Source: Affiliated to Obstetrics and Gynecology Hospital of Fudan University
Xiaoxue just got married this year, because she bought a new house, and her life pressure suddenly increased. In order to upgrade their jobs as soon as possible, Xiaoxue worked overtime every day after buying the house. The "big aunt" who had been on time and timely was on time.I have never visited again.The test strip was not pregnant, and the Internet was checked. The words "premature aging" and "infertility" were scared to insomnia, so they were visited through our hospital’s Internet hospital.
Similar to Xiaoxue, many high -spirited girls will indeed have a secondary amenorrhea. For example, there are also many girls who face the pressure of examinations and promotion, and menstruation suddenly does not come.
Secondary amenorrhea refers to the suspension of menstruation for 6 months after the establishment of normal menstruation, or stopped by 3 cycles based on its original menstrual cycle.There are many reasons for secondary amenorrhea. To understand the cause, you have to talk about the complex and magical endocrine regulating shaft of the human body-HPO axis (H Hulk Brain-P pituitary-O ovary).
If this endocrine adjustment shaft is compared to a factory, the hypothalamus is the factory director of this factory. He is responsible for receiving feedback from the entire body and making decisions. Herecinopulotin is issued by secreting hormones (GNRH) to subordinate instructions.
As the deputy factory director of the deputy factory, the pituitary instructions secrete follicle stimulus (FSH) and lutein gogrus (LH), mobilize the follicle development and excretion of the ovarian workshop, and produce estrogen (E) and progesterone (P).
The uterus is the downstream workshop of the ovarian workshop. After accepting the estrogen hormone produced by the ovarian workshop, the endometrium as a production worker is proliferated and secreted, and finally falls off to form menstruation.
Similar to the operation of the factory, the formation of menstruation is inseparable from the effective and orderly coordination operation of each link of the HPO shaft.Any problems in any link may lead to "menstruation disappear".
Xiaoxue did two tests: blood hormone tests and gynecological ultrasound. The report showed that FSH, LH, and estrogen were very low, and the thickness of the uterine endometrial was only 2mm.What is going on?
Next we look for the clue clues of the axis of the HPO axis.
1. The problem of brain nature
In the secondary amenorrhea of women in the childbearing age, except for tumor, trauma and other organic reasons, functional hypothalamic amenorrhea accounts for 20 ~ 35%of secondary amenorrhea.Started, weight loss and excessive exercise.In addition, some drugs (such as: anti -psychiatric drugs) can also cause drugs to be used to cause amenorrhea through the hypothalamus.
When these induced factors affect the function of the long -secrete GNRH of the Hugkura brain factory, the discontinuation of the production signal step by step through the pituitary deputy factory director and ovarian workshop to reach the uterine workshop, the endometrium workers will eventually stop work.
Xiaoxue’s amenorrhea problem is precisely because of the sudden mental pressure that leads to the "discontinuation of production" of the hypothalamus, and menstruation naturally does not come.
2. Mentalogenic problems
Common causes include pituitary gland secreting FSH and LH reduction.For example, postpartum hemorrhage causes pituitary infarction, and pituitary tumors secrete prolactin (PRL) to inhibit the hypothalamus secretion GNRH.In addition, butterfly saddles are also an important cause of pituitary amenorrhea.
3. Ovarian problem
The ovarian workshop fails, and female and progesterone cannot be produced normally, causing menstrual production lines to interrupt.Common ovarian faults include premature ovarian failure and some ovarian tumors secrete androgens affect the HPO shaft.
4. The problem of uterine nature
The uterus is the end of menstruation, and the endometrium workers are "damage" and can also lead to amenorrhea.Usually uterine cavity surgery, infection (such as: tuberculosis), radiotherapy, etc. may cause endometrial damage. The most common of which is the abortion and the endometrium damage of the uterine cavity and the amenorrhea.In addition, cervical tubular adhesion caused by cervical surgery and blocking blood flow can also lead to amenorrhea.
5. Other endocrine problems
HPO axis regulation function is caused by an increase in androgen increased by abnormality: such as polycystic ovary syndrome.
In addition, the human body is a complex system. The regulation of endocrine not only rely on a shaft regulation, but relies on the well-known or unknown multiple axis intertwined into a network for regulation. The most often affects the HPO axis is the hypothalamus-pituitary-thyroid gland axis shaftThe hypothalamus-pituitary-adrenal axis, so the disorders of thyroid and adrenal dysfunction can also lead to amenorrhea.
By supplementing estrogen hormone to establish an artificial cycle, you can achieve "re -menstruation". Amenorrhea is a symptom. Retrying menstruation is only the first step. The reason behind finding the reason can be found to solve the problem fundamentally.
After inspection, we know the cause of the amenorrhea of the small snow, which is a hypothalamic amenorrhea caused by excessive mental stress.Improve emotional relief pressure through psychological guidance, and cooperate with supplementary hormone to establish an artificial cycle, Xiaoxue gradually restores the natural menstrual cycle.
If it is amenorrhea caused by other reasons, the symptomatic treatment is needed:
1. Pyphiasis prolactinoma: It can be treated with bromine pelvic.
2. Premature ovarian failure: It is an irreversible process. At present, there is no means to reverse it. It can only be treated with symptomatic treatment -by supplementing estrogen hormones to establish an artificial menstrual cycle, and improve the heat, night sweats, poor sleep, bones, bones, bones, bones, poor sleep, poor sleep, poor sleep, poor sleep, poor sleep, poor sleep.Symptoms such as mass looseness.
3. Polycystic ovary syndrome: Some patients can control weight body fat, improve insulin resistance, and antibrokes can temporarily restore ovulation and recover menstruation or conception through their lifestyle adjustment.Unable to cure.In order to prevent the endometrium, long -term lifestyle intervention and drug management need to be needed.
4. Cervical tubular adhesion after cervical surgery: It can be separated by surgery. If the endometrium damage is used to form uterine cavity adhesion, the effect depends on the degree of damage. Severe damage is easy to adhere even after surgical treatment, so take contraception and avoid it.Abortion is the key.
5. Other endocrine reasons: First, solve the initial disorder endocrine problem.
Therefore, not all the amenorrhea can be fundamentally "cured" and can only be "symptomatic".If there are fertility requirements, under the premise that the ovarian has a reserve function and the endometrium is not damaged, it can be resolved by promoting ovulation or auxiliary reproductive technology.
