Amenorrhea is a syndrome of a woman’s condition between the ages of 16 and 45, in which there is a complete absence of menstruation for a period of six months or more. Most often, this phenomenon indicates the presence in the body of certain physiological processes or pathologies.
Some women are confused to hear a diagnosis of amenorrhea. What is this disease, few know. Doctors classify amenorrhea into two basic types: true and false. Also distinguish the following types of this symptom:
- Pharmacological and false amenorrhea.
- Pathological and physiological amenorrhea.
- Primary or secondary amenorrhea.
With this type of syndrome, there is a normal production of female sex hormones, but there is some obstacle of anatomical nature for the normal selection of bloody formations from the sexual passages. False amenorrhea, whose symptoms begin with a lack of menstruation, can cause significant physical discomfort. This is caused by a defect in the structure of the vagina, cervix or hymen of congenital form. In this form of amenorrhea, menstrual flow, not finding a way out, remains in the fallopian tubes, accumulating in large quantities. This leads to the formation of an inflammatory process in this area. The diagnosis of "false amenorrhea", the causes and treatment of this disease are all within the competence of the medical specialist.
This type of amenorrhea is associated with impaired cyclic processes associated with normal maturation of the egg in a woman's body. In this syndrome, menstrual flow is not formed at all. The egg cell either does not mature, or does not enter the fallopian tube, or the hormonal regulation of the process is disturbed. This amenorrhea, whose symptoms are absolutely painless, is the cause of infertility.
True amenorrhea is divided into several types:
- Physiological variety.
- Pathological form.
Physiological true amenorrhea
Doctors do not attribute it to the pathological phenomena. As a rule, the physiological absence of menstruation is associated with pregnancy, lactation, menopause, or childhood.
Lactational amenorrhea is caused by the process of breastfeeding and occurs after childbirth. The duration of this phenomenon is strictly individual and can range from several months to several years. The hormone prolactin, which is secreted in the body of a woman during breastfeeding, does not allow estrogen to form, which, in turn, carries control over ovulation. As a result, ovulation does not occur, and there is no menstruation.
Lactational amenorrhea is a kind of natural contraceptive. But it is worth considering that the effectiveness of this method reaches 98%, provided that the child does not reach the age of 6 months, he is exclusively breastfed, and the frequency of feeding is up to six times a day. If these conditions are not met, then the probability of becoming pregnant with a woman is very high. To prevent this, you need to take care of contraception, after consulting with a gynecologist. This amenorrhea, whose causes are physiological, does not require treatment. If a woman is worried about abdominal pain, abnormal discharge and itching, examination and treatment is necessary.
Pathological true amenorrhea
This phenomenon occurs if a girl is older than 16 years or a woman of fertile age does not have regular menstruation. If this occurs since adolescence, the phenomenon is called primary amenorrhea. What is this type of disease, can be found at the reception of a specialist.
If the absence of menstruation occurred after the woman had a regular cycle, then this phenomenon is called secondary amenorrhea. It can be the result of a hormonal imbalance in the body or the operation of the sexual sphere. Secondary amenorrhea, the causes and treatment of which are described below, is amenable to correction.
Causes of true amenorrhea
Experts identify several reasons why true amenorrhea can occur:
- Congenital hereditary disorders. These are the so-called chromosomal abnormalities. If there are women in the family with a late (older than 18 years) beginning of menstruation, then we can talk about the presence of a genetic predisposition to amenorrhea.
- Underdevelopment of the genital organs - anatomical anomaly. Often accompanied by a general physical exhaustion, defective formation or lack of internal and external genital organs (dystrophy, "infantile uterus", etc.).
- Stress also has a direct impact on the physiology of women. Elevated psychological, emotional, and physical exertion can be causes of both primary amenorrhea in adolescence and secondary.
Causes of secondary amenorrhea
As mentioned earlier, the absence of menstruation in women over 18 years old is called "secondary amenorrhea." The reasons for it may be as follows:
- Polycystic ovary syndrome causes amenorrhea and infertility. Often accompanied by the following symptoms: acne, a high rate of male hormones in the blood, hairiness of auricles.
- Anorexia is a provoked weight loss, including depletion of the body as a result of adherence to a rigid diet and excessive physical exertion. In pursuit of an ideal weight, some women severely limit themselves to eating or completely abandon it, take laxatives and diuretic drugs, provoke vomiting after eating. All these manipulations lead to anorexia and the development of secondary infertility.
- Hyperprolactenemia is one of the most common causes of secondary amenorrhea. Under stress, prolactin is released, blocking ovulation and the onset of menstruation. This is the so-called hormonal amenorrhea. But mostly hyperprolactism is a consequence of endocrine disruption in the woman’s body or the development of changes in the pituitary gland.
Diagnosis of amenorrhea
Before prescribing treatment, the doctor needs to know the causes of the disease. The doctor is asked: "The patient has amenorrhea. What has happened in the woman's body?" The following diagnostic measures are assigned for this:
- A survey of the patient with the elucidation of the features of her physiological state and hereditary factors.
- Physical examination of the external organs of the female reproductive system.
- Conducting ultrasound in order to identify malformations, abnormal location or complete lack of internal organs of the reproductive system. Also in the process of ultrasound examination, you can determine the size of the uterus, the state of the follicular apparatus and the endometrium.
Often there is a need for additional research methods. These include:
- Hysterosalpingoscopy - a method for determining the patency of the fallopian tubes.
- Hysteroscopy - a study of the uterus.
- MRI of the brain to detect the condition of the pituitary gland.
- Laparoscopic diagnostic examination of the ovaries.
Mandatory is the appointment of laboratory tests:
- KLA - complete blood count.
- OAM - urinalysis.
- Test with gestogenami to determine estrogen deficiency.
- Hormonal colpocytological study.
After the doctor has a full set of conclusions about the studies, he will be able to adequately identify the cause of the disease and its type. At the consultation, the specialist will tell in detail about the diagnosis of "amenorrhea", what is happening in the body, what caused this disease, how to proceed. Then the specialist will prescribe the appropriate treatment with a follow-up examination.
Ways to treat amenorrhea
As a rule, after a thorough comprehensive examination and diagnosis, the doctor will advise the patient how to treat amenorrhea. In most cases, treatment is effective. The woman’s menstrual cycle is restored, her fertility is improving, her physiology is returning to normal. There are conservative methods for correcting this syndrome. Treatment of amenorrhea with folk remedies is also common. However, it should be remembered that resorting to alternative medicine should only be after consultation with a specialist. Self-activity in this matter can be not only ineffective, but also dangerous.
Treatment of primary amenorrhea
Conservative treatment of this type of amenorrhea is reduced to the elimination or correction of the causes that provoke the syndrome. If the phenomenon is caused by hereditary factors, then hormone replacement therapy is prescribed in the form of drugs containing estrogens, progestogens.
Adolescents with a delay in the formation of the female genital sphere, as a rule, are assigned nutritional correction and exercise. A balanced diet and sports activities contribute to building muscle, normalizing the general condition and are able to correct the situation. If amenorrhea is not eliminated after this, the doctor may prescribe hormonal drugs.
Treatment of secondary amenorrhea
Secondary amenorrhea, the syndrome of which is caused by the anorexic condition, is eliminated by correcting the diet and the level of physical exertion. Quite often, in this situation, the doctor recommends the use of benign oral contraceptives that stabilize the hormones.
In polycystic ovary syndrome, laparoscopic surgery is used to remove the pathological part of the ovaries in conjunction with hormonal preparations that normalize the reproductive function of the female body.
When hyperprolactenemia prescribed medications containing dopamine agonists, which block the increased secretion of prolactin.
After carrying out the above methods, any secondary amenorrhea is eliminated. Reviews of patients who underwent a comprehensive examination and treatment, talk about the effectiveness of professional procedures.
Traditional methods of treating amenorrhea
In alternative medicine there are a lot of recipes that help women for centuries to cope with such ailment as amenorrhea. Folk treatment, however, should be taken with caution. Mandatory is the examination and consultation with a doctor. First, you should make sure that amenorrhea is not the result of pregnancy. Also very important point is the presence of an allergic reaction to herbal ingredients, which is also a contraindication to many recipes of traditional medicine. If your doctor does not mind and there is no allergy, then you can use one of the following prescriptions:
- The roots of Rhodiola Rosea in the amount of 50 g chop and pour 500 ml of vodka (40%). Insist in a dark place in a corked form for 15 days. Take the tincture need 10-20 drops per spoonful of water three times a day before meals for three months.
- Crush a glass of viburnum fruit in half a liter of olive oil and leave for 10 days. After that, strain and drink on an empty stomach and at bedtime, two tablespoons for three months.
- Dip 100 g of chopped parsley in 1.5 liters of water, boil for 20 minutes and leave for 2 hours. The resulting broth must be drunk for the whole day, and so for two months. After that, the volume of the received solution can be reduced to half a liter and continue to drink for another six months.
- Almonds - 20 pieces, geranium leaves - 20 pieces, lemons with zest - 2 pieces, hawthorn flowers - 2 tablespoons, camphor powder - 1 g, valerian extract - 1 tablespoon, peppermint oil - 20 drops. All ingredients must be mixed and taken three times a day before meals.
- Prepare a mixture of herbs: Amur velvet, nettle, shepherd's purse, licorice root, taken in 1 part, and four parts of the highlander bird. All ingredients must be crushed and dried. Two tablespoons of the mixture pour a liter of boiling water and simmer until boiling for a third. Then you need to remove from heat and insist under the lid for about an hour. Next, you need to strain and drink a tablespoon for two weeks, three times a day.
- Prepare a decoction of 500 g of pine needles in two liters of water. Boil for half an hour and insist 2 hours. Then boil 100 g of chopped ginger root in 1 liter of water for half an hour and leave for 40 minutes. Prepare a bath with a temperature of 38 ˚C, pour into it two broths, adding 1 teaspoon of thuja oil. Take this bath must be daily for half an hour period of 10 days.
Prevention of Amenorrhea
A woman should always remember to maintain her health in good condition. Unbearable physical, psychological and emotional stress, which, of course, has a destructive effect on the body, should be avoided. It is important to keep your weight at the level of the physiological norm, avoiding exhaustion or obesity. Pregnancy needs to be planned, if necessary, to take contraceptives. When stress is recommended soft herbal soothing fees, baths, tinctures. Work out in the gym with a professional trainer and avoid overloading. On time, undergo a medical examination at a medical institution for the timely detection and treatment of diseases.
Concept of amenorrhea
Amenorrhea - a violation of hormonal levels, due to which there is a lack of menstruation. This condition occurs in women aged 16 to 45 years. In this case, the monthly does not occur within 6 months or more. Amenorrhea is not considered an independent disease, it is usually accompanied by many pathological conditions associated with genetic, physiological and psychological genesis. In girls, it may be accompanied by the recent onset of menstruation, which has not yet been fully formed. In women, this condition occurs during menopause. The birth may also lack menstruation for about 2 years if they feed the child during this period.
The classification of amenorrhea is quite extensive, so we consider in detail all types of amenorrhea.
- True. This type of disease is characterized by hormonal disorders, as a result of which, changes in the female genital organs are not observed. This is due to the fact that an insufficient amount of hormones circulate in the body, which are not capable of affecting the maturation of the egg and thus, does not occur menstruation. True amenorrhea is divided into: physiological - when the disease is natural and is associated with pregnancy, feeding, pathological - when the body experiences such disorders as: inflammation, functional disorders in the ovaries, surgery, changes in the composition of hormones in the blood.
- False amenorrhea caused by non-hormonal disorders. Female genital organs function well, however, the onset of menstruation is hampered by an abnormal anatomical structure of the organ. Most often it is congenital pathology: atresia of the uterus or vagina.
There are also primary amenorrhea and secondary.
- Primary amenorrhea inherent in adolescents. This condition is due to the fact that the girl has not yet formed all the secondary sexual characteristics. There is a lack of menstruation up to 14, as well as up to 16 years, but at the same time at least one of the secondary signs must be developed.
- Amenorrhea secondary occurs in women who are not young. Most often it is the ladies who have reached premenopause. Amenorrhea in this case occurs after available, periodically recurring menstruation, for 6 months or more. This type of amenorrhea is not a disease, it is only considered a cycle disorder syndrome.
Depending on the amount of hormones in the blood, these forms of amenorrhea secrete:
- Hypogonadotropic amenorrhea - when the level of hormones is 1.6 U / l,
- Hypergonadotropic amenorrhea - the level of hormones exceeds 30 U / l,
- Normogonadotropic - hormones are contained in an amount from 1.6 to 30 U / l.
In the classification allocate severity.
- Easy - for 6-12 months. With early detection and proper treatment, hormones return to normal.
- Average - 3 years. Because of this period of the disease, complications in the form of vascular disorders are observed.
- Heavy - more than 3 years. The uterus is significantly increased in volume, it is accompanied by vascular diseases. As a rule, treatment is not effective.
There are a variety of causes of amenorrhea. In true amenorrhea, there are no changes on the part of the female organs. This condition occurs during physiological processes such as: pregnancy, breastfeeding, puberty, and menopause.
Primary amenorrhea can occur due to hereditary predisposition. Also the anatomical structure of organs and emotional lability can contribute to its occurrence. The causes of secondary amenorrhea are observed in diseases such as diabetes, as well as disorders in the thyroid gland and adrenal glands. False amenorrhea is a consequence of the cessation of menstruation due to abnormal development of the uterus. Этиология гонадотропной аменореи связана с нарушением выработки гормонов гипофизом. Также аменорея может быть обусловлена наличием опухолей гипоталамо-гипофизарной системы.
The diagnosis of amenorrhea can be made on the basis of such analyzes:
- An examination by a specialist, which includes an examination,
- Mandatory diagnostic criteria - ultrasound of the female genital organs,
- It is necessary to pass tests for the level of thyroid hormones: thyroxin, triiodothyronine and thyrotropic hormone,
- Blood biochemistry, which is necessary to detect the amount of glucose,
- Consultation of a neurologist, for the diagnosis of the brain, to exclude a pituitary tumor,
- Conducting hormonal tests for the diagnosis of amenorrhea,
- Karyotyping to diagnose primary amenorrhea,
- Conducting hysteroscopy, with suspected fusion in the uterus,
- Laparoscopy, which is necessary to rule out polycystic ovarian conditions,
- Hysterosalpingography - a method necessary to identify secondary amenorrhea,
The main symptoms of amenorrhea are cessation of the menstrual cycle. However, depending on the type of the disease, there may be peculiar symptoms. Infertility is also characteristic of all types of diseases. In uterine form of amenorrhea, pain occurs, which lasts up to 3 days. This is due to the fact that blood accumulates in the uterus due to the violation of its structure. Also, pain is not the only sign. Nausea, breast augmentation is also characteristic of this disease.
When a pituitary tumor, in addition to the main signs, there is a release of milk from the mammary glands. Also irritability and emotional lability are inherent in this form of the disease.
Primary amenorrhea, as a rule, is observed in young girls with underdevelopment of organs. They have an unusual body type: tall, long limbs and short torso.
Secondary amenorrhea in adolescents may be accompanied by fever, heart rhythm disturbances, and weakness. The representatives of the fair sex, having polycystic, usually suffer from obesity, severe body hair, excess insulin.
How to treat amenorrhea
For the treatment of amenorrhea, it is necessary to determine its cause. Initially, a pregnancy test is conducted to rule out this condition. In the presence of congenital anomalies, conduct surgical manipulations (dissect the vaginal septum).
Acquired anomalies are treated by curettage of the uterine strips, and then the prescription of antibacterial drugs. Gestagens have become popular, such as: Duphaston. Treatment of secondary amenorrhea is the appointment of synthetic nonsteroidal drugs.
Also, to restore the cycle in case of polycystic ovaries, oral contraceptives can be prescribed, which will help to cope with this problem best. If the cause of the disease are pituitary tumors, they are removed surgically. Vitamins with amenorrhea are also shown to strengthen the body and restore the necessary substances. We should not forget about a healthy lifestyle, proper diet. Positive emotions and proper rest also contribute to the normal functioning of the body. When overweight, it is necessary to normalize it through proper exercises and massages. It is important to remember that heavy physical exertion can cause diseases of the pelvic organs.
Treatment of amenorrhea folk remedies is quite common. However, before using it, you must make sure that it is not a pregnancy. Broth onion peel is a frequently used method. For its preparation, you must take the onion peel and cook on the fire until the water darkens. Then wait until the infusion has cooled and strain. Take half a cup 3 times a day before meals.
Borovaya uterus with amenorrhea is an excellent tool, because in addition to regulating the level of hormones, it contains substances that can positively affect the nervous system. For its preparation, it is necessary to take a spoonful of grass, anger it with 250 ml of water and put on fire for 10 minutes. Then wait for the broth to cool and strain. It is necessary to drink a pine womb 5 times a day, 1 tablespoon.
Herbs with amenorrhea also gained popularity. So, how to be treated in this popular way? To do this, take 3 tablespoons of parsley and pour it with 3 cups of hot water. Let it stand all night and pass through a sieve in the morning. Take a decoction before eating 4 times a day. A course of therapy for a week, then a break for a week and continue treatment.
The consequences of amenorrhea are dangerous because infertility may occur, as well as the impossibility of treating hormonal disorders. Due to a lack of certain hormones, extragenital complications are possible. Cancers can also occur on the background of amenorrhea. Pregnancy also does not always go smoothly, severe gestosis, and sometimes miscarriages can occur in women.
Can I get pregnant with amenorrhea
Pregnancy with amenorrhea is possible, but this does not mean that a woman can bear and give birth to a child. Most often, the pregnancy ends in miscarriage at various times. During this period there will be strong toxicosis, diabetes and other diseases, which will lead to not carrying.
Very often, women use IVF, in some cases this method is doomed to success. However, if the child does not conceive, it does not work, then turn to surrogate mothers.
Lactational amenorrhea is observed in women who breastfeed their babies. At the same time, no changes on the part of the hormonal system are observed. During this period, a woman cannot become pregnant if she adheres to certain rules. It is necessary to feed the child 6 times a day, at night it is also necessary to do it, supplements are also not desirable.
The pathogenesis of the development of postpartum amenorrhea is directly dependent on the central system. The body produces the hormone prolactin, which is necessary for the production of milk. After birth, the uterine lining is restored within 60 days. During this time, the production of oxytocin, prolactin, whose properties include the inhibition of hormone production, occurs.
If the woman stops feeding, then the period begins after 2 months. However, if this does not happen, you need to contact a specialist. The average duration of lactational amenorrhea is 1 year.
How to eat with amenorrhea
Food with amenorrhea should be balanced. It is also necessary to consider the causes of this disease. If overweight is the cause of amenorrhea, then nutrition should be low in calories. In the opposite case, the diet should be dishes with a high content of iron. Diet for amenorrhea should contain all the useful components (vitamins, proteins, fats, carbohydrates). It is important to eat properly in order to have a healthy body. Many processes in the body depend on our lifestyle.
Prevention involves timely visits to specialists and the treatment of endocrine diseases. To lead a regular sex life. Also, do not forget about a healthy lifestyle: proper nutrition and exercise will prevent the occurrence of unwanted diseases.
- Valentine is 27 years old. I have not given birth for 2 months after giving birth. How long should they be normal?
It depends on whether you are breastfeeding. If so, then it may not occur within a year. If the baby is bottle-fed, then after 2 months of menstruation will return.
- Alain, 36 years old, monthly stopped a year ago. Menopause has not come yet. Tell me what to do in this situation and does it require treatment?
It is important to consult a doctor. You may have serious hormonal disorders.
The organism of the woman throughout all life undergoes many changes. It is important to monitor his health, visit specialists in time and lead a healthy lifestyle. If you have such a problem as amenorrhea, then an urgent need to contact a gynecologist. After all, timely treatment will lead to the full restoration of the functions of the female body.
Special Studies Edit
- Laparoscopy - shown to determine the dysgenesis of the Mullerian ducts and ovaries, in case of suspected polycystic ovary
- Ultrasound reveals cysts
- X-ray examination of a Turkish saddle with suspected prolactin
- Evaluation of the endometrium
- Consistent use of estrogen and progesterone (2.5 mg / day of estrogen for 21 days, and in the last 5 days - 20 mg / day of medroxyprogesterone)
- Subsequent bleeding - a sign of hypo-or hypergonadotropic amenorrhea
- The absence of bleeding indicates either abnormalities of the genital tract or the presence of non-functioning endometrium.
- The presence of non-functioning endometrium can be confirmed with hysterosalpingography or hysteroscopy
- Intravenous pyelography is necessary for all patients with dysgenesis of the cervical ducts, often combined with kidney abnormalities
- Computed tomography, MRI.
Eugonadotropic amenorrhea Edit
The effectiveness of treatment depends on the identification of etiological factors. Hormone replacement therapy begins after 6 months of amenorrhea to prevent development due to estrogen deficiency of osteoporosis and hypercholesterolemia .
- Congenital anomalies
- Dissection of a sprouted virginal membrane or transverse vaginal septum
- Creating an artificial vagina in its absence.
- Acquired anomalies
- Scraping the cervical canal and uterine cavity with or without hysteroscopy
- Introduction to the uterus of a baby Foley catheter or intrauterine device
- Use of broad-spectrum antibiotics for 10 days to prevent infection
- Cyclic hormone therapy with high doses of estrogen (10 mg / day of estrogen for 21 days, 10 mg / day of medroxyprogesterone daily for the last 7 days of the cycle for 6 months) for endometrial regeneration.
- Polycystic ovary syndrome. The two main goals of treatment are to reduce the severity of the symptoms of excess androgens and restore ovulation and fertility. Achieving the first goal (for example, contraceptives) may precede the achievement of the second.
- To ease the symptoms of excess androgens
- Oral contraceptives (combination of estrogen with progestin)
- Preparations of glucocorticoids, such as dexamethasone 0.5 mg at night (since the peak of ACTH is released in the early morning)
- Spironolactone 100mg 1-2p / day (reduces the synthesis of androgens in the ovaries and adrenal glands and inhibits the binding of androgens to the receptors of hair follicles and other targets)
- The effects of hormone therapy in relation to unwanted hair growth on the face and body rarely occur quickly (improvement is observed no earlier than after 3-6 months). Often it is necessary to artificially remove hair: shaving, electrolysis, chemical hair removal.
- Clomifentiitrat, by blocking the binding of estrogen to receptors in target cells (hypothalamus and pituitary), stimulates the formation of LH and FSH. When administered from day 5 to day 9 of the progesterone-induced cycle, clomifentirate often stimulates follicle maturation and ovulation
- Menopausal gonadotropin (has FSH and LH bioactivity) is injected parenterally daily until the level of estrogen in the blood is increased and follicle maturation in the ovaries is detected by ultrasound. Next, to stimulate ovulation injected HGT. Due to the risk of ovarian hyperstimulation and the occurrence of multiple pregnancies, such therapy is carried out only if other methods fail.
- Gonadorelin 0.1 mg i.v. or n / a can cause ovulation without ovarian hyperstimulation.
- With chronic anovulation and abnormal menstrual bleeding — progestin (for example, 10 mg of medroxyprogesterone acetate for 10 days every 1-3 months) or cyclic therapy with estrogen-progestin. (interrupt the persistent proliferation of the endometrium).
- With hypertecosis and androgen-secreting ovarian tumors, oophorectomy is indicated.
- Congenital adrenal hyperplasia (adrenogenital syndrome)
- Hydrocortisone replacement therapy to suppress ACTH secretion and excessive androgen synthesis
- Mineralocorticoid replacement therapy (for example, desoxycorticosterone acetate) in the case of the salt-losing form of adrenogenital syndrome
- Surgical correction of external genital anomalies.
Hyperprolactinemia. There is no effective therapy for amenorrhea of this type.
- Estrogen replacement therapy is indicated for genetic disorders in order to form secondary sexual characteristics (2.5 mg estrogen for 21 days and medroxyprogesterone 10 mg / day daily for the last 7 days of the cycle). When prescribing estrogen with progesterone, regular menstrual bleeding occurs, but fertility is not achieved.
- Bromocriptine is recommended for patients with hyperprolactinemia with normal pituitary or microadenoma in continuous mode from 2.5 to 7.5 mg / day. After 30-60 days, the menstrual cycle is restored, in 70-80% of patients, if desired, after 2-3 months pregnancy occurs.
- Surgical excision of gonads containing Y-chromosomes.
Hypogonadotropic amenorrhea Edit
Therapy depends on the patient's interest in the occurrence of pregnancy.
- Periodic therapy with progestins (medroxyprogesterone 10 mg / day for 5 days every 8 weeks) is prescribed to women who are not interested in becoming pregnant.
- Recently, the stimulation of ovulation and even the onset of pregnancy has become possible with the use of synthetic analogues of gonadoliberins (with potentially active pituitary).
- Women who wish to become pregnant are stimulated with ovulation using clomiphene citrate or gonadotropins.
- Surgical treatment is indicated for CNS tumors.
- Treatment of diseases of the thyroid gland or adrenal glands.
Contraindications for use of estrogen
- Hypercoagulation and increased tendency to thrombosis
- Myocardial stroke in history
- Estrogen dependent tumors
- Severe abnormal liver function.
- Care should be taken when prescribing drugs for concomitant diabetes, epilepsy or migraine
- Smoking (especially in women over 35) increases the risk of severe side effects from the cardiovascular system and the central nervous system, such as cerebral ischemia, angina attacks, thrombophlebitis, pulmonary embolism
With the use of estrogen side effects are possible: fluid retention in the body and nausea, thrombophlebitis and arterial hypertension.
- Barbiturates, phenytoin (difenin), rifampicin accelerate the biotransformation of progestins
- Estrogens slow down glucocorticoid metabolism, enhancing their therapeutic and toxic effects.
- Estrogens weaken the effect of oral anticoagulants.
Observation depends on the cause of amenorrhea, treatment tactics. Replacement therapy is recommended to stop after 6 months for self-resumption of menstruation.
- Signs of estrogen deficiency, such as hot flashes with a sensation of heat, vaginal dryness
- Osteoporosis with prolonged amenorrhea with low estrogen levels.
The course and prognosis depend on the cause of amenorrhea. In hypothalamic-pituitary etiology of amenorrhea, the appearance of menstruation within 6 months was noted in 99% of patients, especially after the correction of body weight.
- It is necessary to inform the patient about the expected duration of amenorrhea (temporary or permanent), its impact on the ability to have children and describe the long-term effects of untreated amenorrhea caused by endocrine disorders (for example, osteoporosis, vaginal dryness)
- Recommendations for contraception are necessary, since fertilization of the egg becomes possible before the appearance of the first menstruation.
Prevention. Maintain normal body weight.