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Thursday, April 18, 2024

Amenorrhea

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Amenorrhea is defined as the absence of menstruation after a period of three months. There are many ways to classify amenorrhea, and some authors classify them according to the place of origin (uterus/vagina, ovary, pituitary, hypothalamus). There is also another classification that is more clinical and they are divided into primary and secondary amenorrhea. Primary amenorrhea is if the patient never has menstruated, that is, has reached puberty without periods. Secondary amenorrhea is when a patient has had menstrual cycles, but they have now disappeared.

The most common causes of primary amenorrhea are congenital conditions (the absence of a uterus, transverse septa, or absence of the cervix) and genetic causes ( such as alterations in the sex chromosomes – Turner syndrome, deletion of the X chromosome, etc.).

The causes of secondary amenorrhea, that is, a healthy woman who had menstruation before and now does not, are mainly due to endocrine (hormonal) and metabolic imbalances or eating disorders such as anorexia nervosa or bulimia. Endocrine diseases are generally caused by thyroid disorders, polycystic ovary syndrome, prolactin disorders, and Cushing Syndrome, among others.

To understand secondary amenorrhea it is important to know that there is an endometrial cycle (the inner lining of the uterus that sheds every month) and depends on a series of hormones, including oestrogen and progesterone.

Oestrogens will make the endometrium grow in size, and progesterone when suppressed by the absence of pregnancy, will cause the endometrium to shed in the form of menstruation. Treating a patient with polycystic ovary syndrome is not the same as treating a patient with oestrogen deficiency or one with high prolactin levels.

Each case must be evaluated individually and although in most cases giving contraceptives “solves” the problem, it is necessary to treat the underlying disease that is causing amenorrhea, since when patients generally stop contraceptives (because they already had normal cycles or because the doctor has suggested it) the absence of menstruation returns.

In these cases,  patients undergo a series of hormonal studies to determine what the underlying problem is. By treating the root of the problem, the woman will go back to having regular cycles without the need for contraceptives.

THE TREATMENT YOU HAVE WILL BE BASED ON WHEN YOU WANT TO HAVE CHILDREN. SINCE THE TREATMENT MAY VARY, YOU SHOULD ALWAYS CONSULT YOUR PHYSICIAN  ABOUT THE AVAILABLE OPTIONS, AND THEY CAN ASSESS YOUR CASE ADEQUATELY

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