Uterine amenorrhea

Introduction The endometrium is periodically changed by the stimulation of sex hormones secreted by the ovaries. When the endometrium is peeled off, there is a menstrual cramp. Therefore, in cases of congenital absence of uterus or uterus dysplasia, endometrial damage or hysterectomy, Even if the ovarian function is sound, the secretion of sex hormones is normal, and there is no menstrual cramps. The cause of this amenorrhea is in the uterus, so it is also called uterine amenorrhea.

Cause

Environmental changes, trauma, overwork, sudden weight loss, chronic wasting diseases and surgery. Have a history of blood loss after postpartum or abortion, history of infection, history of shock; used contraceptives.

Common diseases that cause uterine amenorrhea are:

(A) endometrial damage or adhesion syndrome: often occurs after artificial abortion, postpartum hemorrhage or postpartum hemorrhage and curettage, mostly due to excessive curettage, damage to the uterus, causing intrauterine adhesions, amenorrhea.

(B) endometritis: the most common endometriosis that causes amenorrhea is tuberculous endometritis, other endometritis after abortion or postpartum severe endometritis can also occur amenorrhea.

(C) uterine hypoplasia or lack of: due to dysplasia or dysplasia of the uterus due to hypoplasia or lack of development of the uterus, often manifested as primary amenorrhea.

(4) Amenorrhea occurs after hysterectomy or intrauterine radiation therapy after removal of the uterus due to genital tract diseases or destruction of the endometrium by intracavitary radiotherapy for certain uterine malignancies.

an examination

Related inspection

Progesterone progesterone blood withdrawal test abdominal plain film artificial cycle test

1, medical history: 18 years of age without menstruation, for primary amenorrhea. Those who have stopped menstruation for more than 3 cycles after normal menstruation are secondary amenorrhea.

Primary amenorrhea should consult a similar family history. Secondary amenorrhea should ask about the causes of amenorrhea, such as environmental changes, trauma, overwork, sudden weight loss, chronic wasting diseases and surgery. Whether there is a history of blood loss after postpartum or abortion, history of infection, history of shock; whether contraceptives have been used, whether it is accompanied by hairy, hair loss, chills, headache, lactation, vision changes and other symptoms. Whether there is uterine bleeding after progesterone or estrogen.

2, physical examination: pay attention to body shape, height, weight, skin color, hair distribution, breast development, with or without lactation and congenital malformations.

3, gynecological examination: pay attention to vulvar development, pubic hair distribution, clitoris size, with or without vagina, with or without uterus and size, with or without pelvic mass.

4. Auxiliary inspection:

(1) Examination of uterus and endometrium morphology and function:

1 progesterone test: progesterone 20mg, intramuscular injection, or medroxyprogesterone 10mg, oral, 1 / d, for 5d; withdrawal bleeding within 2 ~ 7d after stopping the drug was positive. This indicates that the lower genital tract is smooth, functional endometrium and ovary can still secrete a certain amount of estrogen to stimulate endometrial growth. If only a small amount of blood is present, suggesting that estrogen is at a critical level, close follow-up should be followed and the trial repeated periodically. The test is negative and must be tested for estrogen.

2 estrogen test: estradiol benzoate 2mg, intramuscular injection, 1/3d, a total of 7 times, or diethylstilbestrol 1mg or ethinyl estradiol 0.05mg, 1d, oral 21d, the last 5d of the course, daily intramuscular injection of progesterone 20mg Or oral medroxyprogesterone 10mg. There was withdrawal bleeding within one week of withdrawal, indicating that the endometrial response was good, and the cause of amenorrhea was the lack of estrogen. A negative result can be retested for a course of treatment to confirm the diagnosis; if it is still negative, suggesting that the endometrium is defective, it may be:

Primary amenorrhea should be further analyzed for karyotypes to exclude congenital malformations such as gonadal dysplasia;

Secondary amenorrhea, endometrial biopsy, diagnostic curettage, hysteroscopy or uterine tubal lipiodol angiography, exclude uterine adhesions, genital tuberculosis, if necessary, endometrial tissue tuberculosis culture.

(2), ovarian function test: basal body temperature, regular vaginal exfoliation cell smear and cervical mucus examination; and determination of blood estrogen, progesterone, androgen content, or 24h urine, check estrogen and pregnancy Alcohol discharge. For patients with ovarian dysfunction, further examination is performed to identify the lesion (ovary, pituitary or hypothalamus).

(3), pituitary function check:

1 gonadotropin prolactin (PRL) determination: radioimmunoassay determination of blood follicle stimulating hormone (FSH) luteinizing hormone (LH) content (such as estrogen, progesterone test, can be determined by delay of two weeks). At a time (9 am), blood samples were taken every 15 minutes for a total of 3 times. The average value of the measurements or the mixture was measured to avoid excessive errors. Results: Gonadotropin is high, reflecting the lesion in the ovary, laparoscopic examination, direct observation of the shape of the uterus, fallopian tube, ovary, and ovarian biopsy, to confirm the diagnosis of gonadal dysplasia, hermaphroditism, ovarian impedance syndrome or system Premature ovarian failure (premature menopause). Gonadotropin is low and should be further tested for pituitary stimulation to distinguish the primary system from the pituitary itself or the nervous system above the hypothalamus. Increased PRL, seen in amenorrhea lactation syndrome. FSH, LH and PRL were normal, and a saddle X-ray film should be taken to identify the empty sella syndrome and pituitary tumors.

2 pituitary stimulation test luteinizing hormone releasing hormone (LHRH) test: LHRH 100g, intravenous infusion for 4h, before and after intravenous infusion 0.5, 0.75, 1, 1.5, 2, 4h blood 2ml each determination of blood LH content (RIA )The change. Under normal conditions, it rises 30 to 45 minutes after instillation, decreases from 60 to 90 minutes, and rises for the second time within 2 to 4 hours, and can be maintained for 4 hours.

The result is judged:

There was a first ascending response, but there was no second ascending phenomenon, indicating pituitary failure.

Delayed response occurred 2 to 4 hours after instillation, suggesting that the hypothalamus was damaged and the pituitary was inert.

LHRH repeated stimulation: long-term lack of LHRH, LSRH 100g, intramuscular injection, 1 / d, continuous 5d; or intravenous infusion 7h, 1 / d, for 3 days. The LH response recovered after treatment, suggesting that the lesion is in the hypothalamus.

(4), thyroid function test: basal metabolic rate, serum T3, T4 and 125I-T3 resin uptake test, thyroid 131I test.

(5), adrenal function test.

Differential diagnosis

Differential diagnosis of uterine amenorrhea:

1. Ovarian amenorrhea: The ovaries are organs that provide eggs. There is a cycle of follicular development, the genital tract is smooth, and menstruation can occur. Without the development of the egg, there is no menstruation. This type of amenorrhea is called ovarian amenorrhea. The reason may be due to congenital ovarian hypoplasia without egg, or amenorrhea due to exhaustion of the egg after many reasons. The former is primary ovarian amenorrhea; the latter is secondary ovarian amenorrhea, also known as premature ovarian failure.

2, pituitary amenorrhea: normal menstruation is controlled by the central nervous system, hypothalamic-pituitary anterior lobe and ovarian function. Any factor that directly or indirectly affects hypothalamic-pituitary function, leading to hypothalamic secretion of gonadotropin-releasing hormone (GnRH), and dysfunction or dysfunction of anterior pituitary gonadotropin (GnH), thereby affecting ovarian function for more than 3 months The menopause is called hypothalamic-pituitary amenorrhea.

3, hypothalamic amenorrhea: normal menstruation is controlled by the central nervous system, hypothalamic-pituitary anterior lobe and ovarian function. Any factor that directly or indirectly affects hypothalamic-pituitary function, leading to hypothalamic secretion of gonadotropin-releasing hormone, and hypofunction or disorder of gonadotropin secretion in the anterior pituitary gland, thereby affecting ovarian function caused by menopause for more than 3 months, For the hypothalamus - pituitary amenorrhea.

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