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Disturbances of menstrual function (amenorrhea)
September 25, 2012
The accurate menstrual cycle meaning regularly repeating changes of physiological character is characteristic of a female organism. These changes are regulated by so-called pyatizvenyevy system (it is a cerebral cortex — a hypothalamus — a hypophysis — ovaries — a uterus). The menstrual cycle comes to an end with the beginning of periods. Determining duration of a monthly cycle, consider the first day of the last periods, counting days prior to the beginning of following. Generally average duration of a menstrual cycle at women at reproductive age makes 28 days. However, the cycle can fluctuate, making from 21 to 35 days. The periods to last from 3 to 7 days, and during this time the woman loses up to 150 ml of blood.
Disturbances of a monthly cycle
If at the woman certain deviations from the features of a cycle described above are observed, then in this case disturbances of menstrual function are shown. Specialists define two groups of similar disturbances: hypomenstrual molimina and hyper menstrual molimina. Similar disturbances arise under the influence of many factors. It, first of all, diseases and disturbances of mental character, strong emotional shocks, neurologic diseases, obesity, diseases of infectious character, cardiovascular illnesses, influence of professional factors. Disturbances of menstrual function are also possible as an effect of genetic diseases, a hormonal imbalance, gynecologic operations and some other factors. It is sometimes combined several reasons provoking disturbances of monthly.
Types of an amenorrhea
The concept "amenorrhea" is used for definition of a condition of the woman, a day nursery at her monthly is absent for six and more months. In most cases the amenorrhea is not defined as the independent diagnosis, and is a symptom of some diseases.
Distinguish several types of an amenorrhea which are defined depending on factors which influence its development. The physiological amenorrhea is shown prior to puberty of the girl, during pregnancy, during feeding by a breast, and also during a menstrual pause. A physiological amenorrhea – the natural state which is not an illness. A pathological amenorrhea – an effect of some diseases developing at the woman.
Besides, it is accepted to define primary amenorrhea (in this case periods do not appear at the girl aged till 16 flyings), and also a secondary amenorrhea (periods appeared, but stopped under the influence of certain factors). The doctor considers existence of a pathological amenorrhea as rather alarming sign which testifies to a course of a disease or certain organic or functional disturbances in a female organism. The pathological amenorrhea can be shown at women at any age.
Also false and true amenorrhea is defined. In case of a false amenorrhea in an organism of the patient changes in balance of hormones which are characteristic of a normal monthly cycle are observed. However owing to existence of certain mechanical obstacles blood cannot be emitted normally outside. Similar pathology can arise at an atresia (that is fusion of a hymen or a vagina). Sometimes the false amenorrhea is shown at the women having congenital anomalies in a structure of generative organs.
The true amenorrhea is diagnosed if the patient has no cyclic hormonal fluctuations. Therefore, in a female organism there is no ovulation, and the patient cannot become pregnant.
Primary amenorrhea at the woman can develop under the influence of disturbances of genetic character, chromosomal anomalies, a sexual underdevelopment. Sometimes such state arises at the women sick with serious infectious diseases, and also at the patients having obesity owing to disturbance of functions of a hypophysis. Development of a secondary amenorrhea is influenced by psychogenic factors, the wrong food allowance, strong exhaustion and overfatigue of both physical, and intellectual nature, disturbance of endocrine character, a tumor and inflammatory processes in generative organs.
Frequency of primary amenorrhea rather low, however, such pathology – a serious reason for the address to the specialist.
Doctors allocate several types of the reasons of an amenorrhea. The anatomic reasons of an amenorrhea are defined at the girls having thin type of a structure of a body, an undeveloped breast, a narrow basin. In this case the periods are absent because of a bradygenesis of an organism of the girl. But if similar external anomalies of development are not observed, then pathology of development of generative organs can be the cause of lack of periods. Most often the amenorrhea is shown owing to an abnormal structure of a hymen. The gynecologist at survey can define such deviations.
Sometimes in the course of survey and poll of the patient who complains of lack of periods the doctor defines that at her relatives on the female line the first periods came at rather late age – in 17 years and later. The similar situation demonstrates existence of genetic factors which influence a menstrual cycle.
But in recent years specialists demonstrate that in most cases lack of periods is caused by other reasons. It is about a severe stress, serious shocks of emotional and psychological character. About a third of girls (and at what the periods did not begin yet and girls with the settled cycle) quite so react to stressful situations. At part of patients the cycle is recovered also without additional drug treatment after a while. But on condition of existence of chronic diseases therapy by medicines often is required.
Except the specified factors strong and constant exercise stresses, and also anorexia can be a cause of infringement of menstrual function at women. Therefore doctors strongly recommend all girls not to be overzealous, choosing for themselves methods of sports trainings and keeping to diets. To young girls strength sports can significantly do much harm. However not less notable harm is done by defective food when the organism does not receive the necessary substances with the consumed products.
The secondary amenorrhea is a state at which periods are absent for six and more months at those women whose menstrual cycle was rather settled earlier. If to consider data of medical statistics, then from secondary amenorrheas about 10% of women of childbearing age suffer. The secondary amenorrhea is considered more serious condition, than primary form of an illness.
Doctors also allocate the specific reasons of an amenorrhea of this type. So, the termination of periods can provoke sharp weight reduction at the woman or constant strong exercise stresses. The factor causing a secondary amenorrhea is the polycystosis of ovaries. Periods can stop at women with existence of some pathologies of a uterus, as a result of gipotalamo-pituitary disturbances, as a result of diseases of a thyroid gland, adrenal glands, at tuberculosis. Sometimes the amenorrhea is an effect of reception of some medicines or carrying out chemotherapy, radiation therapy. Besides, this form of an amenorrhea arises at a premature menopause, a giperprolaktinemiya.
Diagnosis of an amenorrhea
If the patient comes to the doctor with complaints to suddenly stopped periods, then the doctor, first of all, conducts survey and survey of the patient. In the course of conversation with the woman the specialist has to find out some features of her life surely. In particular, it is important to learn about whether the patient of a certain diet adheres, how often she plays sports whether serious exercise stresses, constant stresses take place. It is also important to find out, the ratio of weight and growth of the woman is how proportional and whether she has obesity. Rather often the amenorrhea is shown as an effect of obesity or dystrophy as in such state at the woman serious hormonal failures often develop.
After primary survey and a survey was carried out, the woman passes more detailed researches for the purpose of establishment of the exact reasons of an amenorrhea. It is important to exclude initially pregnancy at the woman then the analysis on the content of hormones in blood, ultrasonic research of bodies of a small pelvis is made. In the course of diagnosis of an amenorrhea the doctor considers many different data: rectal temperature, results of cytologic research of a vulval smear, research on existence in urine and blood of gonadotrophins, etc. After establishment of the diagnosis the doctor appoints therapy, considering individual characteristics of an organism of the woman.
Treatment of an amenorrhea
If the diagnosis is established, the specialist appoints to the patient treatment of an amenorrhea, doing it so that to consider all origins of this state. If the arrest of development of genital system in general is found in the patient, then she is recommended to pay attention to a diet surely. It is necessary to keep some time to a diet which will allow to increase the volume of both fatty, and muscular tissue. The course of treatment hormonal means as hormones are capable to stimulate development of women's reproductive system and to accelerate approach of the first monthly is also possible. But it is important that throughout the entire period of treatment the condition of the patient was constantly controlled by the specialist.
If the amenorrhea arose at the woman as an effect of certain features of an anatomic structure of generative organs, then in that case to the patient the surgery is performed. By means of the special tool the surgeon makes a cut of a vagina or a hymen if fusion of channels takes place. Such operation takes place very quickly, at the same time it is possible to carry out it even without the general anesthesia.
Development of primary amenorrhea can happen as an effect of gipotalamo-pituitary insufficiency, and also the insufficiency of ovaries caused by an infection, negative external impacts, disturbances of autoimmune character.
If the amenorrhea arose at the patient because of certain features of way of life, then initially it is necessary to define what became the reason of a similar state. So, the sharp degrowth of a body can provoke an amenorrhea (more, than to 10 kg). Also lack of periods is more often observed at adult women whose weight does not exceed 50 kg. If the amenorrhea is diagnosed for the patient, then she can keep to a diet further only under a constant control of the attending physician. For recovery of a monthly cycle in that case the doctor also appoints to the woman reception of progestagenny oral contraceptives.
Very often now girls at whom periods stopped owing to anorexia see a doctor. Sharp loss of appetite is characteristic of such state. As a rule, the young girls wishing to grow thin at any cost have anorexia. Such patients tell the doctor that they purposefully caused vomiting, refused food, accepted constantly laxative drugs. As a result at such girls a number of serious deviations of mental and physical character among which a specific place is held by an amenorrhea develops.
At treatment of the amenorrhea caused by anorexia, the gynecologist sometimes recommends to the girl to consult also at the psychologist. Besides, in this case full support from close people is important.
At treatment of an amenorrhea which was provoked by a polycystosis of ovaries the patient will begin reception of some oral contraceptives which are selected only in an individual order after carrying out all necessary researches. It is important to determine precisely the level of content of testosterone and estrogen in the woman's blood. The doctor at selection of necessary kontratseprtiv is guided by these data.
If the amenorrhea arises as an effect of a premature menopause, then the speech in this case goes about insufficient function of ovaries. As a result, periods stop at the women who hardly reached forty-year age. Except an amenorrhea such patients state complaints to strong dryness of a vagina. At such pathology especially often the amenorrhea is shown at the women who are constantly staying in a condition of a stress. Treatment of an amenorrhea in that case assumes long hormonal replacement therapy. It is important to note that pregnancy in a similar situation can come only on condition of use of an ovum of the donor.
The amenorrhea owing to a giperprolaktinemiya occurs under the influence of too high content in prolactin hormone blood. In that case the woman periodically has molokoobrazny allocations from mammary glands. At the same time monthly can stop completely. Means which allow to reduce the content of prolactin in the woman's organism are applied to treatment of this morbid condition. At reception of such drugs some women can feel periodic nausea, however other side effects are not observed. Treatment by hormonal drugs should be combined with physiotherapeutic treatment always.
The secondary amenorrhea is a state which will respond to treatment therefore follows, without postponing, to ask for medical assistance.
Speaking about a lactic amenorrhea, specialists mean feeding use by a breast as contraception method. This method of protection from undesirable pregnancy is based that in the course of active chest feeding at young mother the ovulation does not occur. However the similar method of protection works only in the first half of the year after the delivery. At the same time it is necessary to meet a number of conditions — to constantly raise the kid breast milk according to its requirement, to nurse the child and at night. However it is necessary to remember that such protection against pregnancy is always short-term, besides without additional methods of contraception there is a high risk of infection with venereal diseases and other infections.
Complications of an amenorrhea
If the amenorrhea does not respond to diagnosis and the correct treatment in time, at the woman serious complications can develop. So, at a long amenorrhea developing of a terrible disease — osteoporosis is possible. Besides, at the woman the symptoms characteristic of a climacteric can gradually develop.
Treatment of an amenorrhea by national methods
In certain cases also treatment of an amenorrhea folk remedies can be effective. However it is very important not to practice such therapy without preliminary agreement with the doctor. In order that treatment by means of these methods yielded positive result, it is necessary to know precisely what reason provoked emergence of an amenorrhea. For treatment of an amenorrhea it is possible to use broths of some herbs and plants. The good effect can be gained, using several weeks in a row broth of leaves of stone bramble. It is necessary to drink broth before food, twice a day.
Once a day the woman can be syringed by freshly squeezed juice of a white cabbage. It is the best of all to make procedure before going to bed. It is possible to prepare a tray for legs, having added to hot water on two tablespoons of vinegar, sea salt, and mustard powder. Trays lasting 20 minutes are accepted in the morning and in the evening.
Traditional medicine recommends to apply carnation broth also. For its preparation on 1 l of water it is necessary to take 40 inflorescences of a carnation. Mix needs to be cooked until then. So far a half of liquid will not evaporate. Initially broth is accepted small doses – three times a day on one tablespoon. Later the dose can be increased.
At an amenorrhea it is possible to accept also broth of an onions peel. It can be prepared, having boiled the peel which is filled in with water on slow fire until it does not become dark color. Drink broth twice a day before food on one glass.
It is possible to try also treatment by the tampons impregnated with camomile oil or juice of a dogrose. Such tampons are put in a vagina for the night.
Prevention of an amenorrhea
It is difficult to prevent emergence of an amenorrhea, however if the girl carefully traces a state of health and does not allow addictions, the chance to ache considerably decreases. It is important to provide the correct treatment of all diseases and not to ignore the symptoms testimonial of development of female diseases at all.
Section: And Gynecology