Everyone knows that women may experience amenorrhea at a certain age. Regarding amenorrhea, some are caused by malnutrition, while others are due to excessive exercise. Primary amenorrhea is different from regular amenorrhea. So what is primary amenorrhea? How to treat primary amenorrhea?
Diagnosis of amenorrhea: Inquire about medical history and physical examination, and diagnose after excluding organic lesions.
The steps are as follows: First, distinguish whether it is primary amenorrhea or secondary amenorrhea. If it is primary amenorrhea, first check the development of the breasts, female secondary sexual characteristics, and uterus.
1. Uterine function examination
(1) Endometrial biopsy or diagnostic curettage.
(2) Hysterosalpingography with iodine oil.
(3) Drug withdrawal test: used to evaluate estrogen levels in the body to determine the degree of amenorrhea.
Progesterone test: If there is withdrawal bleeding (positive reaction), it indicates that the endometrium has been affected by a certain level of estrogen, which is grade I amenorrhea. If there is no withdrawal bleeding (negative reaction), further sequential tests of estrogen and progesterone should be performed.
Sequential test of estrogen and progesterone: suitable for amenorrhea patients with negative progesterone test. The occurrence of withdrawal bleeding is positive, indicating normal endometrial function and ruling out uterine amenorrhea. The cause of amenorrhea is the low level of estrogen in the patient's body, which is grade I amenorrhea, and further investigation should be conducted to find the cause. If there is no withdrawal of medication and bleeding, the test should be repeated. If there is still no bleeding, it indicates that the endometrium is defective or damaged, and it can be diagnosed as uterine amenorrhea.
2. Ovarian function examination
(1) Basal body temperature measurement
(2) Vaginal exfoliative cytology examination.
(3) Cervical mucus crystallization examination.
(4) Hormone testing: Blood steroid hormone testing: including estradiol, progesterone, and testosterone testing. For those who test positive for estrogen, in order to determine the primary cause in the ovaries, pituitary gland, or hypothalamus, blood FSH, LH, PRL radioimmunoassay is required.
3. Pituitary function examination and measurement of prolactin and pituitary gonadotropin. The normal value of PRL is 0-20 μ g/L. When PRL is 25 μ g/L, it is called hyperprolactinemia. For those with elevated PRL, TSH should be measured. For those with elevated TSH, it indicates hypothyroidism; If TSH is normal and PRL is greater than 100 μ g/L, head MRI or CT examination should be performed to rule out pituitary tumors. If PRL is normal, pituitary gonadotropins should be measured. The normal value of FSH during the menstrual cycle is 5-20U/L, and LH is 5-25U/L. If FSH is 40U/L, it indicates ovarian failure; If the LH25U/L or LH/FSH ratio is 2-3, it should be highly suspected to be polycystic ovary syndrome; If both FSH and LH are 5U/L, it suggests that pituitary dysfunction may occur in the pituitary gland or hypothalamus.
Treatment for Amenorrhea
1. Whole body therapy: including physical therapy and psychological therapy.
2. Etiological treatment.
3. Hormone therapy. Treatment of Asherman syndrome: Separation of adhesions under hysteroscopy; Sequential treatment with high-dose estrogen and progesterone.
When amenorrhea occurs, the first thing to determine is whether it is primary amenorrhea. If it is, systemic treatment and etiological treatment can be used. If you find yourself suffering from primary amenorrhea, don't be afraid and communicate more with your family. Communicate more with doctors. Actively cooperate with treatment. Having a positive mindset is the key to treatment.
