Amenorrhea: lack of men and women in adolescents and women

Amenorrhea is the absence of menstruation( monthly) in adolescent girls and women.

Code on μB-10

In the international classification of diseases 10 revision, each disease is assigned a coding number. Amenorrhea ICD-10 has three codes:

1. N91.0 Primary amenorrhea( violation of menstruation in the puberty period).
2. N91.1 Secondary amenorrhea( absence of menstruation in women who had previously had them).

3. N91.2 Amenorrhea, unspecified( absence of menstruation of the BDU).

Causes of

As a physiological phenomenon observed before puberty, during pregnancy, during menopause and in some women during lactation( lactation amenorrhea ).

The causes of amenorrhea are local and common. Congenital malformations of genital organs, surgical interventions on the uterus and ovaries, neoplasms can be referred to local ones.

Common causes can be conditions after severe infectious diseases, severe chronic diseases of the kidneys, liver, cardiovascular system, tuberculosis, endocrine system diseases, poisoning with salts of heavy metals.

It is necessary to distinguish such concepts as menstruation delay and absence of menstruation .

Diagnosis: baseline measures

Primary amenorrhea

1. Pregnancy test or presence of chorionic gonadotropin in the blood;
2. Ultrasound examination of pelvic organs( presence or absence of the uterus, ovaries, presence of obstruction of the genital tract, signs of the syndrome poliklitoznyhayachnikov);
3. Karyotyping according to indications( Turner's syndrome 45Х0 or testicular feminization 46ХУ);
4. Concentration of follicle-stimulating and luteinizing hormones( high level is a sign of Turner's syndrome or testicular feminization, at a low level of hormones stress, physical exertion, fast weight loss should be excluded);
5. Thyroid hormone concentration( hypo- or hyperthyroidism); Prolactin level( hyperprolactinaemia);
6. Level of testosterone( aplasia of the uterus or syndrome of polycytotic ovaries).

Secondary amenorrhea

1. Pregnancy test or presence of chorionic gonadotropin in the blood;
2. Concentration of follicle-stimulating, luteinizing hormones, prolactin, thyroid hormones;
3. Testosterone level in patients with manifestations of hirsutism;
4. Level of protein that binds sex hormones;
5. Level of estradiol;
6. Ultrasound examination of pelvic organs;
7. Magnetic-nuclear resonance or computed tomography of the skull;
8. Concentration of 17-ketosteroids in urine;
9. Hysteroscopy;
10. Dexamethasone suppression test according to indications;
11. Karyotyping according to indications.

Folk treatment of amenorrhea: remedies, prescriptions and tips

When menstruation is delayed

1. make hot foot baths( 42-45 ° C in the morning and in the evening to 20 minutes).In the bath water, add sea salt( or 2-3 tablespoons of table vinegar), 1-2 handfuls of mustard;
2. to carry out syringing with decoction of mint with honey, juice of fresh white cabbage.
3. put a warm enema with infusion of chamomile pharmacy;

Collection:

1. 1 teaspoon of birch buds;
2. 1 teaspoon of valerian root;
3. 6 g of parsley root;
4. for half a tablespoon of herbs rue medicinal and root lovage.

Mixture pour 500 g of water for 5-10 hours, then boil for 5-7 minutes, let it brew for 1 hour, strain, wring out. Drink three or five meals a day.

Decoction of a mixture of water pepper, rosemary, melissa leaves, cherry branches, taken in equal parts by weight. One tablespoon of the ground mixture, pour one glass of water, bring to a boil, let it brew for 30 minutes, strain. Drink in the morning and in the evening for 200 g.

Chamomile pharmacy, thyme. Take one tablespoon, pour 0.5 liters of boiling water, let it brew for 30 minutes in a sealed container, strain. Take 200 g 3 times daily before meals.

In the absence of menstruation

Prepare a mixture:

1. a pound of pure bee honey;
2. twenty cores of apricot or sweet almonds;
3. twenty green leaves of geranium pink;
4. four lemons through a meat grinder with a peel, but without seeds.

Add a mixture of tincture of valerian root on vodka and hawthorn flowers - 1 tablespoon each, 1 g of camphor powder and 15 drops of peppermint oil.

Take 3 times a day 20 minutes before meals on a tablespoon.

40 buds cloves food ( spice) boil in 1 liter of water until the water is evaporated by half. Drink without restriction, but start with a tablespoon 3 times a day, gradually increasing the dose to the reception.

Calendula tincture drink 40 drops 3-4 times a day. Simultaneously, insert the tampons with into the vagina in tincture of calendula and wormwood.

Constantly instead of water, drink a decoction of onion peel bulb: 1 cup of onion peel for 10 minutes cook in 1 liter of water.

Decoction of parsley leaves: 1 bunch pour 0.6 liters of water, boil over low heat for 10 minutes.

If menstruation does not begin after 7-10 days of treatment, then it is necessary to drink napar from ruta medicinal, oregano, chernobylnik, hemp tops, baskets of flowering sunflowers and onion husks - everything is taken in equal parts. Spread a tablespoon of the ground mixture with a glass of boiling water, boil for 1-2 minutes, let it brew for 1 hour, strain. Take two thirds of the glass 3 times daily before meals.

Some food plants also accelerate the onset of menstruation: onion, red pepper, radish juice, parsley( whole plant), horseradish, garlic, cabbage.

During treatment it is necessary to adhere to a vegetarian or milky-vegetable diet, avoiding fatty foods, canned food, pork, fatty fish, smoked products.

It is recommended to exercise daily, focusing on exercises that train the abdominal muscles. A massage of the abdominal muscles and thighs, as well as warm baths( 37-38 ° C) for up to 30 minutes is useful.

In a day on the abdomen in the lower parts you can apply compresses with a warm broth of finely chopped hay or hay.

Treatment of amenorrhea with official medicine

The nature of the treatment for amenorrhea depends on its causes. Good results are provided by funds aimed at improving blood supply to the pelvic organs. With primary amenorrhea because of ovarian hypofunction for 6-8 weeks, the hormone estrogen is administered. The course of estrogen therapy is a kind of preparation for the further cyclic use of estrogen in combination with progesterone, gonadotropic hormone, etc.

With secondary amenorrhea find out the type of menstruation before the onset of amenorrhea and prescribe an individual hormonal therapy taking into account the hormonal rhythms customary for a given woman.

To enter the appropriate hormones on certain days, three phases of the cycle are identified:

1. follicular( from the onset of menstruation to the 14th day)
2. ovulatory( from 14th day to 17th);
3. phase of the yellow body - progesterone( from 16-18 days to 28 days).

Patients with a 28-day menstrual cycle are intramuscularly administered on the 6th, 8th, 10th and 12th days of the cycle-10,000 ED( 1 mg) of estrogen;in 14, 16, 18 days - 1 mg of estrogen in combination with 5 mg Progesterone( in one syringe);from 20 to 26-day - 10 mg of progesterone daily.

Patients with a 21-day menstrual cycle are administered hormones in the following order: on days 5, 7, 9, 1 mg of Estrogen;on days 11, 13 - 1 mg of Estrogen in combination with 5 mg of Progesterone and from 15 to 19 days - 10 mg of Progesterone daily. The count of days is from the first day of menstruation. Hormones are administered in strictly defined for this particular sick days.

Extinct reflexes can be revitalized and fixed during a long( during 5-6 menstrual cycles) course of treatment. At the onset of menstruation( for fixing the results of treatment) additional light therapy, built on the same principle, but with the introduction of half doses of hormones.

Tactics of treatment of

Treatment of amenorrhea is possible if the following causes are identified:

1. When hypothyroidism is treated with levothyroxine( dosage is coordinated with the endocrinologist);
2. Gipeprolactinemia is treated with bromocriptine at a dose of 5-7.5 mg per day;
3. Small prolactinoma is treated with medications, however, large tumors with visual impairment are subject to surgical treatment.
4. Tumors of the hypothalamus, pituitary gland, ovaries, adrenals are subject to surgical treatment.
5. Treatment of polycystic ovary syndrome begins with a decrease in the weight of the patient, then an agent sensitive to insulin is used - metformin 850 mg( 1 tablet) in the morning during a meal, with increasing dose 2-3 weeks to 1700 mg per day( in 2 divided doses in the morning,at lunch).
6. In case of excessive physical exertion, their restriction is introduced in combination with diet.
7. When anomalies of the urogenital tract are detected, their surgical correction is performed.
8. No specific treatment has been developed for premature ovarian aging.
9. With prolactinoma of large size with visual impairment, tumors of the hypothalamus, pituitary gland, ovaries, adrenal glands - surgical treatment.
10. When anomalies of the urogenital tract are detected, their surgical correction is performed.

List of main medicines:

1. Levothyroxine 25 μg, 50 μg, 75 μg, 100 μg, 125 μg, 150 μg of tablets.
2. Bromocriptine 2.5 mg tablets.
3. Metformin 500 mg, 850 mg tablets.

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Bibliography

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