Amenorrhea is a condition of absence of menstrual periods in women or the presence of less than 9 menstrual cycles per year.
Professor Mordechai Goldenberg – expert in endoscopic surgery, Head of gynecological surgery, Chaim Sheba Hospital (Tel Hashomer), Head of Endoscopic surgery School
Primary Menopause is a condition in which a woman does not have a menstrual cycle before the age of 15 (with the presence of secondary sexual characteristics, such as breast growth or the appearance of axillary hair) or the absence of the cycle up to 13 years in the absence of secondary sexual characteristics.
Secondary Menopause is a condition in which a woman with irregular menstrual cycle is terminated for a period of at least six months.
Diagnosis of amenorrhea
Qualified specialists perform a physical examination and study history. The presence of budding breasts indicates exposure to estrogen.
In addition, conducted BHCG to avoid pregnancy (which may be the reason for the absence of menstruation). After a negative pregnancy test analysis of the hormonal profile, including the assessment of the level of FSH (follicle stimulating hormone) and prolactin.
In the normal level of the above hormones are very important to check the anatomical abnormalities, such as: absence of the uterus (Mullerian agenesis: Mayer-Rokitansky-Kuster-Hauser syndrome). This syndrome occurs during the formation of the uterus, fallopian tubes, cervix, and the two outer thirds of the vagina. This syndrome typically occurs in the absence of one kidney, urinary tract defects. Such women, even without a uterus, in the presence of the egg can still have a biological child through a surrogate mother.
Androgen insensitivity syndrome. From the point of view of the karyotype we are talking about a man who looks like a woman with the lack of male traits – without the development of the penis and scrotum, with external female genitalia, but with undescended testicles. This defect is 5% of the initial menopause. Formation begins breast occurs because of transition peripheral testosterone to estrogen. These women can not have biological children. In this case removal of the testes is also important to prevent the degeneration of a malignancy.
Anatomical issues. Imperforated hymen (a condition in which the membrane is completely closed) or transverse vaginal septum. In such cases women complain of pain each month and over time will create a pool of accumulated blood, which can not come out through the vagina.
High FSH levels. This is a problem in the ovaries that are not responsive to FSH and consequently the FSH indicates a positive feedback mechanism. If this is a secondary controller El, it may be early menopause and premature ovarian failure. The cause of this problem related to the function of the ovaries, and in this case women often have no secondary sexual characteristics since the ovary produces estrogen. There are several reasons:
Turner syndrome. This high level of prolactin, hyperprolactinemia in which creates problems in providing estrogen, resulting in serious damage to the hormone GnRH. Hyperprolactinemia violates a provision of GnRH, which causes hypogonadotropic hypogonadism condition. Hyperprolactinemia pituitary adenoma can be detected in approximately 50% of women. There is no direct relationship between the level of prolactin in the blood and the size of the adenoma. In the case of pituitary adenoma must be performed MRI and treatment.
Low levels of FSH. Menopause begins due to a problem in the hypothalamus (hypothalamic amenorrhea) if it starts before puberty. Thus there is a disturbance in the secretion of the hormone GnRH for various reasons: stress, extreme changes in weight, malnutrition (anorexia or Kallmann syndrome).
The enzymatic defect. Defect enzymes that produce estrogen and cholesterol, cortisol, may lead to the fact that estrogen and FSH levels will not be high due to the estrogen negative feedback on the pituitary.
The main causes of secondary menopause (menopause for six consecutive months) are the following reasons:
1. Polycystic ovarian syndrome
2. Menopause due to a problem in the hypothalamus (hypothalamic amenorrhea). If the problem begins after puberty it refers to the secondary menopause. There is a disturbance in the delivery of GnRH, for various reasons: stress, extreme changes in weight, malnutrition (anorexia).
3. Pregnancy after menopause
4. Menopause occurs gradually at the end of the fertile period.
Less common conditions include:
Failure of the ovaries due to the high level of FSH. This may be a result of chemotherapy and radiotherapy, which results in the destruction of the ovary, the situation with Turner syndrome, chromosome translocations and other chromosomal anomalies. When ovarian failure before the age of 40 years old women complain of hot flashes and cessation of the menstrual cycle. In some cases women with primary immune deficiency occur disorders such as diabetes, thyroid disease, and many others.
Asherman’s syndrome. As a result of adhesions of the uterus (after abortion, for example).
Other causes: chronic diseases (such as diabetes and liver disease, adrenal disease, cirrhosis of the liver) and rarely other reasons.
Progestin test – a study on the allocation of the ovary estrogen. If the ovaries to produce estrogen, progesterone when administered (10 mg per day for five days) in women with menstruation. If not, it can be concluded that there is a problem with the production of estrogen, or Asherman’s syndrome. In the absence of a history of induced abortion, Asherman’s syndrome can be excluded. In this case it will be necessary to find out the cause of the lack of estrogen – the reason may be related to the ovaries or hypothalamus.
Highly qualified specialist can determine the cause of amenorrhea and, after a thorough investigation, appoint a suitable patient, an effective method of treatment.
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Benign tumors of the uterus (fibroid)
Dysmenorrhea (painful menstruation)
Menorrhagia (heavy menstrual periods)
Vaginal infections (vaginitis), including fungal, bacterial, protozoal and viruses
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva