In traditional Chinese medicine, amenorrhea is called amenorrhea, which is mostly caused by congenital deficiency, infirmity, labor pains, kidney qi deficiency and essence and blood deficiency. Serious illness, long illness, postpartum blood loss, or insufficient spleen biochemistry, and less blood volume in Chongren; Modality disorder, mental stress, or stimulation, qi and blood stagnation is not good; Obese people, phlegm-dampness, phlegm-dampness blocking chong ren, etc. Common syndromes are: ① amenorrhea due to kidney deficiency and essence deficiency. In the late period of menstruation, the menstrual flow is less, the color is red, amenorrhea gradually occurs, dizziness and tinnitus, soreness of waist and knees, dry mouth, fever of hands and feet, hot flashes and sweating, red tongue with little fur, and thin or astringent pulse. Prescriptions for invigorating kidney and essence include Guishen Pill and Zuogui Pill. ② amenorrhea due to deficiency of both qi and blood. In the late period of menstruation, there is little menstrual flow, which gradually becomes amenorrhea, dizziness and fatigue, dull complexion, forgetfulness and insomnia, shortness of breath and laziness, dull hair and skin, pale tongue and weak pulse. Treatment to tonify qi and blood, can use ginseng nourishing soup, Guipi decoction. ③ Qi stagnation and blood stasis type amenorrhea. Irregular menstrual period, gradual or sudden amenorrhea, chest and hypochondriac pain, breast and lower abdomen pain, irritability, dark tongue with blood stasis and astringent pulse. It is advisable to use Xuefu Zhuyu Decoction and Xiaoyao Pill to promote qi, promote blood circulation and remove blood stasis. ④ amenorrhea due to phlegm-dampness stagnation. Menstruation gradually reaches amenorrhea, obesity, nausea, burnout, anorexia, nausea, leucorrhea, white greasy tongue coating and slippery pulse. Treating phlegm-dampness with Baizhu and Xiangsha Liu Jun Decoction.
If a woman is over 18 years old and has not menstruated, or an unmarried young woman has normal menstruation, but has stopped menstruating for more than 3 months, it is called amenorrhea. The former is called primary amenorrhea and the latter is called secondary amenorrhea. Some girls can't be regarded as amenorrhea because the interval between menarche and the second menstruation is several months, or the menstruation is irregular within one or two years, and the interval between two menstruation is relatively long. This is because their reproductive organs are not yet mature and the function of their ovaries is not perfect, which is a normal physiological phenomenon.
[Edit this paragraph] What are the types of amenorrhea?
Anyone who has reached 18 years old and will have menstruation in the future is called primary amenorrhea; Most of them are caused by congenital abnormalities, including abnormal development of ovary or Mullerian duct tissue.
After the establishment of menstrual cycle, those who have no menstruation for more than 6 months in a row are called secondary amenorrhea, which is mostly caused by secondary diseases.
True amenorrhea refers to amenorrhea caused by some reasons, such as mental factors, malnutrition, anemia, tuberculosis, excessive curettage, endocrine dysfunction and so on.
Pseudo (or recessive) amenorrhea refers to those who are unable to discharge menstruation due to adhesion and atresia of the lower reproductive tract caused by congenital dysplasia or acquired injury.
[Edit this paragraph] Primary amenorrhea
What is primary amenorrhea?
Internationally, people who have reached 14 years old have no menstrual cramps and their secondary sexual characteristics are underdeveloped; Or 16 years old without menstrual cramps, regardless of whether the secondary sexual characteristics are normal or not, it is primary amenorrhea. Generally speaking, menstruation comes two years after the development of secondary sexual characteristics.
Etiological classification of primary amenorrhea:
Anatomical abnormality of internal and external genitalia
Hymen atresia (1): It is caused by urogenital sinus epithelium not penetrating into vulva and vestibule. Ovary and secondary sexual characteristics develop normally. Puberty often has periodic abdominal pain, and there is also a lump in the lower abdomen caused by vaginal cavity hemorrhage, which can cause frequent urination, urinary retention and constipation in severe cases.
(2) Congenital absence of vagina: the accessory middle renal duct is stagnant and does not extend downward. Normal ovary, such as congenital absence of uterus or trace uterus, is Mayer-Rokitansky-Kuster-Hauser syndrome.
(3) Congenital absence of uterus: the middle and tail of accessory kidney are not developed.
Dysfunction of endocrine organs
(1) hypothyroidism: TSH >；; 10μIU/ml, sensitive thyrotropin STSH >；; 4.0μIU/ml free T3 or free T4 is low. Hypothyroidism in adolescence slows down the metabolism of patients, slows down the maturity of gonadal axis and delays the menstrual period. Early hypothyroidism can be complicated with gonadal hypoplasia and the prognosis is poor.
(2) Hyperprolactinemia: prolactin PRL >；; 30-40ng/ml, accompanied by galactorrhea, pituitary macroadenoma or microadenoma or empty sella disease, or pituitary prolactin secretory cell proliferation. High PRL inhibits GnRH and FSH, causing low estrogen and amenorrhea. Primary amenorrhea occurs in adolescence.
other
(1) Inflammation: Juvenile meningitis, encephalitis sequela, affecting hypothalamic secretion. Or tuberculous peritonitis and pelvic inflammatory disease, causing endometrial tuberculosis, endometrial scar and primary amenorrhea of uterus.
(2) Injury: Surgical resection of the uterus and the juvenile ovarian malignant tumor with double appendages, especially germ cell tumor, has a good prognosis and can survive, but it is primary amenorrhea without uterus and ovary. Radiation therapy can damage the pituitary and ovaries.
(3) Nutrition: Malnutrition can cause amenorrhea and dysplasia.
[Edit this paragraph] Secondary amenorrhea
What is secondary amenorrhea?
The common causes are endometrial damage or adhesion (common in repeated curettage and uterine cavity adhesion caused by excessive endometrial damage), tuberculous endometritis, premature ovarian failure, polycystic ovary, ovarian functional tumor, environmental change, mental trauma and malnutrition, injection of long-acting contraceptive needles or oral contraceptives, amenorrhea and lactation syndrome, and Sheehan syndrome (ischemic necrosis of anterior pituitary tissue and pituitary function caused by postpartum hemorrhage and shock).
What about secondary amenorrhea?
After secondary amenorrhea, you should go to the hospital for examination in time, and look for the cause of amenorrhea according to the medical history, physical examination, relevant auxiliary examination and hormone determination. Treatment should be given according to different reasons. Some patients can recover their menstruation naturally after physical and mental adjustment or stopping using contraceptives, and some patients can recover after using progesterone, artificial cycle and ovulation induction therapy. Hormone replacement therapy can be used for patients with premature ovarian failure caused by impaired or destroyed ovarian function.
Conditioning of secondary amenorrhea
Women who have not menstruated for three months or more after menstrual cramps are called secondary amenorrhea. The menstruation of normal women is completed by the normal regulation of endocrine hormones secreted by hypothalamus-pituitary-ovary, in which pituitary gonadotropin plays a leading role in regulating ovarian function and maintaining menstrual cycle. Secondary amenorrhea is often accompanied by symptoms such as depression, irritability, soreness of waist and knees, dizziness, tinnitus, palpitation, shortness of breath and fatigue. There are many reasons for secondary amenorrhea, and the common ones are as follows:
1, nutritional deficiency. In particular, the lack of protein and vitamins can reduce the function of endocrine glands, and the synthesis and secretion of gonadotropins by pituitary gland are most easily inhibited. At the same time, it also reduces the response of target organs to hormones, such as the sensitivity of endometrium to sex hormones, leading to amenorrhea. The main reason is improper diet, such as partial eclipse and picky eaters, which leads to insufficient intake of protein, lipids and vitamins in food.
2. If amenorrhea is not long, or happens occasionally, you can review whether there are any special circumstances recently, such as mental stimulation, excessive tension, fatigue, environmental change, cold stimulation, malnutrition, etc. The changes of these external factors can sometimes inhibit the function of the central nervous system, thus reducing the secretion of pituitary gonadotropins and causing amenorrhea.
3. Whether to take birth control pills. After taking birth control pills, sometimes it can directly inhibit the secretion of pituitary gonadotropin, causing amenorrhea.
4. Do you have any diseases? Gynecological diseases, endometrial tuberculosis, intrauterine adhesion caused by repeated curettage, polycystic ovary, premature ovarian failure, etc. Endocrine system diseases, amenorrhea galactorrhea syndrome, hypothalamic pituitary dysfunction; Systemic wasting diseases, such as severe anemia, tuberculosis, tumor, etc. , may cause amenorrhea.
[Edit this paragraph] Type
According to the different anatomical sites of the main causes, amenorrhea can be divided into four categories: uterus, ovary, pituitary and hypothalamus.
1. Uterine amenorrhea and its etiology: The so-called uterine amenorrhea refers to amenorrhea caused by endometrial loss caused by uterine diseases. Because there is no endometrium, progesterone and artificial cycle test are negative. The causes of uterine amenorrhea are:
(1) Congenital agenesis or hypoplasia. The uterus is like a nodule. Without vagina, it will cause primary amenorrhea. These patients have normal physical development, but they are often accompanied by skeletal dysplasia, spinal curvature and renal malformation. Ovarian function is normal, ovulation occurs, basal body temperature is bidirectional, and gonadotropin is normal.
(2) Acquired endometrial injury. Amenorrhea can be caused by severe postpartum infection, severe tuberculous endometritis or radiotherapy; Excessive curettage during induced abortion can cause scar or adhesion of uterine cavity and amenorrhea.
(3) Endometrial adverse reactions. Long-term lack of sex hormones caused by long-term breastfeeding or long-term use of contraceptives can cause excessive atrophy of endometrium and amenorrhea.
Causes of secondary amenorrhea:
1. The most common reason is hypothalamic amenorrhea, and its functional reasons are:
1. Mental stress 2. Weight loss and anorexia nervosa 3. Exercise amenorrhea 4. Drug amenorrhea 5. Craniopharyngioma.
2. Systemic amenorrhea, the main lesion is in the pituitary gland, including: 1. Pituitary infarction II. Pituitary tumor 3. Empty sella syndrome.
Three. Ovarian amenorrhea
1. Premature ovarian failure 2. Functional ovarian cyst 3. Polycystic ovary
4. Uterine amenorrhea. This is amenorrhea caused by endometrial destruction or unresponsiveness to ovarian hormones. Mainly 1. Ashman syndrome II. Endometritis III. After hysterectomy or intrauterine radiotherapy.
Pituitary excitation test is an auxiliary examination to diagnose the cause of amenorrhea. The experiment lasted for 3 hours, and the reporting time was 1 hour, with a total duration of 4 hours. This is a highly observable, continuous and dynamic experiment. Firstly, the basic LH (luteinizing hormone) FSH (follicle stimulating hormone) in vivo was detected, and 25,45,90,65438+were injected.
[Edit this paragraph] Pathological amenorrhea
Amenorrhea caused by local diseases of reproductive system and systemic diseases is called pathological amenorrhea.
There are many reasons for pathological amenorrhea, which can be divided into the following aspects:
(1) Mental factors. Mental trauma, fear, tension, etc.
(2) malnutrition.
(3) Systemic diseases. Such as severe anemia, tuberculosis, nephropathy and diabetes.
(4) diseases of the uterus itself. Such as congenital absence of uterus, uterine dysplasia, trauma, excessive curettage, intrauterine adhesion and so on.
(5) Ovarian diseases. Such as congenital absence or dysplasia of ovary or surgical resection, malignant tumor, etc.
(6) Endocrine gland diseases. Such as pituitary gland, thyroid gland and adrenal gland.
In addition, it should be noted that some amenorrhea belongs to pseudo amenorrhea, that is, the menstrual cycle changes, but this amenorrhea is caused by congenital malformation or acquired injury that prevents menstrual blood from flowing out. This kind of patients often have periodic abdominal distension and abdominal pain, which are aggravated month by month, which is different from the above-mentioned true amenorrhea.
[Edit this paragraph] Etiology
(1) disease. It mainly includes consumptive diseases, such as severe tuberculosis, severe anemia and malnutrition. And unique endocrine diseases, such as "obesity and reproductive dysfunction malnutrition"; Some endocrine disorders in the body, such as adrenal gland, thyroid gland, pancreas and other dysfunction. The influence of these reasons may not necessarily come to menstruation. But the amenorrhea caused by these conditions, as long as the disease is cured, menstruation will naturally come.
(2) Inferior atresia of reproductive tract. Such as cervix, vagina, hymen, labia, etc. Others are congenital atresia or adhesive atresia caused by acquired injury. Although there is menstruation, but the menstrual blood flow does not come out. This condition is called recessive or pseudoamenorrhea. The atresia of the lower reproductive tract can be completely cured by the doctor's treatment.
(3) The genital litigation is imperfect or stunted. Some people are born without ovaries, or the ovaries are poor, or the ovaries are bad, so they can't produce estrogen and progesterone, so the endometrium can't change periodically, and there will be no endometrial shedding, so there will be no menstrual cramps. Some are born without uterus, or endometrial dysplasia, or endometrial damage, even if the ovarian function is sound and the secretion of estrogen and progesterone is normal, they do not come to menstruation.
④ Tuberculous endometritis. This is because mycobacterium tuberculosis invades the endometrium, causing different degrees of inflammation and injury, and finally scar tissue appears, leading to amenorrhea. Therefore, if you have tuberculous endometritis, you should treat it in time without delay.
(5) Dysfunction of pituitary or hypothalamus. The pituitary gland can secrete gonadotropins. Gonadotropin can regulate ovarian function and maintain menstruation. If the pituitary gland is dysfunctional, it will affect gonadotropin secretion and ovarian function, and abnormal ovarian function will cause amenorrhea. In addition, abnormal hypothalamic function can also cause amenorrhea. There are many reasons for hypothalamic dysfunction, such as mental stimulation, sadness, anxiety, tension, fatigue, environmental changes, cold stimulation and so on. Amenorrhea caused by hypothalamus is more common.
If amenorrhea is found, you should go to the hospital in time, find out the reasons and treat the symptoms, which will generally get satisfactory results. Don't be afraid of illness and doctors. Otherwise, the longer the amenorrhea time, the more severe the uterine contraction and the worse the therapeutic effect. Whether adolescent female amenorrhea can be cured depends on the cause of amenorrhea. For example, secondary amenorrhea in adolescence is mostly caused by environmental changes, emotional fluctuations and weight changes. After removing these reasons, menstruation can gradually recover. A few amenorrhea caused by diseases, such as polycystic ovary syndrome, thyroid dysfunction, tuberculosis and so on. After treatment, menstruation can also be restored. However, some amenorrhea can't be cured, such as no uterus delivery, too small uterus or amenorrhea caused by endometrial damage caused by pathological changes. No matter what kind of amenorrhea it is, you should check it clearly. Even if it is incurable amenorrhea, it should be examined clearly to determine the short-term impact.
Generally speaking, women who can't cure amenorrhea can get married in the future, but they can't have children. When looking for a partner, they should make it clear to each other that they will get married on the basis of full understanding and trust, even if they have no children.