Overview: amenorrhea is a common gynecological disease symptoms can be different of causes. Usually divided into primary and secondary amenorrhea two. Over 18 years of age who were not walking as primary amenorrhea; at menarche, the normal at any time before menopause (except pregnant or lactating), closed the period ended more than 6 months are known as secondary amenorrhea. This distinction is largely artificial, because the primary and secondary amenorrhea caused by fundamental factors may sometimes be the same. However, in providing clues to etiology and prognosis, this classification is useful, for example, the majority of congenital anomalies, including ovarian tissue or Mullerian abnormalities, caused by being included in the primary amenorrhea amenorrhea, and the majority of secondary amenorrhea is caused by the acquired disease, and easier to treat.[Cause]
amenorrhea is caused by what the?
amenorrhea their remaining rational and pathological distinction. Before puberty, pregnancy, lactation, menopause after the cessation of menstruation, belongs to the physiological amenorrhea. Discussed here is the problem of pathological amenorrhea.
period by the hypothalamus - pituitary - ovarian axis caused by the cyclical adjustment off the formation of the endometrial cycle, so the hypothalamus, pituitary, ovary and reproductive tract, especially the uterus appear on all aspects of any organic or functional changes, may cause amenorrhea. Other endocrine glands of the organic and functional abnormalities, which may also affect the occurrence of menstruation amenorrhea.
(B) the pathogenesis
and menstrual-related organs including the uterus, ovary, pituitary and hypothalamus, any part of that barriers are likely to amenorrhea. according to the site can be divided into disorders in uterine, ovarian, pituitary and hypothalamus of the four types.
1. amenorrhea amenorrhea causes the uterus in the womb. Although normal ovarian function, but can not produce normal endometrial response, and therefore not to menstruation. uterine amenorrhea common diseases:
(1) congenital hypoplasia or absence of the uterus: the embryos as deputy in the development of renal tubular hypoplasia or not due. Performance of primary amenorrhea. After puberty, secondary sexual characteristics such as breasts, genitalia, vaginal, armpit etc developed normally. If the measured basal body temperature showed that ovulation can sometimes, but also performance of cyclical breast pain and abdominal discomfort. Chromosomes and gonads were normal female. Of ovarian hormones and pituitary gonadotropins FSH, LH levels are on the normal female. pelvic examination and B-confirmed absence of the uterus. If the primary amenorrhea associated with recurrent abdominal pain should be considered a congenital uterine or vaginal abnormalities, such as vaginal septum or imperforate hymen and so on. Due to poor reproductive tract, blood can not be discharged. B-can be found in the uterus and vaginal blood clots blood. Surgery to open the channel will return to normal menstruation. The congenital uterine hypoplasia or absence of menstruation is never there.
(2) of endometrial damage or adhesions: usually occurs in post-abortion, post-natal or post-abortion curettage, due to excessive endometrial scraping injury, or surgery infection caused by intrauterine adhesions, amenorrhea. When the uterine part of the adhesion, so that blood can not flow, the performance of cyclical abdominal pain and amenorrhea accompanied by a sense of falling. The symptoms and basal body temperature control, or B-blood found in the uterus, can confirm the diagnosis.
Some infections such as tuberculosis endometritis, miscarriage or severe postpartum endometritis can lead to endometrial destruction of amenorrhea, usually secondary amenorrhea. If the girls before puberty endometrial tuberculosis infection is manifested as primary amenorrhea.
(4) of the androgen insensitivity syndrome: also known as testicular feminization. This is a special form of uterine amenorrhea. Patients with karyotype 46, XY, gonads as testis, because the lack of androgen receptor target organ or receptor can not have normal biological functions, and thus failed to develop into normal males. Mimicking the appearance of complete testicular feminization type women, with breast development, but the absence of the uterus for the blind end of the upper vagina. Patients are often at puberty to primary amenorrhea after treatment.
2. ovarian amenorrhea refers to the primary in the ovary itself, disease or dysfunction caused by menopause. For innate, can be acquired. Diagnosis of ovarian amenorrhea two major endocrine indicators are low levels of estrogen and gonadotropin levels.
(1) congenital ovarian hypoplasia: also known as Turner syndrome. Girls in primary amenorrhea is the most common kind. This is a sex chromosome abnormality of the disease, the majority of the number of X chromosome abnormalities, the basic karyotype is 45, X, but also for the sex chromosome structural abnormalities, such as the X chromosome and other arm, long arm or short arm deletion, ring X chromosome and so on. Some are a variety of chimeric karyotype. In addition to the patients with primary amenorrhea and poorly developed secondary sexual characteristics, the more there is a group of physical abnormalities, such as short stature, webbed neck-like, multi-faceted mole, barrel chest, cubitus valgus, and other deformities. A few with 46, XX mosaicism may appear to be cases of secondary amenorrhea or occasional normal menstruation.
(2) pure gonadal dysgenesis: including 46, XX pure gonadal dysgenesis and 46, XY pure gonadal dysgenesis. In addition to the two different karyotypes, the clinical manifestations are similar. Appeared as primary amenorrhea, secondary sexual characteristics do not develop. A high, long limbs, body type for the castration. Mostly gonadal cords. karyotype XY gonadal tumor-prone. beijing Union Medical College Hospital has reported five cases of XY pure gonadal dysgenesis, the gonads are removed, pathologically confirmed four cases have occurred in tumors, gonadal blastoma in 2 cases, sex cord tumor with Sertoli cell tumor in 1 case. Therefore, XY pure gonadal dysgenesis gonadal surgery should be as soon as possible.
(3) premature ovarian failure: also known as early menopause, menopause that occurs before the age of 40. Occasionally in young women under the age of 20. The majority of secondary amenorrhea, primary amenorrhea is rare. ovarian atrophy, low levels of estrogen, fsh levels increased up to menopause. real mechanism of premature ovarian failure is not yet clear. It was observed that premature ovarian failure and its own immune system, premature ovarian failure was found with a variety of home-immune disease often accompanied by, such as Addison disease, thyroiditis, hypoparathyroidism, myasthenia gravis, diabetes, etc., can be measured against ovarian tissue antibodies, have been observed to have anti-ovarian gonadotropin receptor antibodies, fsh and obstruction on the cell membrane receptors. premature ovarian failure have also reported that family factors, patient mother or sister in the case of early menopause.
(4) ovarian insensitivity syndrome: clinical presentation with premature ovarian failure, for primary amenorrhea or early menopause. The difference is that with premature ovarian failure in such patients have a large number of normal ovarian follicles, but in the resting state, can not mature and ovulation. ovarian insensitivity syndrome pathogenesis is not very clear. More explanation is the existence of ovarian gonadotropin receptor antibodies or anti-receptor biological dysfunction. disease and premature ovarian failure, reproductive hormones change the same, to see if the B-or laparoscopic ovarian follicles do not shrink and has a small presence, you can be identified with premature ovarian failure.
(5) to ovary syndrome: ovarian tissue removed or destroyed. As more bilateral ovarian surgery after radiation therapy or both ovaries, the ovarian tissue is destroyed resulting in loss of function, performance of primary or secondary amenorrhea. Severe ovarian inflammation can destroy ovarian tissue caused the amenorrhea.
(1) primary pituitary hypogonadism: a rare genetic disease, manifested as isolated gonadotropin deficiency, patients are often primary amenorrhea, sexuality not developed, and some with olfactory dysfunction. pituitary gonadotropins and ovarian hormones fsh and LH are low.
(2) secondary pituitary dysfunction: due to pituitary damage, bleeding, inflammation, radiation and surgical destruction of the anterior pituitary function, resulting in anterior pituitary gonadotropin and Other hormones, such as thyroid stimulating hormone and adrenocorticotropic hormone deficiency. Therefore, except for hypogonadism, sometimes there will be hypothyroidism and adrenal insufficiency, showing amenorrhea, weight loss, fatigue, chills, low blood sugar, blood pressure, low basal metabolism and loss of libido and so on. Because postpartum hemorrhage, shock caused by the anterior pituitary tissue necrosis occurred secondary to sheehan syndrome is typical of anterior pituitary dysfunction.
(3) pituitary tumor: pituitary amenorrhea is more common cause of anterior pituitary function by direct damage or because of damage to the hypothalamus and pituitary regulation between channel interference reproductive hormone secretion and regulation, resulting in amenorrhea. Many different types of pituitary tumors, such as growth hormone tumor, prolactinoma, thyroid stimulating hormone adenoma, acth adenomas, gonadotropin adenoma mixed tumor and non-functioning pituitary adenomas and so on. And amenorrhea on the most common pituitary tumor is prolactinoma.
4. hypothalamic amenorrhea refers to the barrier above the hypothalamus or hypothalamus. As the hypothalamic gonadotropin-releasing hormone (GnRH) deficiency or secreted forms of disorders caused by menopause. Including the hypothalamus - pituitary unit dysfunction, central nervous system - the hypothalamic dysfunction, and other endocrine abnormalities caused by inappropriate feedback regulation of hypothalamic amenorrhea due.
(1) of the hypothalamus - pituitary unit dysfunction: can congenital hypothalamic - pituitary dysfunction, can also be secondary to injury, cancer, inflammation and radiation and other hypothalamic hormone GnRH-induced synthesis and secretion disorders. The most common clinical hypothalamic - pituitary dysfunction due to amenorrhea unit is hyperprolactinemia. This is due to hypothalamic prolactin inhibitory factor (mainly dopamine) deficiency, the pituitary secretion of excess prolactin. In addition, any other reasons prevented the inhibition of dopamine on prolactin secretion, can occur hyperprolactinemia. If the tumor pituitary stalk compression would block dopamine inhibition of prolactin secretion; certain drugs can be consumed by blocking dopamine or dopamine receptor reserve leaving prolactin secretion, such as metoclopramide (metoclopramide) , chlorpromazine (wintermine) and other drugs. Other pituitary adenomas, thyroid dysfunction, sucking the nipple and breast stimulation can cause prolactin secretion. Elevated prolactin levels may also act on the hypothalamus, inhibiting the synthesis and release of GnRH; role in the pituitary, reducing pituitary sensitivity to GnRH; role in the ovary, ovarian steroid hormones interfere with the synthesis. In addition to amenorrhea, the lactation hyperprolactinemia are often one of the important performance. However, many patients they can not find milk, about half of amenorrhea or irregular menstruation due to medical treatment when discovered. laboratory tests will find elevated serum prolactin levels,> 30ng/ml, follicle-stimulating hormone (FSH), luteinizing hormone (LH) equal to or lower than normal levels of early follicular phase, estrogen levels low. Except for the pituitary tumor, should be done sellar imaging. vision should be checked if necessary, to alert the optic nerve due to tumor compression of visual field defects.
(2) center - the hypothalamus dysfunction: psychological factors, external or internal environment of the central nervous system can change the brain cortex, thalamus and hypothalamus of the neuroendocrine pathway , or under the influence of the limbic system by the brain caused by hypothalamic amenorrhea. In young women, more common conditions such as by the spirit of the typical stimulation, emotional stress or sudden amenorrhea after replacement of the environment. FSH, LH and estradiol (E2) levels in the normal range, due to the secretion of gnrh pulse rhythm disturbance lead to amenorrhea anovulation. By deliberate weight loss, slim due to the pursuit of anorexia nervosa in adolescent girls are common. They formed from the diet to the eccentricities of anorexia or eating habits, severe weight loss, amenorrhea, so as to cause the thyroid gland, adrenal gland, gonads and pancreas and other organ dysfunction, or even water and electrolyte disorders and life-threatening severe malnutrition, the majority of such patients can be pressed out with a history of psychological factors. normal FSH, LH and E2 levels were low. In addition, false pregnancy is a result of psychological factors central hypothalamic dysfunction. Often occurred in the hope the child eager to infertile women.
(3) Other endocrine abnormalities caused by inappropriate feedback regulation:
① androgen excess: excess of male hormones can come from ovarian and (or) adrenal gland. Clinically, the most common in young women is the polycystic ovary syndrome. The main feature of the pathophysiology of androgen excess and persistent anovulation, amenorrhea, or menstrual disorders showed, hirsutism and obesity, and polycystic ovaries increases and a series of symptoms and signs. Mainly from the excessive ovarian androgen, some from the adrenal gland. Increased androgen in the surrounding tissue into estrogen. This ongoing transformation of non-cyclical estrogen on the Gn-RH to the pituitary increased sensitivity, leading to an increase in LH secretion, and loss of periodicity, and the relative lack of FSH. polycystic ovary syndrome blood circulation in androgen levels than normal females about 50% to 100%. If elevated androgen abnormalities, should be noted that other cases were identified, such as ovarian or adrenal androgen-secreting tumor, enzyme deficiencies due to congenital adrenal hyperplasia and other abnormal sexual development.
congenital adrenal hyperplasia is a girl in another, more common situation of androgen excess. Is due to adrenal steroid hormones in the synthesis process of the lack of certain enzymes and generate too much male hormone, the hypothalamus - pituitary - gonadal axis interference and irregular menstruation or amenorrhea. In addition, patients often have varying degrees of masculinity or even genital deformities.
② thyroid hormone abnormalities: thyroid hormone metabolism of various substances in the body. Therefore, too much or too little thyroid hormone can directly affect the reproductive hormones and reproductive function, as some patients may be manifestations of hyperthyroidism after a few months or amenorrhea.
③ tumor hormone secretion: the ovaries and adrenal tumors more common. Tumors secrete too much hormone feedback mechanism by inhibiting the secretion of hypothalamic and pituitary regulatory function, the destruction of their periodicity, leading to anovulation or amenorrhea. according to the blood levels of estrogen or androgen abnormal increase of the characteristics of the tumor can determine the nature of hormone secretion. Careful pelvic examination, the corresponding parts of the imaging studies, such as pelvic and adrenal B-ultrasonography, CT scan, MRI, etc. contribute to tumor diagnosis.
④ movement and amenorrhea: athletes, ballet dancers and other exercise activities for engaging large, too little body fat, there will be exercise-induced amenorrhea. energy consumption as well as training and competition stress can affect the nervous endocrine and metabolic function, so that abnormal secretion of hypothalamic GnRH, resulting in amenorrhea.
⑤ drug-induced amenorrhea: Some drugs can affect the hypothalamic amenorrhea caused, especially thiazide sedative, often large doses can cause amenorrhea lactation, after stopping menstruation can be restored. long-acting contraceptive injection needle a few women or long-term high-dose oral contraceptives results in secondary amenorrhea, the drugs on the hypothalamic - pituitary axis suppression due to persistent.
⑥ obesity: obesity is sometimes associated with other endocrine abnormalities. This refers to obese. body weight and hypothalamic - pituitary - gonadal axis close. accumulation of adipose tissue is estrogen place outside the gland is androgen into estrogen the main part. Excessive adipose tissue leading to increased estrogen. This non-cyclical estrogen produced by the feedback mechanism of the hypothalamus - pituitary produces sustained inhibition, leading to anovulation or amenorrhea.
the first area of lower genital tract or uterine lesions
The second area of ovarian lesions
What are the early symptoms of menopause?
(1) prepubertal amenorrhea: 6 to 9-year-old girl can be identified from the urine of dehydroepiandrosterone (DHEA) and its sulfate, rapid increase in the age of 10, which was the performance of the early adrenal function, from adrenal androgen to promote pubic hair, armpit hair there, she quickly grow taller, because the hypothalamic - pituitary - ovarian axis to be further development of sound, estrogen level is still low, less endometrial proliferation, it does not cause bleeding, so delayed menstrual cramps. This stage before menarche, menstrual cramps are no physiological phenomenon, there are some girls after menarche tide once a year or so months of menstruation, ovulation and menstruation is not normal.
(3) menopausal transition and postmenopausal amenorrhea: a few months menopausal transition may occur once uterine bleeding, postmenopausal genital shrinking, the uterus is also reduced.
(1) uterine amenorrhea and hidden by:
① non-porous hymen: the gradual emergence of clinical symptoms, initially a sense of cyclical lower abdominal bulge, pain, progressive increase, hematoma urethra and rectum, can cause difficulties in urination and defecation, suprapubic spasmodic pain, anal, urinary frequency, urgency, dysuria, urination and even guttate. When a lot of blood in the uterine cavity, can lead to ureteral displacement, distortion, water, or hydronephrosis. blood reflux into the pelvic cavity, it can produce severe abdominal pain, peritoneal irritation. abdominal examination was tenderness and a palpable mass, with deep tenderness, a small number of patients may have mild muscle tension, rebound. gynecological examination found that thin bulging hymen, no openings, the surface was purple blue. dre palpable vaginal hematoma, enlarged uterus, tenderness, two accessories for the sausage-like strip mass, tenderness. Duration of the elderly may have irregular thickening, tenderness, ranging from the number of nodules. B-mode ultrasound or CT could be detected and cystic mass in the vaginal barrel, fluid within the uterine cavity and fallopian tubes.
② congenital absence of vagina: The disease often do not come because of puberty menstruation or cyclical abdominal pain, or marriage, dyspareunia, or infertility, when examination revealed treatment . Breast, secondary sexual characteristics and normal external genitalia, normal ovarian function; basal body temperature (BBT) biphasic type, blood women of childbearing age of reproductive hormones were measured periodically change. If the uterus associated with absence or primordial womb, may be asymptomatic; if a functional uterus lining, it might be due to uterine hemorrhage with progressive increase of periodic abdominal pain. gynecological examination can be found in the vulva vagina free, if only doctor who married a long time, can be found in the vestibular area formed a shallow due to sexual intercourse nest. Most patients with a pelvic palpable cord-like traces of the uterus. If patients with functional endometrium, while the younger doctor who checks can be found a small uterus, or palpable normal or increased pain of the uterus, sometimes palpable sausage-like thickening of the fallopian tubes. B ultrasound, CT and other imaging studies can confirm these findings, and found that the urinary system abnormalities.
③ vaginal diaphragm: the diaphragm were not entirely, because blood can flow through the holes, so no amenorrhea. Complete discharge of the diaphragm are due to blood disorders, of a primary amenorrhea, cyclic abdominal pain and other symptoms.
complete vagina, the upper diaphragm by gynecological examination can be found a certain length and width of the lower vagina, top closure, a sense of volatility hit a membrane, the top vaginal expansion, like cystic sexy. Lower vaginal diaphragm is sometimes difficult to distinguish with vaginal atresia, a careful combination of gynecological examination after every cavity puncture is effective identification method.
④ vaginal atresia: clinical manifestations of primary amenorrhea, cyclic abdominal pain. Adverse gynecological examination See vulva, the hymen is no hole, but the surface color, normal, non-bulging outward sign, rectal examination can be found in the vulva about 3cm from the top there is a sudden cystic mass to the rectum, vagina, abdominal pain and tension when the mass large. Transabdominal or transrectal probe in B-3 ~ 4cm from the anal probe above the barrel and a cystic mass in the B-guided puncture through the vulva to the tumor, can be removed from the old dark red blood or chocolate-like paste. type Ⅱ were vaginal atresia, clinical manifestations of primary amenorrhea, cyclic abdominal pain. gynecological examination or higher in the pelvic side of the 4 ~ 8cm in diameter at the mass, for the malformation of the uterus or attachments tumor.
⑦ primordial womb: patients showed primary amenorrhea, rectal examination and B ultrasonic imaging can be found in a small uterus, only 2 ~ 3cm long, laparoscopic When inspection or laparotomy can see a flat solid, 0.5 ~ 1cm thick traces of the uterus.
⑧ Miller tube hypoplasia syndrome: the performance of primary amenorrhea, reproductive tract defects, including congenital absence of vagina, the uterus can be normal, but also for a variety of malformations including double uterine horn, one uterine horn, primordial uterus, rudimentary horn of the uterus, double uterus, etc., rare congenital absence of uterus. The symptoms in patients with ovarian development and function were normal, the normal development of secondary sexual characteristics. About 34% of patients with urinary tract abnormalities, 12% had bone deformities, 7% had inguinal hernia, there is 4% of congenital heart disease. The case of double uterus, uterine horns or single horn, rudimentary uterine horn, not cause amenorrhea.
⑨ traumatic intrauterine adhesions: clinical manifestations and adhesion location and extent a certain extent, but not completely consistent between the two. Menstruation, menstrual period shortened, amenorrhea, infertility, miscarriage and obstetric complications are the main clinical symptoms. In the uterine cavity after surgery to reduce menstrual flow or amenorrhea, especially in one week postpartum curettage or endometrial regeneration after induced abortion or hydatidiform mole easy to damage in patients with endometrial curettage on several occasions. Some patients have recurrent abdominal pain, palpable too bimanual or normal uterus is slightly larger, and have a mild tenderness tenderness and two annexes. Mouth of the cervix patients with multiple adhesions that amenorrhea after abortion, in some patients due to uterine hemorrhage and blood reflux into the abdominal cavity can be expressed as abdominal pain, cervical pain, increased tenderness Palace, after vaginal vault puncture dark red coagulation of blood, similar to the performance of ectopic pregnancy. Uterine cervix probe tests can be found obstruction or stenosis, the probe along the direction of the uterus and uterine cavity axial buckling forward, the adhesion of light can be blocked after a breakthrough in a sense, after entering the uterine cavity, while there may be a very small amount of dark red thickening of the blood flow. Such as intrauterine adhesions, after a probe into the uterine cavity was limited mobility. Severe adhesions inside the mouth of the cervix is the probe can not enter inside the mouth, need to continue to sacral nerve block anesthesia for exploration cervix, cervix such severe adhesions may also occur in patients with non-pregnant uterus for cervical laser or electric When baked, endometrial and cervical injuries surgery inside the mouth.
(2) ovarian amenorrhea:
① Turners syndrome: A.16-year-old still no menstruation; B . short stature, hypoplasia secondary sexual characteristics, webbed neck, shield chest, cubitus valgus; C. high gonadotropin and low gonadal hormones; D. karyotype 45, XO; 46, XX/45, XO ; 45, XO/47, XXX.
③ premature ovarian failure: A.40 before the age of menopause; B. high gonadotropin and low gonadal hormones; C. About 20% have chromosome abnormalities; D. about 20% associated with other autoimmune diseases; E. pathological examinations showed no ovarian follicles or only very few primordial follicles; F. laparoscopy see ovarian atrophy; G. has a history of iatrogenic damage to the ovary; H. on endogenous and exogenous gonadotropin stimulation without response; I. clomiphene trials, on the 5th day cycle of oral clomiphene 50 ~ 100mg, 1 times / d, for 5 days. In cycle 3 and 10 days were measured in serum FSH, such as day 10 fsh values> 20U / L, suggest ovarian dysfunction.
④ resistance syndrome: A. primary or secondary amenorrhea; B. high gonadotropin and low gonadal hormones; C. pathological examinations showed how the amount of the beginning of the ovary immature follicles and follicle base; D. laparoscopy see the size of normal ovaries, but no traces of the growth of follicles and ovulation; E. endogenous and exogenous gonadotropin stimulation without response.
⑤ polycystic ovary syndrome: clinical manifestations seen with oligomenorrhea, amenorrhea, infertility, chronic anovulation phenomenon; more hair, acne and acanthosis nigricans and other androgen blood levy phenomenon; obesity.
(3) pituitary amenorrhea:
① pituitary tumors and hyperprolactinemia: clinical manifestations seen amenorrhea or irregular menstruation; lactation; as large pituitary tumor can cause headaches and visual disturbances; such as empty sella syndrome may have pulsating headache; rule out medication-induced hyperprolactinemia.
② pituitary failure: clinical manifestations can be seen with post-partum bleeding or a history of pituitary surgery; weight loss, fatigue, chills, pale, no post-partum lactation, no sex, no follicle developmental, reproductive tract atrophy; check for low levels of sex hormones and thyroid dysfunction and adrenal dysfunction symptoms and signs.
① low single gonadotropin-releasing hormone: A. original onset amenorrhea, follicles present but not developed; B. Some patients have varying degrees of secondary sexual characteristics disorders; C. Kallmann "s in patients with olfactory loss; D. FSH, LH, E2 are low; ⑤ of gnrh treatment respond; ⑥ X chromosome (Xp22.3) of the KAL gene defect.
② functional hypothalamic amenorrhea: A. amenorrhea or irregular menstruation; B. common in adolescence or young women, more than a diet, stress, strenuous exercise and not the law of life history; C. body more thin; D. tsh levels were normal, T3 and T4 low; E. fsh and LH low or near normal, E2 levels low; F. ovarian ultrasound examinations showed normal size, many small follicles scattered in the medulla, reflecting not enhanced.
A history of primary amenorrhea patients should be asked during growth and development, whether childhood suffered from viral infection or tuberculous peritonitis, with or without a family of similar diseases. Of secondary amenorrhea should be aware of age at menarche, duration of amenorrhea, amenorrhea before menstruation, as well as mental stimulation or whether the living environment and changes in incentives; is taking some pills, ever received hormone therapy and response to treatment; whether the cycle of lower abdominal pain; past health situation, with or without tuberculosis or thyroid disease; without headache, visual impairment, or unconsciously, galactorrhea and other symptoms. If pregnancy history, the need to ask abortion, curettage, postpartum hemorrhage and breast-feeding history and so on.
Second, the physical examination
1, body checking attention and development, nutrition, weight and mental conditions; measured weight and height ; check the degree of development of secondary sexual characteristics, how much hair and sub-terror; light squeeze the breast, to observe whether lactation.
2, watch for abdominal and gynecological examination groin mass; external genitalia, and whether or deformity; whether the increase in uterine and ovarian, uterine mass or nodule with or without attachments, etc. .
three diagnostic steps
the normal menstrual cycle is normal hypothalamus-pituitary-ovarian axis function of the specific performance of amenorrhea patients, using the following diagnostic steps to help understand where the lesion site, and then according to disease site to find the cause.
(a) the first estimate of endogenous estrogen levels, in order to understand ovarian function. amenorrhea for each patient, we must first understand the level of estrogen, can be used to estimate the following types of tests. For at least six weeks before the test is not used hormone drugs.
1, withdrawal of progesterone blood test This test is to estimate the level of endogenous estrogen is relatively simple and fast method. The specific method is: the use of progesterone in oil 20mg intramuscular injection, once daily for 5 days; or oral medroxyprogesterone vinegar daily 10mg, even for 5 days. 2 to 7 days after treatment, there herbal withdrawal bleeding as positive, indicating that patients with functional endometrium, and estrogen has been subject to adequate effect of exogenous progesterone to produce changes in the secretory phase, after stopping in membrane stripping caused by bleeding. I called this degree of amenorrhea amenorrhea, amenorrhea is estimated that the next-pituitary lesions, causing ovulation disorder, common in puberty in the hypothalamus - pituitary - ovarian axis immature, polycystic ovary syndrome and hyperprolactinemia patients. herbal withdrawal amount of bleeding and the level of estrogen, such as only a small amount of blood, suggesting that the critical level of estrogen, attention should be paid.
2, vaginal exfoliated epithelial cells in check, and check the vaginal epithelium and cervical mucus cervical mucus effects of ovarian hormones are affected by cyclical changes occur. vaginal epithelial cells nuclear condensation and eosinophilic reaction may reflect the level of estrogen. estrogen makes the cervical mucus becomes thin, drawing long, and the emergence of fern crystals. test 2 to 3 times per week, for a month, you can understand the level of estrogen, with or without cyclical changes.
according to reports, about 33% of secondary amenorrhea due to hyperprolactinemia caused, so check in the first step should be included in the determination of serum prolactin. When the blood prolactin greater than 25μg / L (ng / ml), it shall be more than the sella radiography to CT to rule out pituitary tumor. Due to conditions, is not yet able to measure blood prolactin as a routine examination.
(b) the second step of estrogen withdrawal of the blood test if progesterone failed to arouse herbal withdrawal bleeding may be due to lack of endogenous estrogen, the endometrium has not been enough so that the effects of estrogen without the normal proliferative changes in the rules, although in this case to progesterone, the endometrium does not make changes in the secretory phase was off; may also be defective endometrium, estrogen not react. estrogen trials are designed to give patients sufficient amount of estrogen and progesterone, after stopping to observe the bleeding. The specific method is: oral diethylstilbestrol daily 1mg, even for 20 days; or ethinyl estradiol, daily 0.05mg, even for 20 days. In the 16th day of medication, intramuscular injection of 20mg daily plus progesterone, or oral medroxyprogesterone acetate daily 10mg, even for 5 days. 2 to 7 days after stopping bleeding as positive reaction, indicating that patients with normal function of the endometrium, exogenous estrogen, progesterone responsive to prove that amenorrhea is due to lack of estrogen in the body, therefore, called Ⅱ degree amenorrhea. If there is no herbal withdrawal bleeding after stopping, can be repeated estrogen trial, the purpose is to promote endometrial produce estrogen receptors. If still no bleeding, suggesting that the endometrium is defective or damaged, the uterus is called amenorrhea.
(c) The third step gonadotropin determination of estrogen withdrawal in patients with positive blood test, should find the reasons for the lack of estrogen, the difference is due to ovarian estrogen deficiency has been loss of the ability of estrogen secretion, or because the body is not a lack of gonadotropin secretion and ovarian steroid hormones. Thus a need to determine gonadotropin. There are two specific ways:
1, measured by radioimmunoassay of follicle stimulating hormone (FSH) and luteinizing hormone (LH) normal serum fsh is 5 ~ 40IU / L ( mIU / ml); normal serum LH value of 5 ~ 25IU / L, in the menstrual cycle, ovulation peak value of approximately 3 times the base value. After 2 to 3 times after the measurement results can be divided into higher and lower normal three. Clinically, fsh increased the significance of the larger, such as fsh than 40IU / L, suggest ovarian function has been failure. Such as LH less than 5IU / L that gonadotropin insufficiency. If the fsh and LH are reduced, and often prompts the central function of the pituitary or higher low.
2, bioassay method used is to measure the past 24h urinary gonadotropins (FSH and LH) levels, but mainly 24h urinary excretion of fsh in clinical meaning, so often called fsh determination. 24h urinary excretion of FSH, the different times were measured 2 to 3 times> 52.8 units of mouse uterus, suggesting that pituitary hyperfunction, causes of ovarian amenorrhea; If the 24h urinary excretion of fsh <6.6 units of mouse uterine , suggesting that pituitary dysfunction, causes amenorrhea in pituitary or pituitary more positions. However, due to differences in animal reactivity, and urine collection, extraction, concentration and other steps of error, often affect the accuracy of this Act, the current conditions of the unit, are used gonadotropin radioimmunoassay.
normal pituitary stimulation test in the morning, the specific method is: 100μgLHRH dissolved in 5ml normal saline, intravenous injection, injection finished in 30 seconds. Before injection and at 15,30,60,120 min after injection of the blood 2ml, separation of serum, cold storage, measured by radioimmunoassay of LH content. If 15 to 45 minutes after injection of LH release compared with the value before the injection of more than 3 times higher, indicating that the pituitary response to exogenous LHRH good, its normal function, hypothalamic amenorrhea or more parts of the pathogen. If no value is increased after injection of LH or increased much, the pathogen may be in the pituitary.
the above test method known as typical pituitary pituitary stimulation test, has been widely used, but it has limitations. Sometimes pituitary lesions, but not completely destroyed, can release more LH; contrast, the normal pituitary gland in a long time to lose endogenous gonadotropin-releasing hormone stimulation, can appear inert, on the first injection of LHRH may reaction or delayed reaction appeared to be several consecutive injections, in order to gradually return to normal reaction. Therefore, cases of pituitary stimulation test was negative, repeated tests have clinical significance. Combes introduced intravenous LHRH test method is to use 100μgLHRH intravenous infusion for 4 hours. Under normal circumstances, when the infusion of 30 to 45 minutes after the LH rise, fall 60 to 90 minutes, 2 to 4 minutes, the second rise, can be maintained for 4 hours. This two-phase model is based on the secretion of human pituitary LH pools there are two theories, the first pool in the immediate release of LHRH stimulation of LH, while the second pool to be in large or longer-term stimulation of LHRH release before the new storage synthesis of LH. Intravenous drip method can distinguish between hypothalamic or pituitary disease, if the cause of the hypothalamus and pituitary gland caused by inertia, the single LHRH test may be negative, but intravenous infusion method in 2 hours after the delayed response; if there are defects in pituitary function , LH, although the first time may have increased, but not maintain, and continue to intravenous infusion, a second time is no longer rising, suggesting that the function of pituitary LH synthesis is limited.
iv diagnosis of the above steps for the early diagnosis to treatment, a fashion clues to the cause of the lack of patients with amenorrhea. Clinically, sometimes by history and physical examination, the pathogen can be found amenorrhea clues, then according to the condition of patients, the diagnosis of direct use of special measures to confirm the diagnosis. Commonly used diagnosis methods are as follows:
(a) diagnostic curettage This law applies to married women. reproductive tract for suspected tuberculosis, or amenorrhea occurred in patients with post-abortion by curettage can understand the size of the uterine cavity, cervical or uterine cavity without adhesions. Scrapings for endometrial biopsy, hormone secretion indirectly understand the situation, and the diagnosis of endometrial tuberculosis.
(c) of the peripheral blood of primary amenorrhea chromosome, chromosome peripheral blood should be routinely checked, in particular, short stature, developmental delay, not developed breasts or genitalia malformations who should check the karyotype, in order to identify the causes of amenorrhea.
(d) of the sella and more complaints to the fault radiography combined lactation amenorrhea patients should be more to the faults sella radiography. sella and more can be found in the fault-ray film 3 ~ 10mm size of micro-adenoma, showing the bottom side of the protruding anterior sella and sellar floor in front of or behind the erosion.
(f) of steroid hormones were measured by radioimmunoassay in the first step in the diagnosis of amenorrhea, estrogen levels required for a preliminary estimate. Measured by radioimmunoassay of steroid hormones in the blood can provide the diagnosis of the cause of amenorrhea, such as low serum E2, fsh abnormal increase when combined, suggesting that ovarian failure; often suggestive of blood testosterone increased symptoms of polycystic ovary group, or secretion of male hormonal tumors may exist; with amenorrhea Y chromosome may also have increased serum testosterone phenomenon.
(g) to consider menopause and thyroid function test abnormalities of thyroid function when iodine absorption test should be carried out and T3, T4 determination. Some patients with hyperprolactinemia may be due to primary hypothyroidism caused.
amenorrhea is a common gynecological diseases. Chinese medicine is due to kidney deficiency, blood deficiency, blood loss due to pass. There is actual situation of the points, were more a result of the virtual lack of blood and kidney, were more real by the Hanning, qi stagnation and blood stasis. Treatment, due to lack of blood should be replenishing qi and blood; need for kidney tonic roadway; due to Hanning need to warm and cold; need for liver qi stagnation; need blood circulation due to blood stasis. Symptoms can be implemented according to different syndrome differentiation soup. Choice of the following therapeutic side:
(1) peach cattle blood soup. peach kernel 10 grams to 12 grams of fresh bovine blood (blood is clotting) 200 grams of salt a little. Cut the cattle blood, add water and peach soup, add a little salt when seasoning food. blood circulation with Po Yu, management of blood circulation, skin color effect benefits. For amenorrhea, dryness, constipation embolism.
(2) fungus walnut sugar. black fungus 120 g, 120 g walnuts, brown sugar, 200 grams, amount of rice wine. The fungus, walnuts grind the end, add brown sugar mixture evenly, porcelain cans sealed. Per serving 30 grams, 1 to 2 times, until the menstrual cramps. With aids liver and kidney, blood, raising the effectiveness of Chong and Ren. For uterine hypoplasia of amenorrhea.
(3) Wudou double-TANG. Wudou (black beans) 50 grams -100 grams, safflower 5 grams brown sugar 30 grams to 50 grams. Will be placed in front 2 taste the steaming pot, add water, ranch to Wudou cooked to safflower, release the brown sugar and mix thoroughly. With nourishing liver and kidney, blood passing through, beauty UFA effect. For blood deficiency qi stagnation amenorrhea.
(4) turtle pig meat. turtle (turtle) 1, 500 g pork, rice wine appropriate. Slaughter of live turtle to head, feet, blood, washed into the casserole, add pork, plus the amount of water, first with high heat and boil, then simmer simmer until thoroughly cooked. In multiple eating, turtle should be valid only ate a few. Up blood, the raising of Chong and Ren. For Chong and ren (uterine hypoplasia), blood deficiency amenorrhea.
(5) pigeon ginger porridge. pigeon 150 grams, the end of 20 g ginger, pork last 50 grams, 100 grams of rice, pepper the end of 1 gram, cooking wine 10 grams of sesame oil, salt, monosodium glutamate. The pigeon net spur to cut into bowl, add pork, ginger at the end, wine and salt, mix well spare. Panning clean pot add water 1000 ml, boiled into a pigeon, a total of congee, when transferred to sesame oil, MSG, and pepper can. With kidney qi, Qufeng detoxification, and blood Wyatt color effect. For blood deficiency amenorrhea purposes.
(6) Izume Kwai stems fried. pig 250 grams of sunflower stems 10 grams. First Izume wash, scrape off the dirt into the casserole, stew overripe with slow fire, add sunflower stems, boil boiled gravy, to the residue, drink juice. Serving 2-3 times daily, per 20 ml -30 ml. With the blood circulation of qi stasis effect. For blood stasis type of amenorrhea.
(7) mushrooms, bamboo shoots squid porridge. Dried squid 1, water, mushrooms, bamboo shoots 50 grams of pork, 100 grams of rice, pepper, 1 g, cooking wine 10 grams, salt, monosodium glutamate. Boneless dried cuttlefish, swollen with warm water, wash, cut into filaments; pork, mushrooms, bamboo shoots were also cut wire back. Panning clean pot, add pork, squid, mushrooms, bamboo shoots, wine Aozhi Shulan, last Sprinkle the salt, monosodium glutamate and pepper can. There are replenishing essence, through the transfer period, the convergence of bleeding, skin beauty effect. For amenorrhea, vaginal discharge, minimalist looking embolism.
(8) coix fried. coix Seed, coix root of 30 grams. coix Seed, coix root segments decoction to drink juice residue. Sooner or later, fasting drink, once more than 10 agents. With the benefit of cloud wet, blood lead down effect. Drinking water for phlegm cells by blocking the amenorrhea.
(9) ginger and fried squid. 50 grams of ginger, boneless squid 250 grams. shredded ginger, squid slices, fry oil, meal. And with the blood pass through with a cosmetic effect. Of blood deficiency amenorrhea role of adjuvant therapy.
(10) turtle stew pigeons. turtle 30 grams, pigeon one, a little rice wine. The turtle crack, net of pigeons placed in treatment of intra-abdominal, add some water, a little rice wine, put tile cup ranch cooked, seasoning food. With kidney Qi, Sanjie pass through, ze skin beauty effect. Applicable due to physical weakness caused by amenorrhea.
(11) achyranthes stewed trotters. cyathula 15 grams, pig 2, rice wine 80 ml. Trotters scrape to the hair. Cut open on both sides, cut into several small pieces, put together with achyranthes large steaming pot, add 500 ml of water, ranch to trotters Shulan, to bidentata, pig meat and remaining soup consumption. With promoting blood circulation and skin effect. qi stagnation type for women, amenorrhea.
the information for reference only, please consult the relevant details of doctors.
(2) empirical amenorrhea who diet should be light and easy to digest, eat with the blood pass through the role of food, such as hawthorn, rape, black beans, black mushrooms, squid, orange, orange cake.
amenorrhea is best not to eat those foods?
(3) fatty food
such as preserved eggs, yellow, egg yellow, yellow duck, pig brain, liver, kidney, lard, pork fat, pig intestines, pig heart, lamb, goat, carp, squid, chicken, turtle, black carp, grass carp, shrimp, octopus, clams child, crab, cream, chocolate and so on. These foods are high protein, cholesterol, fat, eat more easily after the body cause excess nutrients, further increase fat accumulation, increased obesity, blocked meridians, so that blood can not function properly, it should be minimal food or not eat.
amenorrhea should be how to prevent?
period is affected by the hypothalamus - pituitary - ovarian axis hormone under the control of the axis of any one link in the chain will affect the normal menstrual cramps. The axis of the feature by many external factors, such as the environment changes, the conversion of seasonal mood changes, etc., can obviously cause abnormal menstruation, as well as amenorrhea.
Prognosis: prognosis is good.
1, after a few months or can be developed for the late period of amenorrhea, and actively heal after a few months or later, can reduce the incidence of amenorrhea.
2, a clear cause and location of amenorrhea, the treatment effect and prognosis of amenorrhea have a certain reference value. As hypothalamic amenorrhea, by psychological factors, environmental changes, malnutrition and other causes, drug treatment better prognosis. Another example of the uterus caused by mycobacterium tuberculosis amenorrhea, endometriosis has been destroyed, were less likely to restore menstruation. Another example is the use of progesterone test positive (after the energy transfer through the use of progesterone), the prognosis is good.
3, amenorrhea with infertility due to families, individuals and the surrounding environment and mental depression, clinical examination and laboratory tests was normal, drug treatment for these patients while in the spirit of comfort and encouragement, when the cerebral cortex disinhibition, and endocrine function returned to normal pregnancy. Have adopted a child, the patient soon pregnancy, which is a common example of.
5, the current weight-loss drugs a large number of women, some women resulting amenorrhea, but also because of obesity and diet, leading to anorexia and amenorrhea, as well as multiple flow surgery and amenorrhea, amenorrhea is more than can be prevented, some drugs must be taken under the guidance of doctors, to prevent their adverse reactions.
6, intractable amenorrhea alone those in poor Chinese or western medicine combined with western medicine can be used in the treatment cycle, to be gradually reduced after the onset of the dose medicine, Chinese medicine treatment eventually.[Treat]
prevention: family planning, to minimize uterine surgery, can prevent amenorrhea. amenorrhea relationship with impassioned internal injuries close, should regulate emotions. correctly handle the production process, to prevent intrapartum, postpartum hemorrhage. in the event of bleeding, blood transfusion should be rescued in time to prevent Sheehan's syndrome, the occurrence of Xueku amenorrhea.
main point: the long and strong.
amenorrhea should be how?
1. vaginal cytology is more commonly used methods to understand the level of estrogen. Cotton stick soaked with saline after taking the upper vaginal wall of exfoliated cells, coated on a glass slide, fixed and stained to observe the table, the percentage of cells in the bottom layers. The higher the percentage of superficial cells, reflecting the higher estrogen levels.
2. amenorrhea in patients with cervical mucus cervical mucus is found as a transparent, pull a good thin mucus, coated on glass can be seen under the microscope after drying fern crystals, indicating that The patient has ovarian secretion of estrogen function.
3. drug test is commonly used in clinical diagnostic tests for amenorrhea, especially in the absence of hormone determination of laboratory equipment, drug testing for evaluation of ovarian function and uterine endometrial function has an important help.
amenorrhea diseases easily confused?
amenorrhea may be caused by the diseases?
trophoblastic tumor, ovarian dysgerminoma cervical infertility Giant prolactinoma pituitary tumor function of hypothyroidism disease tuberculosis skull ring tube sex cord ovarian tumors anovulatory dysfunctional uterine bleeding, ovarian dysfunction syndrome prolactinoma persistent ectopic pregnancy, cervical pregnancy, dysfunctional uterine bleeding endometrial disease gland follicular cell proliferation syndrome in tuberculosis in children with congenital adrenal hyperplasia endometrial hyperplasia in children with anorexia nervosa aged pituitary tumor pituitary ovarian menstruation gender neuroblastoma tuberculous cervicitis intracranial chordoma tubal pregnancy, tubal climacteric syndrome tuberculosis amenorrhea headache dub abdominal pregnancy uterine prolapse imperforate hymen ovarian granulosa cell tumor theca cell tumor testicular feminization molar pregnancy with premature ovarian failure Cushing's disease Cushing's syndrome, uterine abnormalities of ovarian cysts syndrome, pituitary gland hypothalamus dried blood tuberculosis functional tumor hypothalamic amenorrhea gigantism and acromegaly
intrauterine fractures candida albicans vaginal discharge increased vaginal discharge amenorrhea amenorrhea - galactorrhea - not sterile three flat pelvis, incomplete abortion ovulation flat narrow birth canal birth canal birth canal laceration, hematoma, postpartum hemorrhage postpartum lochia without a net is no longer menstrual cramps rotten postpartum uterus abnormal contraction of productivity lochia postpartum puerperal infection long-term pelvic pain
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