Amenorey is disorder of menstrual function at which at women of childbearing age (16 - 45 years) there do not come the periods for half a year and more. Amenorey, as a rule, is not an independent disease, and serves as a symptom of genetic, biochemical, physiological, psycho-emotional frustration in an organism. At a false amenorea cyclic and hormonal changes in ovaries and a uterus are kept, but menstrual allocations from a genital tract are absent because of any anatomic obstacle. At a true amenorea there is no ovulation, and there is impossible pregnancy.
Amenorey is disorder of menstrual function at which at women of childbearing age (16 - 45 years) there do not come the periods for half a year and more. Amenorey, as a rule, is not an independent disease, and serves as a symptom of genetic, biochemical, physiological, psycho-emotional frustration in an organism.
Classification of an amenorea
Classifications are the cornerstone two types of an amenorea – false and true. At a false amenorea cyclic and hormonal changes in ovaries and a uterus are kept, but menstrual allocations from a genital tract are absent because of any anatomic obstacle. I can serve as such obstacles congenital defects of a structure of genitals: atresia of a vagina, neck of a uterus or virgin pleva. Thus, depending on anatomic defect at a false amenorea menstrual blood can accumulate in uterine tubes (), cavities of a uterus (gematometr) or a vagina ().
True characterizes absence of menstrual bleedings and the cyclic processes causing them in an organism. At a true amenorea there is no ovulation, and there is impossible pregnancy. In turn, depending on the reasons causing it, true can be physiological or pathological.
Physiological is not disease state and it is caused by natural states (pregnancy, feeding by a breast) or the age periods of the woman (the childhood, a menopause). On the contrary, pathological serves as the disturbing symptom demonstrating functional or organic violations in a female body. If the periods do not come initially at teenage age, speak about primary amenorea. When regular periods stop in connection with any reasons, consider secondary.
Main reasons for primary amenorea
Genetically caused (hereditary), anatomic and psycho-emotional factors can serve as the reasons of primary amenorea. At many patients with primary amenorey in the family anamnesis approach of periods at mother or elder sisters is noted later (after 17 years). In such cases speak about the hereditary factors causing . Primary it is observed at Turner's syndrome – the disease which is characterized by an underdevelopment of gonads as a result of abnormal development of sexual chromosomes.
Treat anatomic factors of primary amenorea the general delay of physical development which is shown in features of a constitution (leanness, insufficient weight, an undeveloped breast, a narrow basin etc.) and also deviations in development of genitals (a zarashcheniye of the channel of a vagina or a virgin pleva). Stresses, heavy psycho-emotional shocks, anorexia and wearisome physical activities are frequent responsible for primary amenorea. Such factors are extremely dangerous to an undeveloped teenage organism since they cause violations at a stage of formation of menstrual function.
Treatment of primary amenorea
The principles of treatment of primary amenorea are directed to elimination or correction of the factors which caused it. Lifelong replaceable hormonal therapy (estrogenization) is shown to patients with Turner's syndrome. At a delay of physical and reproductive development to girls the diet directed to the accumulation of muscle and fatty bulk and hormonal treatment stimulating menstrual function is appointed. Hormonal therapy has to be carried out under strict observation of the gynecologist-endocrinologist. If primary is caused by the anatomic reasons, surgical removal of obstacles – creation of conditions for normal outflow of menstrual blood from a uterus cavity on a genital tract outside is carried out.
At the increased emotional instability the treatment directed to strengthening of nervous system is carried out. At early age it is especially dangerous to be fond of various diets: restrictions of in food lead to the insufficient receipt in an organism of protein, fats, vitamin and mineral connections which is slowing down development, including and sexual and to the promoting development of an amenorea. It is necessary to avoid interests in strength sports: weightlifting, single combats, bodybuilding etc.
Main reasons for a secondary amenorea
Secondary occurs approximately at 10% of women at the age of 17-45 years and is considered as heavy violation of menstrual function. The factors which are the most often influencing the termination of the established periods and development of a secondary amenorea are:
- anorexia, the progressing weight reduction owing to rigid diets or wearisome physical activities – at 38% of women
Most of patients with secondary amenorey are the victims of fashionable diets and anorexias – the heavy mental and physical disorder which is characterized by the persuasive aspiration to lose weight. The purposeful refusal of food, abuse of laxative procedures, artificially caused vomiting at anorexia lead to sharp weight reduction and development of psychosexual violations, a depression, locks and a secondary amenorea.
- polycystous damage of ovaries – at 26% of women
- early menopause - at 22% of women
The menopause is considered early (premature) if the periods stop at the woman who did not reach 40-year age because of insufficient function of ovaries. To provoke a premature menopause and the long stress can.
- giperprolaktinemiya – at 11% and other factors of a secondary amenorea.
Giperprolaktinemiya is the state caused by increase in level of hormone of Prolactinum in blood. It is characterized by molokoobrazny allocations from mammary glands, various violations of menstrual function, up to complete cessation of periods – amenore.
In some cases the termination of periods can serve as temporary reaction to nervous shocks and be restored through certain time independently, without additional interventions. However, in most cases secondary demands the qualified medical intervention.
Diagnostics of a secondary amenorea
On gynecologic reception at the patient complaining of the termination of periods first of all exclude pregnancy and find out the moments provoking development of a secondary amenorea: hobby for diets, physical and mental overworks, associated diseases, time of approach of a menopause at mother and grandmothers etc. The gynecologist estimates growth and the patient's weight, their ratio with each other and norm indicators. In certain cases dystrophy or, on the contrary, obesity can cause secondary owing to hormonal and physiological failures in an organism.
At suspicion on a secondary amenoreyu inspection is directed to detection of nature of dysfunction of ovaries. The research of level of hormones (first of all Prolactinum, gestagen, estrogen, sexual chromatin, a kariotin), is for this purpose conducted by ultrasonography of bodies of a small pelvis (for an exception of a polikistoz of ovaries and definition of a condition of endometrium). In addition the schedule of changes of rectal temperature is formed, the cytologic analysis of dab of the back arch of a vagina for definition of an estrogenic saturation of an organism of the patient is carried out.
Important diagnostic test criterion at a secondary amenorea is "the pupil symptom". At a normal current of a menstrual cycle, during the period from the 6th to the 20th day, diameter of the external pharynx of a neck of a uterus filled with transparent slime increases and at survey reminds a pupil. Insignificant disclosure of a uterine pharynx and small amount of slime is characteristic of an amenorea. Proceeding from the received results the reason of a secondary amenorea, as a rule, is established and the medical course is appointed.
Treatment of a secondary amenorea
Treatment of again arisen amenorea is directed to elimination of the factors which caused it.
Amenorey, connected with sharp weight reduction or physical activities, is a consequence of the wrong way of life and demands its change. A critical indicator for a normal current of a menstrual cycle at the adult woman is loss of 10 and more kilograms of weight, and also body weight less than 50 kg. Before full normalization of menstrual function the progestagenny oral contraceptives which are not containing estrogenic components are usually appointed. Quite often secondary is eliminated without hormonal therapy at observance of reasonable physical activities, a rational diet, work and rest, normalization of a psycho-emotional background.
Secondary , developing at a syndrome of polycystous ovaries, demands treatment of a background disease. For normalization of an ovulyatorny cycle at a polikistoza of ovaries appoint hormonal contraceptives or carry out a laparoscopic diatermokoagulyation of fabric of body (according to indications).
Giperprolaktinemiya as factor of development of an amenorea, is eliminated with administration of drugs - the agonists of dopamine lowering Prolactinum level. Efficiency of treatment is defined by control of basal temperature which increase indicates commission of an ovulation. At tumoral damages of a hypophysis neurosurgical intervention is shown. Secondary , caused by a premature menopause, it is corrected with the help it is long the carried-out replacement hormonal therapy.
VRT and method of extracorporal fertilization which is successfully applied by modern gynecology allows to carry out pregnancy to women with a premature menopause and the secondary amenorey which is not giving in to treatment. In such cases for artificial insemination (IKSI, PIKSI or IMSI methods) use a donor ovum or a donor embryo. Then replanting of embryos in a uterus of future mother is carried out.
The sudden termination of periods at women of childbearing age (secondary ) is a distress signal and the malfunctions in an organism requiring to themselves attention. Part of them is easily removable changes in a way of life, others need the qualified medical aid. Danger of an amenorea consists that it is always accompanied by a female factor of infertility.
The lack of periods and hormonal and dependent cyclic changes in a reproductive system accompanying the period of breastfeeding of the child is called laktatsionny amenorey. Laktatsionny is the physiological method of contraception based on lack of an ovulation and thereof, impossibility of pregnancy. However the method of a laktatsionny amenorea only for half a year from the moment of childbirth is effective and it is exclusive when breastfeeding.
Conditions of efficiency of a laktatsionny amenorea as method of contraception is observance of the following rules:
- feeding of the child according to each his requirement of at least 6 times a day;
- obligatory night feeding;
- lack of the mixed feeding and feedings up.
The mechanism of a laktatsionny amenorea is based on suppression at the woman of an ovulation at continuous sucking of breast milk by the child, and, therefore, lack of a menstrual cycle and pregnancy. Efficiency of contraceptive effect at a laktatsionny amenorea is close to 98%. Among undoubted advantages of a method of a laktatsionny amenorea there is high reliability, naturalness, advantage for the child, simplicity in application, lack of collateral influence, bystry postnatal restoration.
To shortcomings of a laktatsionny amenorea as contraception method, it is necessary to refer short duration of protection from pregnancy (at most half a year), obligatory need of observance of all conditions of its efficiency. Besides, laktatsionny does not guarantee protection against sexually transmitted infections and venereal diseases (including HIV and hepatitis B). At impossibility to use laktatsionny as the main method of contraception, it is necessary to pick up more well-tried remedy of protection against undesirable pregnancy together with the gynecologist observing the woman.