difficult to find them during an X-ray or MRI. After surgery to remove the neoplasm, menstrual function is stabilized.

Primary amenorrhea without delayed puberty

If a girl does not have menstruation, but secondary sexual characteristics develop as expected, then the reason for this is most often ginatresia or uterine aplasia. These pathologies originate while the fetus is in the womb. With ginatresia, the girl will have a part of her vagina that is overgrown, or her hymen will be completely overgrown. Treatment is prompt. In most cases it is successful. If the operation is not performed before the start of your period, your menstrual blood will have nowhere to flow. Therefore, it will not be possible to do without surgical intervention.

Aplasia of the uterus is its absence. Often the girl has underdevelopment of the vagina, defects of the kidneys and organs of the urinary system. The ovaries are functioning as expected, and the hormone levels are normal. In this case, the uterus will be represented by a striped neoplasm, which is often not defined at all. Such women cannot become a mother, menstruation is impossible for them. However, the operation allows them to have a normal sex life.

Such disorders, which are caused by intrauterine malformations, are often found only during puberty of a girl. Medical care allows girls with identified pathologies to adapt as much as possible to the natural needs of a growing body and live fully. However, it is often not possible to completely cope with congenital malformations.

Secondary amenorrhea

Intrauterine pathology

Many operations performed on the uterus negatively affect the woman's health. Intrauterine abortion, curettage, hysteroscopy, removal of polyps are dangerous in this regard.

Such manipulations can lead to a significant thinning of the uterine wall, which affects the functioning of the organ. During the natural cycle, the endometrium cannot fully grow, so when the time comes for the next menstruation, there is simply nothing to be rejected. Such a violation does not develop on its own. Menses become less abundant over time, after which they stop going altogether. If a woman has an inflammation of the internal genital organs in parallel, then the pathology becomes severe.

Sometimes after the operation, the cervical canal becomes clogged. You can cope with the pathology in an operative way.

Adhesions may result from an abortion or other traumatic procedure. They grow in the uterus, filling it from the inside.

All these complications lead to the fact that it will be difficult for a woman to get pregnant, and sometimes impossible.

Treatment is reduced to carrying out hysteroscopy, cutting adhesions, the introduction of special drugs that prevent their re-growth. Hyaluronic acid preparations can be used to cope with the disorder.

Disorders in the functioning of the hypothalamic-pituitary system

Amenorrhea associated with low body weight. This amenorrhea most often occurs in adolescent girls. Many of them, in pursuit of imaginary beauty, begin to lose weight a lot. This leads to the fact that the body fat completely disappears. The body perceives menstruation as a loss of blood and energy, so it stops producing hormones so that the follicles continue to mature.

To cope with the problem, you need to start eating right and gain weight. The girl must be prescribed vitamins.

Amenorrhea of psychogenic genesis. If a girl is experiencing a strong emotional shock, then her periods may stop. So, during the war, women who sent their husbands and sons to the front often had no menstruation.

To cope with the problem, you need to minimize the effects of stress on the body. Hormones are most often not used in such situations. If the stress persists for a long time, you should consult a specialist, since the absence of menstruation can cause early menopause.

Ovarian hyperinhibition syndrome

OHSS develops after a woman has been taking hormonal drugs for a long time, including:

• Oral contraceptives.
• Gonado-releasing hormone agonists (Goserelin, Buserelin).
• Gestagens (Visanne).

Most often, some time after the drug is discontinued, menstruation returns to normal on its own. If menstruation does not occur 2-3 months after the end of taking hormonal drugs, then you need to see a doctor. Moreover, the lower the woman's body weight, the higher the likelihood of developing amenorrhea.

Patients will be assigned an analysis to determine the level of prolactin. If no failures are observed, then Clomiphene citrate can be used to restore menstruation. This drug stimulates ovulation. It is used for 1-4 months. When the situation stabilizes, the drug is canceled.

Bromocriptine is prescribed for patients with high prolactin levels. The drug is taken until the hormone levels drop to 5430 mMe and below.

Disorders of the hypothalamic-pituitary system of organic nature

A delay in menstruation against the background of a tumor growing in the brain can occur, but this does not happen often. Growing neoplasms press on the pituitary gland and hypothalamus, which entails a whole cascade of reactions: hormonal imbalance occurs, menstruation stops. To cope with the disease is possible only by surgery. After removal of the tumor, menstruation resumes. This happens in six months or a year.

Sheehan's syndrome is a vascular spasm, or hemorrhage in the pituitary gland. A similar disorder most often occurs in women after childbirth, when the pregnancy itself was complicated by preeclampsia. Nursing mothers may not notice the absence of menstruation, since amenorrhea is covered by lactation. However, after giving up breastfeeding, your period does not start. After 2 months of their absence, it is necessary to contact a specialist.

If the doctor detects Sheehan's syndrome, he will prescribe the patient Metipred or Prednisolone, thyroid hormones, or hormone replacement therapy with Angelik, Divina, Femoston. You should not take drugs on your own, since it will not be possible to restore the cycle without understanding the cause of amenorrhea, but it is quite possible to gain excess weight.

Empty Turkish Saddle Syndrome

The Turkish saddle is located in the brain next to the pituitary gland. It becomes empty when the pituitary gland is under pressure for a long time and atrophies. Frequent pregnancies or difficult labor activity can provoke a similar situation. Treatment is carried out in a similar way to the treatment of Sheehan's syndrome.

Ovarian amenorrhea

Sometimes the cause of amenorrhea is a malfunction of the ovaries. In this case, the hormonal system as a whole will function properly.

With resistant ovary syndrome, these organs of the reproductive system simply stop responding to stimulation with sex hormones. The disorder develops in women under 36 years of age. Often a similar situation is observed in the grandmother, mother, daughter, that is, it is of a family nature. To cope with the problem is possible only with the use of hormonal drugs of combined action. A woman cannot give birth on her own. IVF will be required using a donor egg.

The syndrome of premature ovarian exhaustion leads to the fact that the eggs are no longer produced and the patient develops a menopause. Moreover, this can happen at an early age (up to 43 years). This syndrome can be caused by severe infections (flu, rubella, mumps, measles), or undergoing treatment for cancerous tumors.

Other types of amenorrhea

False amenorrhea. This type can be attributed, for example, when the process of menstruation proceeds normally, but, for one reason or another, the blood does not leave the body. This can be, for example, any congenital pathology, as well as deviations acquired in the process of life. An overgrowth of the hymen or vagina is a striking example of this. Here we are talking about acquired mechanical obstacles. Some abnormalities can only be diagnosed by ultrasound, in any case, the word "mechanical" is defining here.

True amenorrhea is the absence of a monthly cycle in girls. Here the absence of the menstrual cycle manifests itself, but without visible hormonal signs and changes in the reproductive system. A woman's ability to become pregnant is completely lost.

Physiological amenorrhea is called the absence of a cycle due to various age deviations. Deviations can occur both during the growing up of the body, and after its end, the disease can manifest itself and end by itself. Here we are no longer talking about the disease, since this is completely normal. For example, some women lose their ability to cycle while breastfeeding. Or after pregnancy, while the body is recovering.

Pathological amenorrhea is the most serious type of amenorrhea. Here we are talking about a disorder in the body. In this case, fertility can be completely lost. Most often this happens in those girls who have never had a monthly cycle, that is, young or, conversely, women in middle age. Violations are both functional and organic.

Diagnosis of amenorrhea

Diagnosis of amenorrhea begins with taking anamnesis and examining the patient. The doctor must ascertain the state of the mother's female health. This will allow you to track your family history of the disease. It is important to clarify when exactly the woman's period began, whether she was exposed to radiation, whether she was overweight. If the patient suffers from other chronic diseases (cardiovascular pathologies, obesity, joint diseases), she should inform the doctor about it.

The doctor pays attention to the woman's body type, hair growth, the degree of development of the mammary glands and other characteristics of sexual health.

The next stage of diagnosis is the examination of the patient on the gynecological chair. The doctor evaluates the condition of the small pelvis, external genitalia. If the girl is a virgin, then examination with the use of mirrors is not practiced.

Ultrasound of the genitals and mammary gland provides information about the size of organs, about their functioning, about the maturation of ovarian follicles. The study allows you to identify cysts and tumor neoplasms.

Blood sampling for hormones is mandatory. Determine the level of thyroid hormones (T4 and TSH), as well as sex hormones (FSH, LH, DHEA, AMG, prolactin, testosterone, etc.).

A woman may need to consult narrow specialists: oncologist, geneticist, endocrinologist, neurologist, neurosurgeon, nutritionist, pediatrician. Ultrasound of the adrenal glands, thyroid gland, MRI of the brain, X-ray of the skull are performed. All these studies in combination are rarely prescribed. The doctor chooses certain diagnostic techniques that are needed to confirm the diagnosis and find out the cause of amenorrhea.

Treatment of amenorrhea

For the treatment of amenorrhea, drugs such as:

• Preparations containing estrogens: Folliculin, Estrogel, Divigel, etc. They are prescribed in a situation where amenorrhea develops against the background of estrogen deficiency.
• Progestogens: Utrozhestan, Prajisan, Dyufaston, Norratistron. They are prescribed with a deficiency of hormones of the second phase of the cycle, or gestagens.
• Antiestrogens: Clomiphene citrate. This drug is used to stimulate ovulation.
• Combined hormones: Femoston, Angelique, Divina. They are prescribed to restore ovarian function.
• Thyroid hormones: L-thyroxine, Eutirox.
• Glucocorticosteroids: Prednisolone, Metipred. They are prescribed to restore adrenal function.
• Bromocriptine (Parlodel). This drug lowers prolactin levels.
• The operation is prescribed for gynecological pathologies, as well as for brain damage by tumor neoplasms.

Amenorrhea is a serious disorder in the body that should not be ignored. If a woman of childbearing age does not have periods, then she needs to see a doctor and receive treatment.

The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist

Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.