Anyone who has reached the age of 18 and has not yet had a menstrual cycle is called primary amenorrhea; it is mostly caused by congenital anomalies, including abnormal ovarian or uterine development.
After the menstrual cycle is established, those who have no menstruation for more than 6 consecutive months are called secondary amenorrhea, which is mostly caused by secondary diseases.
Primary amenorrhea
Internationally, primary amenorrhea is defined as the absence of menstruation at the age of 14 and the absence of secondary sexual characteristics, or the absence of menstruation at the age of 16, regardless of whether the secondary sexual characteristics are normal. Usually, menstruation occurs two years after the development of secondary sexual characteristics.
The etiology of primary amenorrhea is classified as
Internal and external genital anatomical abnormalities
(1) Hymenal atresia: often found in adolescence with periodic abdominal pain and also lower abdominal mass due to accumulation of blood in the vaginal cavity of the uterus.
(2) Congenital absence of vagina. The ovaries are normal, if combined with congenital absence of uterus or traces of uterus
congenital anomaly of the female genital tract syndrome
(3) congenital absence of uterus.
(4) Hypothyroidism: Hypothyroidism in adolescence causes slow metabolism, slow maturation of the gonadal axis, and delayed menstruation. Early onset hypothyroidism can be combined with gonadal insufficiency, resulting in a poor prognosis.
(5) Hyperprolactinemia: Prolactin PRL>30-40ng/ml, may be accompanied by overflow of milk, pituitary macroadenoma or microadenoma or empty saddle, or prolactin-secreting cell hyperplasia of pituitary gland.
High PRL suppresses GnRH and FSH, causing amenorrhea due to low estrogen, and primary amenorrhea due to puberty.
Other
(1) Inflammation: juvenile meningitis, sequelae of encephalitis, which affects hypothalamic secretion. Or tuberculous peritonitis pelvic organitis, causing endometrial tuberculosis, endometrial scarring, causing uterine primary amenorrhea.
(2) Injury: surgical removal of the uterus and both adnexa in juvenile malignant ovarian tumors, especially germ cell tumors, has a better prognosis and can survive, but for primary amenorrhea without uterus and ovaries. Radiation therapy causes damage to the pituitary gland and ovaries.
(3) Nutritional: Very poor nutrition can cause amenorrhea, due to poor development.
Secondary amenorrhea
Common causes include endometrial damage or adhesions (commonly caused by multiple scrapings and excessive scrapings that damage the endometrium and cause adhesions in the uterine cavity) and tuberculous endometritis, premature ovarian failure and polycystic ovaries, functional ovarian tumors, environmental changes, external factors such as trauma and malnutrition, amenorrhea and lactation syndrome, Sheehan’s syndrome (due to postpartum hemorrhage, shock-induced ischemia and necrosis of anterior pituitary tissue), hypopituitarism and amenorrhea. (due to postpartum hemorrhage, shock caused by ischemia and necrosis of anterior pituitary tissue, hypopituitarism and amenorrhea).
In recent years, the incidence of polycystic ovary syndrome has increased, which is also a female endocrine disorder that can lead to sporadic menstruation and even amenorrhea. The exact cause is not known, but it is generally associated with hyperandrogenism and insulin resistance, leading to anovulation or sporadic ovulation. Patients tend to have obesity, facial acne, hirsutism, and polycystic ovarian echogenicity on ultrasound. The dangers are that the immediate complications are infertility, scanty menstruation and excessive menstruation, and in the long term, it is associated with type 2 diabetes and endometrial cancer. This disease requires long-term treatment.
What to do with secondary amenorrhea
When secondary amenorrhea occurs, the cause of amenorrhea should be promptly investigated in the hospital based on medical history, physical examination, relevant auxiliary tests and hormone measurements. Treatment should be tailored to each cause. In some patients, menstruation can be restored spontaneously after physical and psychological adjustment or discontinuation of birth control pills, while in others it can be restored after progesterone, artificial cycles and ovulation treatment. In some cases, progesterone, artificial cycles and ovulation treatment may be used.