Violation monthly rate : amenorrhea
Endocrinology / / April 22, 2016
dysrhythmia monthly by type hypomenstrual syndrome can manifest itself in the form of a complete cessation of menses - amenorrhea, and as a rare monthly with the interval between krovootdeleniyami from 4 weeks to several months (opsomenoreya), and shortening the intervals between krovootdeleniyami (polimenoreya).
Amenorrhea Amenorrhea can occur as a physiological condition during pregnancy, lactation and after menopause.
To distinguish primary amenorrhea, when menstruation was never in my life, and secondary if monthly stopped after a number of years or months of their normal flow.
severity amenorrhea is divided into light, or amenorrhea I level, and heavy, or amenorrhea II degree.
Causes of amenorrhea can be very diverse: acute infectious processes and chronic debilitating diseases, severe intoxication, nutritional causes (starvation), diseases of organs and systems, endocrine disorders, some neuro-psychiatric disorders and psychological trauma, congenital anomalies (congenital virilizing hyper
Thus, the causes of amenorrhea is very diverse, and the mechanism that makes the menstrual cycle, reduced or hormonal dysregulation processes, either to a primary disturbance of trophism of the uterus (myometrium and endometrium).
Pathologic pattern observed in amenorrhea in the uterus, determined by the degree of hormonal activity of the ovaries.
In severe cases, with deep lesions ovarian parenchyma can occur processes of ovarian tissue fibrosis, a sharp decrease in the number of follicles, the absence of maturing follicles at any stage of maturation.The absence of estrogen results in products in such cases a sharp decrease in size of the uterus, endometrial atrophy: endometrial functional layer is absent, basal - undergoes fibrosis.Vaginal flattened part of the uterus and shortens the vagina is narrowed, flattened arches, mucous smoothed out.
In mild cases of amenorrhea, changes in the ovarian parenchyma absent.The eggs undergo maturation processes periodically, but ovulation does not occur due to the atresia follicles.In such cases the ovaries rich growing follicles and ripening and atresial follicles.In some cases there is cystic follicles.The uterus may have a normal amount or somewhat reduced in size.Depending on the amount of estrogen produced by the ripening follicles proliferative endometrium undergoes changes.If estrogen production is small, the endometrium may be able to atrophy.
clinical picture with amenorrhea depends on the extent of ovarian insufficiency.Severe lesions in the absence of ovarian follicular maturation and estrogen production are accompanied by severe degrees of atrophy of the genital tract.The development of secondary sexual characteristics is dependent on when the operation occurred damaging factors.If it took place before puberty, there are marked physical signs of infantilism.
case of violation of the central regulation mechanisms can not be any anatomical abnormalities of the reproductive organs.
With this type of amenorrhea products and release of pituitary gonadotropins sharply reduced, so that in the urine, they are not detected.Isolation of estrogen is also very low, as in postmenopausal women (6-10 mg / 24 h).This dramatic inhibition of pituitary function may be due to the inhibitory influences of the cerebral cortex in the hypothalamic centers responsible for the regulation of gonadotropic pituitary function.Such forms of amenorrhea observed in psychogenic amenorrhea.For example, according with psychogenic amenorrhea wartime experience low urinary excretion of both gonadotropins and estrogen, which is then replaced by their cyclical release.There hypogonadotropic amenorrhea at psychotraumas to 34-44%.
Furthermore, hypogonadotropic amenorrhoea could be due to the direct damage hypothalamic centers (such as inflammatory processes, diseases Simmonds kraniofaringeome, hydrocephalus et al.), When damaged the hypophysis (pituitary tumors).However, the violation of the hypothalamic regulation of pituitary function is not always reduced only to a complete cessation of the production of gonadotropins.Many authors have observed that in most cases a normal level is stored amenorrhea gonadotropin release urine.But it is broken into a cyclical production of gonadotropin - their level is monotonous, there are no fluctuations in the ratio of FSH and LH, which is typical of a normal cycle.Many women with amenorrhea release of estrogen is maintained at a level typical for the beginning of the normal proliferative phase of the cycle -. An average of 24 micrograms / 24 hours, but due to the absence of the cyclic release of gonadotropins ovulation does not occur, there is no ovulation and peaks in the excretion of estrogen.The corpus luteum is not formed, as evidenced by the consistently low level of excretion pregnandiol.
Violations gonadotrophic pituitary function, leading ultimately to a violation of cycle or complete amenorrhea, may also be due to endocrine disorders correlations.So, when overproduction of androgens (eg, congenital virilizing adrenal hyperplasia) amenorrhea in women is accompanied by adequate production of gonadotropins, but the cyclic release of gonadotropins suppressed and ovulation does not occur.
case of insufficient thyroid function developing amenorrhea is a consequence of the suppression of pituitary LH release.
- Menopause (Menopause) and diseases of menopause in women
- Pathology of menopause (menopause).Climacteric neurosis
- diagnosis and treatment of climacteric neurosis
- menstrual cycle Hormonal disorders
- menstrual cycle Use of estrogen for the treatment of climacteric neurosis
- The use of androgens in the treatment of climacteric neurosis
- ovarian hormones.Estrogens
- ovarian anatomy
- ovarian hormones.Androgens
- tests of functional diagnostics activities ovarian
amenorrhea due to insufficient ovarian function
ovarian failure may be primary (due to malformations), and can occur secondarily influenced by a numberreasons.
sharp decline of ovarian function is accompanied by a significant decrease in estrogen excretion (6-8 mg / 24 h), high levels of gonadotropins (100 or more mouse-uterine units per day).
chronic psychological trauma in 23% of cases lead to amenorrhea with increased production of gonadotropins and low estrogen production, ie. E. The primary decrease in ovarian function.
lowering ovarian function due to what is happening in their disease process, may be accompanied by varying degrees of refractory ovaries to gonadotropic stimulation.These forms of amenorrhea accompanied by normal levels of gonadotropins excretion in the urine with the preservation of their cyclical release.Ovaries are responsible only produce a certain amount of estrogen is not reached, however, the values of the normal cycle (21 mg per day), and ovulation does not occur.Isolation pregnandiol is kept low, basal temperature - monophasic.
amenorrhea flowing with partial refractory ovarian in primary pathological process in the ovaries, is clinically very difficult to differentiate from amenorrhea due to some, but not complete suppression of pituitary function, since the nature of the excretion of hormones and their metabolites are very close to each other.The difference is in response to treatment with gonadotropins.In the primary, even a relatively small decrease in ovarian function gonadotropic drug therapy does not succeed, and with amenorrhea due to violation of pituitary gonadotropins treatment can be successful.