Amenorrhea aetiological agent and treatment
The Amenorrhea is the gynecology department common one symptom, but because the whole body or the topicality pathological change cause. Every 18 year old of menstruations not yet the incoming tide, calls the primary Amenorrhea; Once had had the normal menstruation formerly, above the present Amenorrhea 3 months call the sequential Amenorrhea; After gestational, the breast-feeding period, within the Amenorrhea Amenorrhea as well as the young girl first menstruation latter 1 year has the Amenorrhea, call the physiology Amenorrhea.
??First, cause of disease and classification
??(one) the womb Amenorrhea congenital vagina and (or) the womb lacks, if the maldevelopment may cause the primary Amenorrhea. The testicle feminization (masculine false hermaphroditism) is one rare hereditary familial disease, because the body surface shape is a female, Chang Yinwu the menstruation comes the gynecology department seeing a doctor. The sex chromosome nuclear type is 46, XY. The excessive dilation and curettage either the serious infection like tuberculosis and so on create the internal membrane damage or the adhesion, the nursing time are excessively long cause the endometrium atrophy and so on, may cause the sequential Amenorrhea.
??because (two) the ovary Amenorrhea the ovary pathological change causes Amenorrhea. The congenital ovary lacks, if the germ cells maldevelopment (the Turner syndrome, approximately composes the primary amenorrhea 12~20%. Many because the sex chromosome exceptionally causes, the main nuclear type is 45, XO, because the sex chromosome is unusual, the ovary cannot the normal growth and the growth. Therefore, the ovary assumes the strip funicular Fiber structure. Typical clinical characteristic after short, web neck, elbow joint eversion, intelligence low, sends the border low and the second sexual character does not grow and so on. , because after sending the Amenorrhea to be possible the ovarian function early aging, the surgery excise, the radiotherapy as well as the ovary virilization tumor and so on. The latter may accompany the virilized characteristic, like pilosity and clitoris large and so on.
??(three) the pituitary gland Amenorrhea occurs before the puberty pituitary gland tumor may cause the primary amenorrhea. But sees Yu Ji to send the Amenorrhea patient. Because mainly the pituitary gland suffers injury causes the function not entire, common when is in shock, the serious post-natal infection in the post-natal massive hemorrhage partner or the disseminated intravascular coagulation (DIC), sends the prehypophysis ischemia necrosis, presents the function along with it to drop, the Amenorrhea, also calls the mat Chinese syndrome. This sickness besides affects FSH, but may also implicate TSH and the ACTH secretion, thus may also have other corresponding symptoms, like becomes emaciated, the dyspepsia, the fear to be cold, the asthenia, the reproductive organ wither, the basal metabolism to be low and the hair falls off and so on. The pituitary gland tumor may occur in the sella tarcica or outside, because but mechanicalness oppression or tumor’s unusual function causes the Amenorrhea, the hypofunction and other related symptoms, like the field of vision barrier, the headache, secrete the breast and the acral growth sickness and so on.
??(four) the hypothalamus Amenorrhea hypothalamus the central nervous system control, the excessively mental strain, the anxiety, the fear, the living conditions change, may cause the central nervous system and hypothalamus function being out of balance, presents the Amenorrhea. Specially young woman. The ovarian function was not still perfect, the change presents the disorder phenomenon. Often first displays in the ovulation function exceptionally presents the Amenorrhea.
??The multi-pouch ovary syndrome causes the menstruation to send thinly much or following sends the Amenorrhea, because menstruation being out of balance, does not have the ovulation, in vivo estrogen secretes excessively many, may be accompanied by, the pilosity to have and so on obese sterile, the two-sided ovary assumes polycystic increases, may compared to normal big 1~3 times, have the tenacious feeling. The ovary involucrum is plump, under the cerebral cortex presents the most growth varying degrees the follicle. The endometrium assumes the varying degree the multiplication condition. Presently thinks that the multi-pouch ovary is the non-ovulation result which the hypothalamus - pituitrism causes, grows take the graafian follicle and pauses in each different period as the result.
??Other like serious malnutrition, specially the nervous apositia, the consumptive disease, the serious anemia and so on, may affect hypothalamic GnRH the synthesis secretion, but causes the Amenorrhea. Takes certain medicines for a long time for example: The reserpine, the wintermin, sleep Tong and the contraceptive and so on, may also cause the Amenorrhea. The pituitary tumor patient besides affects the GnRH synthesis secretion, but may also cause PIF and the dopamine receives suppresses, presents the Amenorrhea and secretes the breast, said that the Amenorrhea secretes the young syndrome.
??(five) other endocrine function disorder and so on when gland unusual adrenal gland, thyroid gland and pancreatic gland may also affect the menstruation. For example: The adrenal cortex function hyperfunction either the decrease, the thyroid function hyperfunction or drop as well as diabetes and so on, can cause the Amenorrhea through the hypothalamus influence pituitary gland function.
??Second, diagnosis
??(one) medical history?
??First differentiates the primary amenorrhea with following to send the Amenorrhea. Because to the primary amenorrhea, should understand its family history, whether there is the growth development and some kind of serious disease to affect its growth and so on. To before sending the Amenorrhea to find out in the past the menstruation situation, the Amenorrhea deadline, whether there is the Amenorrhea the cause, the diagnosis situation, whether or not has used the endocrine treatment and to each kind of treatment response, the state of health and the birth, the life and the working condition and so on.
??(two) physical examination
??1. whole body situation attention growth, nutrition, degree of stoutness, state of mind, intelligence and second sexual character growth as well as hair how many and distribution, breast whether there is milk secretion and so on. When necessity looks up the field of vision, the sella tarcica fault to absorb the piece, the CT inspection, the chromosome nuclear type analysis, the abdominal cavity microscopic exam and the related endocrine inspection and so on.
??2. is the gynecological examination attention vulva growth situation, whether there is abnormal and in the reproductive organ whether there is exceptionally and so on. Doubts has the cervix of the uterus, the palace cavity adhesion, the available uterine probe surveys whether unobstructedly, or makes the iodine oil radiography. When necessity makes the vagina, the cervix of the uterus mucilage smear and/or the internal membrane biopsy and so on, by preliminary understanding sex hormone level.
??(three) endocrine inspection
??After exception organic pathological change, may make the related endocrine aspect according to the below step the inspection.
??1. the progestogen experiments this examines the endocardial estrogen level, appraises in vivo estrogen level and the genital tract integrity. Uses the progestogen to perform the experiment alone, the method: Progestin 20mg, daily intermuscular injection one time, continuously 5 days; Or oral administration armor progesterone 10mg, daily one time, including takes for 5 days, whether there is observes to remove the property hemorrhage. Applies drugs latter 2~7 days to appear removes the property vagina bleeder is the positive reaction, indicated that the genital tract growth is normal, endometrium’s function existence, has been affected fully the estrogen, can thus have the secretory phase change to the progestin. Simultaneously explained “germ cells axis” the function basically exists, but possibly insufficiently consummates but does not ovulate. The negative reaction cannot be an exception the womb and the genital tract is unusual, must perform the female - progestogen experiment, by is further clear diagnoses.
??Has when the condition decides the blood lactation element observable, like normal, may be an exception initially the pituitary gland tumor. If is higher than normally, specially has when secretes the young situation, ought to do the sella tarcica level to absorb the piece, rules out the tumor possibility. When essential and is possible, may make the CT inspection, discovers the pituitary gland small tumor.
??2. the female - progestogen experiment progestogen experiment negative, possibly is the endocardial estrogen level is insufficient, the internal membrane grows the insufficient result the estrogen stimulation. May take orally stilboestrol 1mg every day, including takes for 21 days; Also the available benzoic acid estradiol, every 3 day of intermuscular injection 2mg, is used together 7 times, finally 5 day of intermuscular injection progestin every day 20mg. After stopping the medicine, has the bleeder, explained that in vivo estrogen level is insufficient, pathological change many above ovary spot, must further seek for the cause of disease. After stopping the medicine, indicates the pathological change without the bleeder in the endometrium.
??3. the pituitary gland presses the gonadotrophic hormone determination estrogen to remove the medicine hemorrhage experiment masculine gender, shows in vivo estrogen level to be low, should further differentiate is because the ovary itself or because of the hypothalamus - pituitrism result. Available puts exempts the law or the biological law determination presses the gonadotrophic hormone (FSH, LN) the level. LH low (<5IU/L) either thought that is presses the gonadotrophic hormone synthesis secretion insufficiency, the cause of disease possibly in the pituitary gland or the hypothalamus. The FSH rise (>40IU/L) many concerns with the ovarian function decline. The FSH value between 5~30IU/L, prompts the ovary to have the follicle existence.
??4. the pituitary gland excited reagent like presses the gonadotrophic hormone to be lower than normal or in the normal lower limit scope, should distinguish the pathological change is in the pituitary gland or in the hypothalamus. Available presses the gonadotrophic hormone releasing hormone (GnRH) to make the pituitary gland to experiment excitedly differentiates. Method: Before the experiment, measures LH, then calmly drops LHRH100 ? the g4 hour, every 15, 30, 60 and 120 minutes draw blood respectively measure LH. The hypothalamic function barrier, pours 30~45 minute LH rises in the drop, when 60~90 minutes drops, in 2~4 hours may have the second rise, and can maintain for approximately 4 hours. When the pituitary gland function has the flaw, although LH has the first rise, but cannot maintain is very long, even if continues to apply drugs, also does not present the second rise phenomenon, explained that the pituitary gland synthesizes LH the function to be restricted. Because if the hypothalamus suffers injury, but the pituitary gland has time the inertia, starts when the drop medicine may not have the response, but may present the deferred reaction about 2 hours.
??Third, treatment
??(one) the just right for the illness treatment strengthens the bodily exercise, possible arrangement life, work. Avoids the mental strain, eliminates the bad stimulation; Increases the nutrition, the elimination chronic infection, eliminates the patient to worry, enhancement confidence. The breast-feeding period is excessively long causes the atrophia uteri, should stop nursing immediately. To causes the Amenorrhea organic pathological change, should give the treatment.
??(two) hormone treatment
??1. the adjustment menstrual cycle use sex hormone facilitates removes the property hemorrhage, has the psychotherapy goal.
??Female - progestogen sequential therapy (artificial cycle): Is insufficient to vivo estrogen level, the congenital germ cells lack like. Above germ cells maldevelopment or ovary spot pathological change, available this law. On the one hand may enable of the endometrium to conform with the physiology cracking-off, on the other hand can stimulate normal feedback mechanism between the ovary and pituitary gland’s. Usage: Ethylene female phenol 0.5~1mg, daily one time, continuously 21 days, latter 5 day of daily intermuscular injection progestin 20mg. Stops in the medicine 2~7 days to occur removes the property hemorrhage, from bleeds the 5th day to start the first cyclical treatment again, applies drugs with on, is redundant for 3~6 cycles.
??2. the induced ovulation after adjusting the menstrual cycle, uses the induced ovulation. The method are many, the majority presses the ovulation medicine the effect and in vivo estrogen level concerns.
???The Chromium fragrance (chlorine ? phenol amine) is one kind of non-steroid body preparation, its function not yet is clear, possibly affects in the hypothalamic spot, with estrogen competition acceptor. The stimulation endocardial LHRH release, promotes the pituitary gland to secrete FSH and LH, the induced ovulation. Is suitable has the estrogen in vivo not to have the ovulation. Its ovulation rate and conception rate and in vivo estrogen level related; Is low to the androgen level, the atrophia uteri, uses the small amount estrogen first after suitably, may increase the ovulation success ratio. Usage: Chromium fragrance 50mg, daily one time, including takes for 5 days, 5th day or the progestin causes from the menstrual cycle removes the property to bleed the 5th day to start to take, stops the medicine latter 3~8 day of ovulations. If does not have the ovulation, may in apply drugs 20th day of Canada with progestin 20mg, the daily intermuscular injection one time, 5 days, causes to occur continuously removes the property hemorrhage. After the hemorrhage, the 5th day starts the second cyclical treatment, but the Chromium profuse coca to 100mg, including takes massively for 5 days. If still did not have the ovulation, should change to other medicines or and other medicine merge use. For example the Chromium Finland and Canada chorion presses the gonadotrophic hormone (hCG): After Chromium fragrance 3~4th day of Canada with hCG5000IU, the intermuscular injection one time, the goal is to create or strengthen the LH peak artificially. Observes continuously for 5~6 cycles. Treatment period should measure the foundation body temperature, whether there is observes to ovulate.
???Presses the graafian follicle mature element (hMG): Stimulation graafian follicle growth, secretion estrogen. Is suitable in the pituitary gland function not entire, presses the gonadotrophic hormone level to be low, but ovary response function normal person. hMG (1 including presses graafian follicle mature 75IU; Yellow body production hormone 75IU (daily intermuscular injection, continuously 7~14 days. May cause the estrogen secretion obvious markup, induces the LH secretion to send the ovulation. When medication observes the cervix of the uterus mucilage to crystallize, in 5 days appear without the crystallization, may use judgment to increase the dose. Simultaneously determines the urine estrogen and the ultrasound monitor graafian follicle growth, if the cervix of the uterus mucilage presents the typical list dentate crystallization, the urine estrogen total quantity to reach the 50~100mg/24 hour, when the graafian follicle diameter reaches 20mm, but intermuscular injection hCG3000~5000IU, 3~4 days, hMG uses continuously excessive may have the abdominal pain, the headache and the ovary increases, even cystic turns the breakage, meets this situation to stop the medicine.
???The yellow body production hormone releasing hormone (LHRH) is suitable the Amenorrhea which and the pituitary gland response insufficient creates in endocardial LHRH is normal, follicle growth satisfactory person. The ovulation affects strongly. To the pituitary gland, the ovary Amenorrhea is invalid. Usage: Simulates LH-RH the pulse labor release physiological phenomenon, uses the intermittent small dosage to give the medicine. The vein or the hypodermic every 60~90 minutes pour into 5~10 ? gLHRH, the effect are good.
??(three) the Chinese medicine traditional Chinese medicine will treat the motherland medicine to stop menstruating divides into the kidney empty, to stagnate, the vitality to lose money, the stagnation of flow of vital energy blood stasis, the phlegm cold-damp to be wet and blood dry six, may dialectical treat according to illness carries on the treatment.
