Amenorrhea (no monthly)

Primary amenorrhea can cause severe anxiety in the patient. In many cases, the reason for this is the delay in puberty (often hereditary). The patient must be assured that there is no organic cause of the disorder. Other reasons include those that cause secondary amenorrhea, but appear before the onset of menarche. Only a few reasons are hereditary or arise as a result of morphological disorders, so check the following.

• Does the patient have secondary sexual characteristics? If so, is the structure of the external genitalia normal?
• If development has been disrupted, a survey and definition of a karyotype can help identify Turner's syndrome or testicular feminization. The goal of the treatment is to help the patient look like a normal woman, capable of a normal sexual life and, if possible, to childbearing (if she wishes).

[2], [5]

Causes of amenorrhea

• The reasons for the disruption of the hypothalamic-pituitary axis are very common, therefore, irregularities in the menstrual cycle often result from emotional stress, examinations, weight loss, excessive production of prolactin (30% of women suffer from galactorrhea), imbalance of other hormones and severe systemic diseases, for example kidney failure . Tumor and necrosis (Shikhen's syndrome) rarely serve as a cause. Causes associated with ovarian pathology: polycystic ovaries, tumors, ovarian failure (premature menopause) are rare.
• Disorders of the uterus: complications of pregnancy, Asherman's syndrome (adhesion of the uterus after the previous curettage). "Amenorrhea after taking pills" is an ordinary oligomenorrhea masked by regular "cancellation" of bleeding.

[7], [8], [11], [12]

Diagnosis of amenorrhea

LH serum levels (increased with polycystic ovaries), FSH (very high in premature menopause), prolactin (increases with cipecce, prolactinomas and after taking some medicines, eg phenothiazines) and thyroid function test the most informative diagnostic studies. In 40% of patients with hyperprolactinemia there are tumors, so a radiographic examination of the skull and computer scanning may be required.

[16]

Treatment of amenorrhea

Treatment of amenorrhea is determined by the cause. In premature menopause, hormone replacement therapy should be prescribed, which requires monitoring of symptoms of estrogen deficiency and protection from osteoporosis.

Dysfunction of the hypothalamic-pituitary axis

In the case of disorders of average severity (for example, as a result of stress, a slight decrease in body weight), it is possible to stimulate sufficient oestrogen production for the formation of the endometrium (which will be rejected after progesterone withdrawal, for example, norethisterone at a dose of 5 mg every 8 hours for 7 days) Regulation, as a result of which cycles are not restored. For more serious violations, the activity of the axis stops (for example, with a sharp decrease in body weight). The content of FSH and LH and, consequently, of estrogen is low. With the patient it is advisable to conduct an appropriate conversation, prescribe a therapeutic diet, relieve stress, recommend to consult a psychiatrist. Advise her to use contraceptives, since ovulation can occur at any time. If the patient wants to restore fertility immediately or she needs confidence, reinforced by the onset of menstruation, then in cases of moderate manifestations clomiphene-citrate can be prescribed, but to restore the activity of the axis, stimulation of gonadotropin-releasing hormone is necessary.

[17], [18], [19], [20], [21], [23], [24], [25]