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Amenorrhea

Amenorrhea is the absence of menstruation for 3 months with a previously irregular cycle and 6 months with a previously regular cycle.

For the examination of this diagnosis, there is a clear protocol and adherence to it, allows you to make a diagnosis with 97% accuracy.

Classifications of amenorrhea today

First option:

Primary amenorrhea is the absence of menstruation before the age of 16 (that is, it never happened) and secondary – the cessation of menstruation for three months (yes, three, according to foreign classification, with a previously irregular cycle) and more in women of reproductive age with a previously established menstrual cycle.

The second classification, more modern, 2011, according to WHO:

Amenorrhea is classified into categories:

I – Hypogonadotropic hypogonadism (damage to the hypothalamic-pituitary axis)

II – Normogonadotropic normoprolactinemic hypogonadism

(chr.anovulation, etc.)

III – Hypergonadotropic hypogonadism (ovarian damage)

IV – Amenorrhea against the background of a violation of the structure of the uterus and vagina

V – Hyperprolactinemic hypogonadism due to tumor – prolactinoma

VI – Hyperprolactinemic hypogonadism, in the absence of prolactinoma

VII – Normogonadotropic normoprolatictinemic hypogonadism, due to a tumor (not prolactinoma).

I will not decipher the second classification, since there is a detailing of diseases behind it, and the doctor is engaged in this process!

What tests must be passed without fail in order to make a diagnosis.

Regardless of the day of the menstrual cycle (after all, there is no cycle):

FSH, LH, E2, prolactin, DHA-S, TSH, T4 free, Clinical blood test.

Ultrasound of the small pelvis (you need to know the development of the uterus, the thickness of the endometrium, the structure of the ovaries!)

Without an ultrasound of the small pelvis to the endocrinologist for an appointment with the issue of disrupting the cycle, it is useless to walk! An ultrasound scan helps determine the diagnosis and treatment.

The doctor can, for diagnostic purposes, conduct 2 hormonal tests (!) With Duphaston table. or Progesterone 1% and 2.5% IM, which is now used less often (called a gestagen test) and / or a test with Proginov + Dufaston or Femoston 2/10, less often COC (estrogen-gestagen test).

A study of the karyotype (set of sex chromosomes, in women it is 46XX) or other genetic studies may be required. More often it is a search for the syndrome of a fragile X chromosome, as the cause of premature ovarian failure, this is when the menstrual cycle can end before the age of 40, for example, one of my patients ended menses at the age of 18.

It is very important in the research process to focus on the level of E2 (estrogenization)

If E2 is more than 40 ng / ml or 150 pmol / l, and on ultrasound OMT of the endometrium is more than 6 mm, then the cause of amenorrhea is hr. violation of ovulation, more often it is polycystic ovary syndrome and hyperandrogenic syndrome (HCI)

If E2 is below 40ng / ml and the endometrium is less than 6 mm, then FSH and LH are most often reduced, then an MRI of the pituitary gland should be done and abnormalities at the level of the hypothalamic-pituitary axis should be looked for.

And rarely, when E2 is normal, and the endometrium is not developed, less than 6 mm, the Proginov + Duphaston test should be performed and endometrial pathology should be excluded!

In adolescents and young girls, amenorrhea often occurs with low-calorie diets and veganism, with a sharp weight loss of more than 5 kg per month or with weight loss, more than 10% of the ideal weight, which can be found out with an active conversation with the patient (but this is often hidden) … Anorexia nervosa is a vivid example of such a condition, you can suspect anorexia by two hormones: leptin and IGF1, with normal physical development and anorexia, they will be greatly reduced!

An increase in prolactin is not an uncommon cause of a cycle disorder, but it is easy to calculate. But with prolactin above 1000 IU / ml, MRI of the pituitary gland is always shown to look for a tumor. And in general about tumors: there are no cancers in the pituitary gland, these tumors are always benign. But at large sizes, they can be dangerous in the form of impairment or loss of vision, if they grow in the area of ​​the optic chiasm. Cancer is the greatest rarity in this organ !!! Indicators FSH and LH below 5.0 in violation of the cycle, and in the formula LH / FSH below 1 mIU / ml – are an indication for MRI of the pituitary gland.

For adolescents, the usual delayed sexual development is also characteristic (this is a full-fledged diagnosis), that is, when the pubertal period is protracted (from the onset of the first sexual characteristics: the growth of m / glands and the appearance of pubic hair until menses takes more than 5-6 years, when this is normal the term takes 3.5-4 years). More often it is caused by any concomitant pathology, but often it also has a hereditary nature – in the form of a slowdown in sexual development in parents.

Treatment for amenorrhea is determined on a case-by-case basis!

And this is not always hormone therapy https://en.wikipedia.org/wiki/Hormone_therapy, which is good news 🙂

Therefore, one should not strive to accept KOC, more often it is possible to do without this “heavy artillery”. This is especially important for girls under 20. I would not rush to take COCs (oral contraceptives)!