Amenorrhea is when menstruation never occurs or stops abnormally. Physiological amenorrhea refers to the absence of menstruation before puberty, during pregnancy, during lactation and after menopause. There are two types of pathological amenorrhea: primary amenorrhea and secondary amenorrhea. Primary amenorrhea refers to the absence of menstruation in women older than 16 years of age or older than 14 years of age, and the absence of secondary sexual characteristics (e.g., breast development, appearance of axillary and pubic hair). Secondary amenorrhea refers to the cessation of menstruation for 6 months after the establishment of normal menstruation, or for more than 3 cycles according to one’s original menstrual cycle.
Etiology of primary amenorrhea Chromosomal abnormalities; developmental malformations of the reproductive tract, etc. It should be noted that if it is one of the hermaphroditic abnormalities and there is cryptorchidism in the abdominal cavity, it should be detected and surgically removed in time, otherwise there is a possibility of cancer.
If a woman has had her first menstrual period and is sexually active, she can first rule out the possibility of pregnancy by herself. You can use a “pregnancy test” to monitor your urine. If you are not pregnant, then you should consider pathological secondary amenorrhea. You will need to go to the hospital.
The following tests can be performed in the clinic: (1) six hormone tests, including follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, progesterone, and prolactin; (2) thyroid function tests, usually TSH for the first time; (3) pelvic ultrasound.
The results of this set of tests are usually available 2-3 days later. Based on the results, the cause of amenorrhea is determined.
The causes of amenorrhea are classified according to the location of the lesion: (1) uterine amenorrhea; (2) ovarian amenorrhea; (3) pituitary amenorrhea; (4) hypothalamic amenorrhea. Alternatively, a “progesterone test” may be performed. If there is bleeding after progesterone, then there is a certain amount of estrogen in the body.
If there is no bleeding after progesterone, two conditions may be considered (again, pregnancy should be ruled out): (1) uterine pathology; (2) low estrogen levels in the body. The cause can be premature ovarian failure or central amenorrhea (lesions in the hypothalamus or pituitary gland); in patients without bleeding, the doctor will perform another “estrogen and progesterone test” and rule out uterine amenorrhea if there is bleeding after the medication; if there is still no bleeding, consider uterine amenorrhea. It may be endometrial tuberculosis, uterine adhesions, etc. Hysteroscopy, diagnostic endometrial curettage, hysterosalpingography, etc. can be done to find the cause.
One of the diseases, called polycystic ovary syndrome (PCOS), patients are mostly seen with sparse menstruation or even amenorrhea. This constant, acyclic, relatively high estrogen level in the body stimulates the endometrium without progesterone antagonism and can increase the incidence of endometrial and breast cancer.
Therefore, parents should pay attention to their daughters’ menarche, detect abnormalities and seek medical attention in a timely manner; patients with long-term secondary amenorrhea should draw their own attention and seek medical attention in a timely manner to avoid delaying treatment.