When Menstruation Not Come
Came too late for most women menstruation cause anxiety. In couples who longed for children lead to feelings of hope - hope anxious about pregnancy, in contrast to other women who refuse pregnancy raises intention to strive to make menstruation is coming back.
In general, no menstruation is divided into two, namely:
· Physiological amenorrhea: Pregnancy, lactation, menopause, prabubertas.
· Amenorrhea pathologic divided by 2 again, namely:
· Primary amenorrhea is a woman who has never
menstruation up to the age of 16 years. Average - Average menarse (first period) was 12 years (range 9-16 years) at 99% of normal women.
· Secondary amenorrhea is a woman of reproductive age who have experienced menstruation, but her periods stop for at least 3 months - respectively.
The growth of secondary sexual signs (breast and hair pubes / armpit) appeared two years before menarse. Failure message has appeared not menstruating after two years raised breast and hair pubes / armpit is abnormal. Similarly, the absence of any clear sign Abnormal secondary sex at the age of 16 years. Causes of primary amenorrhea: 60% due to the abnormal development of the ovaries / genital tract / genital outside and 40% are due to hormonal disturbances. It is wise for parents to immediately check / do not delay the evaluation of these circumstances are easily recognizable in their daughters.
Pathologic amenorrhea is not a clinical picture of a collection of diseases, but must be seen as a symptom of a disease, which should receive serious attention.
The cause is the emergence of menstruation can be caused by the organ responsible for the occurrence of the menstrual cycle, and the process of menstrual blood loss. Organ - The organ is:
1. Hipotalamushiposfisis
2. Ovary
3. Rahim
The first stage of evaluation of amenorrhea is a careful history will menstrual history, psychosocial stress / emotional and sexual activity. The second phase is the development of secondary sex physical examination, and the development of eg hormonal gland goiter (thyroid) or out of milk (galactorrhea). If no abnormality ensure that no pregnancy.
The following laboratory examination is important levels of prolactin and thyroid levels (TSH). Also conducted tests of progesterone (progesterone hormone drug administration), if a positive result on prolactin levels and normal thyroid then amenorrhea occurs due to anovulatory cycles. When the diagnosis of high prolactin levels hyperprolactinemia, when TSH is high then the diagnosis is hypothyroidism.
If the test result is negative and progesterone unclear diagnosis tests estrogen and progesterone (hormone estrogen that is taking medication for 21 days) and the hormone progesterone 10 days) after the drug expires arise when menstruation continue examination FSH hormone. If high FSH and patients aged over 30 years, the indications for chromosome examination. If found to be mosaic with the Y chromosome, a 25% chance of malignant ovarian tumors. If FSH normal / low do head CT scan is a pituitary tumor. When not arise menstruation, problems in the womb. Asherman's syndrome is the most likely.
Treatment of amenorrhea:
Treatment of amenorrhea depends on the cause and the patient's wishes. But best directed at the background causes. If found background medical disease, the disease must be addressed (eg in women with hiperprolaktin, dealt with the administration of lowering prolactin, thyroid therapy on thyroid disorders) If you do not find the background causes of the treatment depends on the patient's wishes or fertility status. If patients want to get pregnant then the treatment is induction of ovulation, when not managed to become pregnant at least regular menstruation. If the patient does not want to get pregnant, the treatment of estrogen dependent status of these patients, when hipoestrogen, give estrogen replacement therapy if there is no uterus. If the cause of anovulation with normal or high estrogen status should be given the hormone progesterone periodically to menimhulkan artificial menstrual bleeding (bleeding lucut) to reduce the risk of endometrial cancer. Bleeding lucut with the hormone progesterone can be administered monthly or 2-3 months.
Source: http://www.rsazra.co.id
In general, no menstruation is divided into two, namely:
· Physiological amenorrhea: Pregnancy, lactation, menopause, prabubertas.
· Amenorrhea pathologic divided by 2 again, namely:
· Primary amenorrhea is a woman who has never
menstruation up to the age of 16 years. Average - Average menarse (first period) was 12 years (range 9-16 years) at 99% of normal women.
· Secondary amenorrhea is a woman of reproductive age who have experienced menstruation, but her periods stop for at least 3 months - respectively.
The growth of secondary sexual signs (breast and hair pubes / armpit) appeared two years before menarse. Failure message has appeared not menstruating after two years raised breast and hair pubes / armpit is abnormal. Similarly, the absence of any clear sign Abnormal secondary sex at the age of 16 years. Causes of primary amenorrhea: 60% due to the abnormal development of the ovaries / genital tract / genital outside and 40% are due to hormonal disturbances. It is wise for parents to immediately check / do not delay the evaluation of these circumstances are easily recognizable in their daughters.
Pathologic amenorrhea is not a clinical picture of a collection of diseases, but must be seen as a symptom of a disease, which should receive serious attention.
The cause is the emergence of menstruation can be caused by the organ responsible for the occurrence of the menstrual cycle, and the process of menstrual blood loss. Organ - The organ is:
1. Hipotalamushiposfisis
2. Ovary
3. Rahim
The first stage of evaluation of amenorrhea is a careful history will menstrual history, psychosocial stress / emotional and sexual activity. The second phase is the development of secondary sex physical examination, and the development of eg hormonal gland goiter (thyroid) or out of milk (galactorrhea). If no abnormality ensure that no pregnancy.
The following laboratory examination is important levels of prolactin and thyroid levels (TSH). Also conducted tests of progesterone (progesterone hormone drug administration), if a positive result on prolactin levels and normal thyroid then amenorrhea occurs due to anovulatory cycles. When the diagnosis of high prolactin levels hyperprolactinemia, when TSH is high then the diagnosis is hypothyroidism.
If the test result is negative and progesterone unclear diagnosis tests estrogen and progesterone (hormone estrogen that is taking medication for 21 days) and the hormone progesterone 10 days) after the drug expires arise when menstruation continue examination FSH hormone. If high FSH and patients aged over 30 years, the indications for chromosome examination. If found to be mosaic with the Y chromosome, a 25% chance of malignant ovarian tumors. If FSH normal / low do head CT scan is a pituitary tumor. When not arise menstruation, problems in the womb. Asherman's syndrome is the most likely.
Treatment of amenorrhea:
Treatment of amenorrhea depends on the cause and the patient's wishes. But best directed at the background causes. If found background medical disease, the disease must be addressed (eg in women with hiperprolaktin, dealt with the administration of lowering prolactin, thyroid therapy on thyroid disorders) If you do not find the background causes of the treatment depends on the patient's wishes or fertility status. If patients want to get pregnant then the treatment is induction of ovulation, when not managed to become pregnant at least regular menstruation. If the patient does not want to get pregnant, the treatment of estrogen dependent status of these patients, when hipoestrogen, give estrogen replacement therapy if there is no uterus. If the cause of anovulation with normal or high estrogen status should be given the hormone progesterone periodically to menimhulkan artificial menstrual bleeding (bleeding lucut) to reduce the risk of endometrial cancer. Bleeding lucut with the hormone progesterone can be administered monthly or 2-3 months.
Source: http://www.rsazra.co.id
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