Amenorrhea

Introduction to amenorrhea Amenorrhea is a common symptom in gynecological diseases and can be caused by a variety of different causes. Amenorrhea is usually divided into primary and secondary. Those who have not passed the age of 18 years old are called primary amenorrhea; after menarche, any time before normal menopause (except pregnancy or lactation), menstrual closure for more than 6 months is called secondary amenorrhea . This distinction is largely artificial, as the underlying factors that cause primary and secondary amenorrhea may sometimes be the same. basic knowledge The proportion of illness: 0.02%-0.03% Susceptible people: good for young women Mode of infection: non-infectious Complications: premature ovarian failure

The cause of amenorrhea

Uterine amenorrhea (30%)

The cause of amenorrhea is in the uterus. Although the ovarian function is normal, the endometrium does not produce a normal reaction, so it does not come to menstruation. The diseases that cause uterine closure are:

(1) Congenital uterine hypoplasia or absent: due to hypoplasia or non-development of the secondary renal tube in the embryo, manifested as primary amenorrhea, after puberty, secondary sexual characteristics such as breast, external genitalia, yin, mane Normal development, if the basal body temperature can sometimes show ovulation, it can also show periodic breast pain and abdominal discomfort, chromosomes and gonads are normal women, all kinds of ovarian hormones and pituitary gonadotropins FSH, LH, etc. At the normal female level, pelvic examination and B-ultrasound confirmed no uterus, if the primary amenorrhea with periodic abdominal pain should be considered congenital uterus or vaginal deformity, such as vaginal septum or hymen atresia, due to poor reproductive tract, menstrual blood Can not be discharged, B-ultrasound can be found in uterine hemorrhage and vaginal blood, surgery will open the channel will restore normal menstruation, and congenital uterine hypoplasia or lack of it will never have menstruation.

(2) endometrial injury or adhesion: often occurs after artificial abortion, postpartum or abortion curettage, due to excessive scratching injury to the endometrium, or postoperative infection caused by intrauterine adhesions, amenorrhea, when the uterine cavity adhesion When the menstrual blood can not flow out, manifested as amenorrhea accompanied by periodic abdominal pain and falling sense, the symptoms and basal body temperature, or B-ultrasound found uterine hemorrhage, you can confirm the diagnosis.

Some infections such as tuberculous endometritis, abortion or severe postpartum endometritis can cause damage to the endometrium, leading to amenorrhea, usually secondary amenorrhea, if the girl infected with endometrial tuberculosis before puberty Hair amenorrhea.

(3) uterine treatment: uterine amenorrhea can occur after uterus or endometrial resection or intrauterine radiation therapy.

(4) Androgen insensitivity syndrome: also known as testicular feminization, this is a special form of uterine amenorrhea, the patient's karyotype is 46, XY, the gonad is the testis, due to the lack of androgen receptors in the target organ or The body can not develop normal biological function, so it can not develop into a normal male. The full-type testicular feminization looks like a woman, has breast development, but the uterus lacks the upper part of the vagina as a blind end. Patients often have a primary amenorrhea after puberty. .

Ovarian amenorrhea (30%)

(1) Congenital ovarian hypoplasia: also known as Turner syndrome, is the most common type of adolescent girls with amenorrhea, which is a disease of abnormal sex chromosomes, most of which are abnormal X chromosome number, the basic karyotype is 45, X, can also be abnormal for sex chromosome structure, such as X chromosome and other arms, long arm or short arm deletion, circular X chromosome, etc., and some are multiple karyotype chimeras, patients with this disease in addition to primary amenorrhea and If the sexual characteristics are not developed, there is a group of abnormal physical manifestations, such as short stature, neck sputum, faceted sputum, barrel chest, elbow valgus and other deformities. A few cases with 46, XX chimerism may be secondary. Amenorrhea or occasional normal menstruation.

(2) simple gonadal dysplasia: including 46, XX simple gonadal dysplasia and 46, XY simple gonadal dysplasia, except for karyotype, the clinical manifestations are similar, both manifested as primary amenorrhea, secondary sexual development is not developed The height is high, the limbs are long, the body shape is castrated, the gonads are mostly cord-like, and the gonads with karyotype XY are prone to tumors. Peking Union Medical College Hospital has reported 5 cases of XY simple gonadal dysplasia, all of which have been removed, and pathologically confirmed. There have been tumors, including 2 cases of gonadal cell tumor, 1 case of sexomyma and supporting cell tumor, so XY simple gonadal dysplasia should be surgically removed as soon as possible.

(3) Premature ovarian failure: also known as early menopause, that is, menopause occurs before the age of 40, occasionally seen in young women under the age of 20, most of them are secondary amenorrhea, rarely primary amenorrhea, ovarian atrophy, low estrogen levels, FSH liters Up to the level of menopause, the true mechanism of premature ovarian failure is not very clear, it has been observed that premature ovarian failure is related to the autoimmune system, because the premature ovarian failure is often accompanied by a variety of autoimmune diseases, such as Addison disease, thyroiditis, parathyroid function. Low, myasthenia gravis, diabetes, etc., can detect antibodies against ovarian tissue. It has been observed that there are anti-gonadotrophin receptor antibodies on the ovary, which hinders the binding of FSH to receptors on the cell membrane. It has also been reported that there are families with premature ovarian failure. Factors, early menopause in the patient's mother or sister.

(4) ovarian insensitivity syndrome: clinical manifestations with premature ovarian failure, may be primary amenorrhea or early menopause, and different from premature ovarian failure, there are many normal follicles in the ovary of such patients, but in a state of rest, unable to develop Mature and ovulation, the pathogenesis of ovarian insensitivity syndrome is not very clear, more explanation is that the ovary has anti-gonadotrophin receptor antibody or receptor bio-function disorder, the reproductive hormone changes of the disease is the same as premature ovarian failure, If B-ultrasound or laparoscopy sees that the ovary does not shrink and there are small follicles, it can be differentiated from premature ovarian failure.

(5) Ovariectomy syndrome: Ovariectomy or tissue destruction, mostly due to surgical removal of bilateral ovaries or bilateral ovaries after radiation therapy, ovarian tissue is destroyed and loss of function, manifested as primary or secondary amenorrhea, severe ovary Inflammation can also destroy ovarian tissue and cause amenorrhea.

Pituitary amenorrhea (30%)

(1) Primary pituitary gonadotropin: It is a rare genetic disease, characterized by isolated gonadotropin deficiency, patients often have primary amenorrhea, sexual characteristics are not developed, and some are accompanied by olfactory disorders, pituitary gonads Hormones FSH and LH and ovarian sex hormones are low levels.

(2) secondary anterior pituitary dysfunction: due to pituitary injury, hemorrhage, inflammation, radiation and surgery destroy the function of the anterior pituitary, causing gonadotropins and other hormones in the anterior pituitary, such as thyroid stimulating hormone and adrenal cortex Lack of hormones, etc., in addition to hypogonadism, sometimes hypothyroidism and adrenal insufficiency, showing amenorrhea, weight loss, fatigue, cold, hypoglycemia, hypotension, low basal metabolism and loss of libido, etc. Because of postpartum hemorrhage, Xihan syndrome, which occurs in the anterior pituitary tissue caused by shock, is a typical case of secondary hypopituitarism.

(3) pituitary tumor: also a common cause of pituitary amenorrhea, can directly disrupt the function of the anterior pituitary or destroy the regulation channel between the hypothalamus and the pituitary, interfere with the secretion and regulation of reproductive hormone, leading to amenorrhea, pituitary tumor There are many types, such as growth hormone tumor, prolactinoma, thyroid stimulating hormone adenoma, adrenocortical adenoma, mixed tumor of gonadotropin adenoma and non-functional pituitary adenoma, the most common pituitary related to amenorrhea. The tumor is a prolactinoma.

Hypothalamic amenorrhea (10%)

Refers to an obstacle in the hypothalamus or hypothalamus, due to hypoxia-derived gonadotropin-releasing hormone (GnRH) deficiency or secreted form of dysregulation leading to amenorrhea, including hypothalamic-pituitary dysfunction, central nervous system-hypothalamic dysfunction, and other endocrine Abnormal amenorrhea caused by inappropriate feedback regulation of the hypothalamus.

(1) hypothalamic-pituitary unit dysfunction: may be congenital hypothalamic-pituitary dysfunction, may also be secondary to injury, tumor, inflammation and radiation caused by hypothalamic hormone GnRH synthesis and secretion disorders, clinical The most common hypothalamic-pituitary unit dysfunction caused by amenorrhea is hyperprolactinemia, which is due to the hypothalamic prolactin inhibitor (mainly dopamine) deficiency, which causes the pituitary to secrete excessive prolactin, in addition, any Other causes prevent dopamine inhibition of prolactin secretion, can occur hyperprolactinemia, such as tumor compression pituitary stalk will block dopamine inhibition of prolactin secretion; some drugs can consume dopamine storage or block dopamine Receptor action increases prolactin secretion, such as metoclopramide (metamethoxazole), chlorpromazine (hibernation) and other drugs, other pituitary adenomas, hypothyroidism, sucking nipples and chest irritation can also cause Increased prolactin secretion, elevated prolactin levels can also act on the hypothalamus, inhibit the synthesis and release of GnRH; act on the pituitary, reduce the sensitivity of the pituitary to GnRH; In addition to amenorrhea, lactation is often one of the important manifestations of hyperprolactinemia. However, many patients cannot find lactation by themselves. About half of them are found in physical examinations due to amenorrhea or irregular menstruation. Laboratory tests will find elevated levels of blood prolactin, >30 ng / ml, follicle stimulating hormone (FSH), luteinizing hormone (LH) is comparable to or lower than normal early follicular phase, estrogen levels are low, excluding pituitary Tumors should be used for imaging examination of the sellar area. If necessary, the visual field should also be checked to guard against the visual field defects caused by the oppression of the optic nerve.

(2) Central-hypothalamic dysfunction: mental factors, changes in the external or internal environment can lead to amenorrhea through the central nervous system through the neuroendocrine pathways of the cerebral cortex, thalamus and hypothalamus, or through the limbic system to influence hypothalamic function. In young women, the more common typical conditions such as mental stimulation, emotional stress or sudden amenorrhea after changing the environment, FSH, LH and estradiol (E2) levels can be in the normal range, due to the interference of GnRH pulse secretion rhythm No ovulation, resulting in amenorrhea, due to deliberate weight loss, the pursuit of slim body caused by anorexia nervosa is common in young girls, they from dieting to anorexia or the formation of quirky eating habits, severe weight loss, amenorrhea, resulting in thyroid, adrenal gland, gonads and The function of multiple organs such as the pancreas is low, and even water and electrolyte disturbances and extreme malnutrition are life-threatening. Most of these patients can be asked for medical history related to mental and psychological factors. Generally, FSH, LH and E2 levels are low, in addition, false pregnancy It is also a central hypothalamic dysfunction caused by mental and psychological factors, often Born child eager hope of infertile women.

(3) Other endocrine abnormalities cause inappropriate feedback adjustment:

1 excessive androgen: excessive androgen can come from the ovary and / or adrenal gland, the most common clinical adolescent women are polycystic ovary syndrome, the main pathophysiological characteristics are excessive and sustained androgen Anovulatory, manifested as amenorrhea or menstrual disorders, hairy and obese, and a series of symptoms and signs of ovarian polycystic enlargement, excessive androgen mainly from the ovary, partly from the adrenal gland, increased androgen in the surrounding tissue Converted to estrogen, this continuous non-cyclical estrogen conversion increases the sensitivity of the pituitary to Gn-RH, leading to increased LH secretion and loss of periodicity, while FSH is relatively insufficient, and blood circulation in patients with polycystic ovary syndrome The level of androgen in the diet is about 50% to 100% higher than that of normal women. If the androgen is abnormally elevated, it should be distinguished from other conditions, such as ovarian or adrenal gland secretion of androgen tumor, congenital adrenal hyperplasia caused by enzyme deficiency. And other sexual developmental abnormalities.

Congenital adrenal hyperplasia is another common androgenic condition in girls. It is due to the lack of an enzyme in the adrenal cortex during the synthesis of steroids to produce excessive androgen, making the hypothalamic-pituitary-gonadal axis In addition to irregular menstruation or amenorrhea, the patient often has varying degrees of masculinization and even genital malformations.

2 thyroid hormone abnormalities: thyroid hormones participate in the metabolism of various substances in the body, therefore, too much or too little thyroid hormone can directly affect reproductive hormones and reproductive function, such as some patients with hyperthyroidism can show less menstruation or amenorrhea.

3 Secretory hormone tumors: more common in ovarian and adrenal tumors, excessive secretion of sex hormones through the feedback mechanism can inhibit the secretion regulation of the hypothalamus and pituitary, destroy its periodicity, leading to anovulation or amenorrhea, according to blood estrogen or The abnormal increase in androgen levels can be used to judge the nature of the hormone secreted by the tumor. Careful pelvic examination, imaging examination of the corresponding parts, such as pelvic and adrenal B-ultrasound, CT scan, MRI, etc. contribute to the diagnosis of the tumor.

4 Exercise and amenorrhea: athletes, ballerinas, etc. due to engaging in large-volume activities, too little fat in the body, exercise amenorrhea, energy consumption and mental stress of training and competition can affect neuroendocrine and metabolic functions, making the hypothalamic GnRH Abnormal secretion, leading to amenorrhea.

5 drug-induced amenorrhea: some drugs can affect hypothalamic function and cause amenorrhea, especially thiazide sedatives, high-dose applications can often cause amenorrhea lactation, menstruation can be restored after stopping the drug, a small number of women injected long-acting injectables or long-term oral High-dose contraceptives lead to secondary amenorrhea, which is caused by the drug's persistent inhibition of the hypothalamic-pituitary axis.

6 Obesity: Obesity is sometimes accompanied by other endocrine abnormalities. Here, it refers to simple obesity. The body weight is closely related to the hypothalamic-pituitary-gonadal axis. Adipose tissue is the place where estrogen accumulates and is the main part of androgen conversion to estrogen. A large amount of adipose tissue leads to an increase in estrogen. This non-periodic estrogen produces a continuous inhibition of the hypothalamic-pituitary body through a feedback mechanism, resulting in anovulation or amenorrhea.

Amenorrhea prevention

1, less menstruation or late menstruation can develop into amenorrhea, actively cure less menstruation or later, can reduce the incidence of amenorrhea.

2, to determine the etiology and location of amenorrhea, the treatment of amenorrhea effect and prognosis have a certain reference value, the following hypothalamic amenorrhea, caused by mental factors, environmental changes, malnutrition, etc., drug treatment prognosis is better, and such as tuberculosis Uterine amenorrhea caused by bacilli, the endometrium has been destroyed, the possibility of restoring menstruation is less, and if the progesterone test is positive (transfer after progesterone), the prognosis is good.

3, in the Chinese medical literature, there are those who do not come to menstruation for a lifetime, called "dark classics", which requires caution, carefully ask the medical history before using the drug.

4. There are many women taking diet pills at present. Some women have amenorrhea due to obesity. They also have diet due to obesity, resulting in anorexia and amenorrhea. There are many abortions and amenorrhea. The above amenorrhea can be prevented. Some drugs Must be taken under the guidance of a doctor to prevent adverse reactions.

5, for the intractable amenorrhea alone with traditional Chinese medicine or Western medicine, the effect of poor treatment can be combined with Chinese and Western medicine cycle treatment, after the onset of treatment gradually reduce the amount of Western medicine, and ultimately Chinese medicine treatment.

Amenorrhea complications Complications of premature ovarian failure

Uterine amenorrhea: due to the endometrium does not respond to hormones or low response, more common in endometrial tuberculosis, endometrial damage (such as uterine intestines after the curettage), endometrial adhesions and dysplasia, etc. Even if the patient is adjusted by artificial hormones (artificial cycle), the endometrium will not fall off.

Ovarian amenorrhea: mainly caused by ovarian disease, because the level of estrogen is too low, can not promote endometrial growth, such as congenital ovarian dysplasia, premature ovarian failure, non-responsive ovary, etc., these people have low levels of estrogen and gonads The hormone is normal or high, and artificial cycle treatment can be applied.

Pituitary amenorrhea: amenorrhea is associated with inadequate pituitary function, which can be seen in craniocerebral injury, Xi's syndrome, and after brain radiation therapy.

Hypothalamic amenorrhea: The problem lies in the hypothalamus, which can be caused by neurological organic diseases such as inflammation, tumors, ischemia, etc. It can also be caused by mental factors, environmental changes, systemic diseases, malnutrition and drug effects.

Amenorrhea symptoms common symptoms sports amenorrhea polycystic ovary secondary amenorrhea pituitary amenorrhea pituitary dysfunction postpartum no milk secretion pulsating headache postpartum menstruation no longer come to the uterus amenorrhea menopause transition period and ...

1. Clinical manifestations of physiological amenorrhea

(1) Pre-puberty amenorrhea: girls 6 to 9 years old can detect dehydroepiandrosterone (DHEA) and its sulfate from the urine, which rises rapidly at the age of 10, which is the first appearance of adrenal function, derived from the adrenal gland. Androgen promotes pubic hair, mane appears, and the body grows rapidly, because the hypothalamic-pituitary-ovarian axis needs further development, estrogen levels are still low, endometrial proliferation is poor, and bleeding is not caused, so menstruation is delayed. At this stage before menarche, there is no physiological phenomenon in menstrual cramps. Some girls have a menstrual flow for a period of one and a half years after menarche, and it is normal for anovulatory menstruation.

(2) Lactation amenorrhea: Breastfeeding women who are weaned at any time often return to menstruation 2 months after weaning.

(3) Menopausal transition period and postmenopausal amenorrhea: uterine bleeding may occur in the menopausal transition period for several months. After menopause, the reproductive organs gradually shrink and the uterus shrinks.

2. Clinical manifestations of pathological amenorrhea

(1) Uterine amenorrhea and cryptography:

1 non-porous hymen: clinical symptoms gradually appear, initially can feel cyclical lower abdominal bulge, pain, progressive aggravation, hematoma compression of the urethra and rectum, can cause urination and difficulty in defecation, suprapubic pain, anal bulge, frequent urination, Urinary urgency, dysuria, and even drip urination, when the uterine cavity massive blood, can cause ureteral displacement, distortion, stagnant water, and even hydronephrosis, when the blood flows back into the pelvis, it can stimulate the abdominal membrane to produce severe abdominal pain, abdominal examination When you can see a painful mass, there is deep tenderness, a small number of patients may have mild muscle tension, rebound pain, gynecological examination found that the hymen thinning bulging, no opening, the surface is purple blue, anal Diagnosis can touch vaginal hematoma, uterus enlargement, tenderness, double attachment is a sausage-like strip, tenderness, elderly patients with irregular disease, irregular thickness, varying degrees of tender nodules, B-mode ultrasound or CT The examination can detect solid vaginal barrel-like masses, uterine cavity and effusion in the fallopian tube.

2 congenital absence of vagina: this disease often does not come to menstruation during puberty, or periodic abdominal pain, or difficult sexual intercourse after marriage, or infertility, check at the time of treatment, breast, secondary sexual characteristics and external genital development, ovary The function is normal; the basal body temperature (BBT) is biphasic, and the blood reproductive hormone is measured periodically in women of childbearing age. If accompanied by a uterus deficiency or a primordial uterus, it can be asymptomatic; if there is a functional endometrium of the uterus, then There may be periodic abdominal pain due to progressive aggravation of uterine hemorrhage. In the gynecological examination, the vulva can be found without vaginal opening. If the patient is pregnant for a long time after marriage, it can be found that there is a shallow fossa formed by sexual intercourse in the vestibular area. Most patients can touch a cord-like uterus in the pelvic cavity. If the patient has a functional endometrium, the patient will be younger and a small uterus may be found when the patient is examined, or a normal or enlarged painful uterus may be touched. Touching the tubal-like thickening of the fallopian tube, B-ultrasound, CT and other imaging examinations can confirm the above findings, and can find urinary system malformations.

3 vaginal diaphragm: incompletely separated, because the menstrual blood can flow through the small hole, so no amenorrhea, complete transection due to menstrual discharge disorder, primary amenorrhea, periodic lower abdominal pain and other performance.

In the complete vagina, the upper section of the gynecological examination can be found to have a certain length, the width of the lower part of the vagina, the top is closed, touching a diaphragm with a sense of volatility, the vagina above it, like a sac sexy, the lower part of the vagina is sometimes difficult Different from vaginal atresia, careful gynecological examination combined with posterior cavity puncture is an effective method of identification.

4 vaginal atresia: clinical manifestations of primary amenorrhea, periodic lower abdominal pain, gynecological examination see genital dysplasia, hymen no hole, but the surface color is normal, no outward bulging sign, can be found in the anus examination about 3cm from the vulva There is a vaginal cystic mass protruding to the rectum. When the abdominal pain is high, the tension of the mass is large. The transabdominal or transrectal B-ultrasound can detect a cystic mass in the upper 3~4cm from the anus. Puncture of the vulva to the mass, can extract old dark red blood or chocolate-like paste, type II vaginal complete atresia, clinical manifestations of primary amenorrhea, periodic lower abdominal pain, etc., gynecological examination on the pelvic side or At the height, there is a mass of 4 to 8 cm in diameter, which is a deformed uterus or an attachment mass.

5 Cervical atresia: If the patient has no endometrium, only the primary amenorrhea, if there is endometrium, its clinical manifestations are similar to congenital absence of vagina.

6 congenital absence of uterus: clinical manifestations of primary amenorrhea, anal abdominal examination can not reach the uterus, B-ultrasound, CT and MRI can not detect the presence of the uterus.

Amenorrhea check

1. Vaginal exfoliation cell examination is a commonly used method to understand the level of estrogen. After immersing physiological saline with cotton stick, take the exfoliated cells on the side wall of the upper vagina, apply it on the slide, fix and stain, observe the table, middle and bottom. The percentage of stratified cells, the higher the percentage of superficial cells, reflects the higher estrogen levels.

2. Cervical mucus If the cervical mucus of the amenorrhea is found to be transparent, the thin mucus with good pulling force, after drying on the glass piece, the fern-like crystal can be seen under the microscope, indicating that the patient's ovary has the function of secreting estrogen.

3. Drug-testing This is a clinically used diagnostic test for amenorrhea, especially in experimental equipment lacking hormone determination. Drug testing is important for assessing ovarian function and endometrial function.

(1) Progesterone test: application of progesterone to amenorrhea patients, intramuscular injection of 20mg / d, for 3 to 5 days; or medroxyprogesterone (ancillary progesterone) 5 ~ 10mg / d, and even served for 5 to 7 days, 3 to 7 days after withdrawal (usually no longer than 2 weeks), withdrawal of drug withdrawal is positive, suggesting that the endometrium has function, can exclude uterine amenorrhea; ovary has the function of secreting estrogen, endometrium After being affected by a certain level of estrogen, it can respond to progesterone and fall off, indicating that amenorrhea is not a lack of estrogen, but a lack of progesterone due to various anovulation. If the progesterone test is negative, there is no bleeding after stopping the drug. Prompt the following possibilities: First, the ovarian function is low, there is no proper estrogen on the endometrium; second, the ovarian function is normal, but the endometrial defect or damage, can not respond to estrogen, that is, does not rule out uterus Amenorrhea; the third is not to exclude pregnancy.

(2) Estrogen test: amenorrhea patients with negative progesterone test oral administration of diethylstilbestrol 1 mg / d, or ethinyl estradiol 10 g / d, or other biological estrogen for 20 days, the last 3 to 5 days plus progesterone 20mg / d, intramuscular injection, 3 to 7 days after stopping the drug to observe whether there is withdrawal of blood, if there is still no bleeding, suggesting that the lesion may be in the uterus, that is, uterine amenorrhea, with the above test withdrawal of blood, indicating endometrium to female The role of progesterone is reactive, and normal growth and shedding changes can occur. The cause of amenorrhea should be in the ovary or higher, and the level of sex hormones should be further tested to confirm the diagnosis.

4. Determination of sex hormone levels Determination of pituitary hormones is particularly important for the diagnosis of amenorrhea. Patients with amenorrhea and low estrogen should further measure the levels of blood FSH, LH and prolactin (PRL). If FSH and LH increase, Tips for ovarian amenorrhea, if FSH, LH is low, the cause may be in the pituitary or hypothalamic FSH, LH is equivalent to the normal follicular phase, amenorrhea is due to hypothalamic secretion dysfunction; if LH is elevated and FSH is relatively insufficient, more The diagnosis of cystic ovarian syndrome should be considered; if abnormal PRL is elevated, amenorrhea is caused by hyperprolactinemia, and the cause of hyperprolactinemia should be further examined, especially the possibility of pituitary tumors.

Amenorrhea diagnosis

diagnosis

First, the history of patients with primary amenorrhea should ask about the growth and development process, whether there have been viral infections or tuberculous peritonitis in childhood, patients with similar diseases in the family, for menopausal patients should understand the age of menarche, amenorrhea , menstrual conditions before menopause, and whether there are incentives such as mental stimulation or changes in living environment; whether they have taken contraceptives, whether they have received hormone therapy and response to treatment; whether there is periodic abdominal pain, how healthy in the past, No tuberculosis or thyroid disease; with or without headache, visual impairment, or conscious galactorrhea, if you have a history of pregnancy, you need to ask about abortion, curettage, postpartum hemorrhage and breastfeeding history.

Second, physical examination

1, systemic attention to development, nutrition, fat and mental and intelligence, weight and height, check the development of secondary sexual characteristics, hair and how much distribution, light breasts, observe the presence or absence of lactation.

2, gynecological examination to pay attention to the presence of abdominal and groin mass, external genital development and presence or absence of deformity, whether the uterus and ovary increase, there are no mass or nodules at the attachment of the uterus.

By consulting the medical history and physical examination, the pregnancy can be excluded, and the false amenorrhea caused by the hymen or vaginal atresia of the hymen can be excluded.

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