What Is Hypothalamic Amenorrhea?

Normal menstruation is controlled by the mutual regulation of the central nervous system, hypothalamus-anterior pituitary gland, and ovarian function. Any factor that directly or indirectly affects hypothalamus-pituitary function, causes hypothalamus to secrete gonadotropin-releasing hormone, and anterior pituitary gland to secrete hypogonadism or disorder, which affects ovarian function and causes menopause for more than 3 months. Hypothalamic-pituitary amenorrhea.

Hypothalamic amenorrhea

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Normal menstruation is controlled by the mutual regulation of the central nervous system, hypothalamus-anterior pituitary gland, and ovarian function. Any factor that directly or indirectly affects hypothalamus-pituitary function, causes hypothalamus to secrete gonadotropin-releasing hormone, and anterior pituitary gland to secrete hypogonadism or disorder, which affects ovarian function and causes menopause for more than 3 months. Hypothalamic-pituitary amenorrhea.

Causes of hypothalamic amenorrhea Mental and neurological stress, fear, anxiety, environmental changes, regional migration, and cold stimulation can all cause amenorrhea. Due to various stimuli from inside and outside, the dysfunction between the central nervous system and the hypothalamus affects the pituitary function. Among them, the luteinizing hormone (LH) is the most susceptible to dysfunction of ovulation. When the degree of inhibition is intensified, ) When affected, obstacles to follicular development can lead to amenorrhea. Causes of hypothalamic amenorrhea 2. Intracranial organic lesions such as prolactinoma, craniopharyngioma, pineal tumor, thalamic tumor, third ventricle tumor, etc .; congenital malformations (hamsteroma); inflammation (such as acute meningitis and chronic granulomatosis) Sexual damage-tuberculous meningitis); sarcoidosis, xanthomas and histiocytosis; vascular damage (such as bleeding, infarction, ischemia, capillary hyperplasia, and fat embolism, etc.); trauma, degeneration, and hematoporphyrin Disease, Wernicke syndrome (hemorrhagic and necrotic damage to the brain caused by vitamin B deficiency); all of the above lesions can cause hypothalamic dysfunction and cause amenorrhea.

Causes of hypothalamic amenorrhea 3. Chronic wasting diseases such as chronic liver, kidney disease, tuberculosis, severe anemia, and gastrointestinal dysfunction can all affect the anterior pituitary function and sensitivity of the endometrium to sex hormones through the hypothalamus. And due to nutritional deficiency, it can affect the synthesis and secretion of GnH by the anterior pituitary gland and cause amenorrhea.

Causes of hypothalamic amenorrhea 4. Obesity reproductive incompetent dystrophy (dystrophiaadiposo-genital)

Due to the pathological changes in the hypothalamus and its surrounding tissues, the neurohumoral connection between the hypothalamus and pituitary gland is abnormal, which is manifested by obesity, amenorrhea, genital and secondary sexual dysgenesis, diabetes insipidus, and mental retardation or decline.

4. Causes of hypothalamic amenorrhea 5. Drug effects, such as a small number of women causing secondary amenorrhea after using contraceptives, are mainly caused by temporary suppression of GnRH, thereby inhibiting the normal periodic secretion of pituitary FSH and LH. In addition, drugs such as reserpine, chlorpromazine, and -methyldopa can also cause amenorrhea and galactorrhea.

Causes of hypothalamic amenorrhea 6. Lactating amenorrhea syndrome due to hypothalamic prolactin release inhibitory factor (PIF) secretion decreases, resulting in increased pituitary prolactin (PRL) secretion and lactation. Because PRL can competitively inhibit the ovarian GnH receptor, which leads to amenorrhea and forms amenorrhea-galactorrhea syndrome.

Causes of hypothalamic amenorrhea 7. Young women with polycystic ovary, amenorrhea, infertility, hairiness, obesity, and polycystic enlargement of the ovary.

Causes of hypothalamic amenorrhea 8. The effects of other endocrine gland diseases, such as hypothyroidism or hyperthyroidism, adrenal cortex dysfunction, or diabetes, can all affect the secretion of pituitary GnH through the hypothalamus and cause amenorrhea. Increased androgen in adrenal syndrome leads to amenorrhea.

The causes of hypothalamic amenorrhea are:

1. Mental and neurological factors

2. Intracranial organic lesions

3 Chronic wasting disease

4 Obesity reproductive incompetence dystrophy due to pathological changes in the hypothalamus and its surrounding tissues that cause abnormal neurohumoral connections between the hypothalamus and pituitary gland, including obesity, amenorrhea, genital and secondary sexual dysgenesis, diabetes insipidus and intelligence Dysplasia or regression.

5. Drug effects

6. Lactating amenorrhea syndrome

7. Young women with polycystic ovary, amenorrhea, infertility, hairiness, obesity, and polycystic enlargement of the ovary.

8. Other endocrine gland disease effects

1. Menstrual symptoms: According to the severity of GnRH pulse secretion, it can be manifested as inadequate corpus luteum function, anovulation, menstruation, thinning or amenorrhea. Depending on the age of onset, primary amenorrhea may be accompanied by varying degrees of sexual naiveness or secondary amenorrhea.

2, endocrine characteristics: single blood LH, FSH levels can be normal or low, frequent measurement can be completely disappeared LH pulse peak, or only appear during sleep, or the pulse frequency decreased. GnRH response to GnRH stimulation can be adult-type (LH response> FSH response) or no response. Blood E2 levels are lower or equivalent to normal early follicular phase levels. According to the above characteristics, Yen believes that hypothalamic amenorrhea is characterized by the reversal of ovarian function from sexual maturity to prepubertal state, and the process of treating hypothalamic amenorrhea is essentially a "mini-pubertal development".

Leyendecker et al. Divided the hypothalamic amenorrhea into three types according to the patient's response to clomiphene, progesterone and GnRH:

Mild (type I): Uterine bleeding in CC test.

Moderate (type II): No uterine bleeding in the CC test, but a positive progestin test.

Severe (type III): Both the CC and progesterone tests are negative, and the GnRH test response can be adult (IIIa), prepubertal (IIIb), and non-responsive (IIIc).

Leyendecker compared the above classification with the 24-hour blood LH pulse type and the size of the follicles in the lower ovaries of the B-ultrasound. As a result, severe hypothalamic amenorrhea. With the decrease in the reactivity of the GnRH stimulation test, the values of LH, FSH, and LH pulse frequency decreased accordingly. Follicles with a diameter of> 10mm can be seen in the ovaries of patients with a and above, and those with b and c have a diameter of <5-10mm. Of the 17 patients with primary amenorrhea, 16 were IIIb and IIIc, 1 was IIIa; 58 were secondary amenorrhea, 57 were I-IIIb, and only 1 was IIIc. ^[1]

First, the lower part of the reproductive tract is atresia. Such as the cervix, vagina, hymen, labia, etc., part of the congenital atresia, or acquired injury caused by adhesive atresia, although menstruation, but menstrual blood can not flow. This condition is called recessive or pseudomenopause. The lower part of the genital tract is completely curable after treatment by a doctor.

Second, the genitals are not healthy or stunted. Some people have congenital absence of ovaries, or ovarian dysplasia, or even ovarian damage. They cannot produce estrogen and progesterone, so the endometrium cannot change periodically, and there will be no endometrial shedding, so there is no Menstrual cramps. There are also congenital absence of uterus, or endometrial dysplasia, or endometrial damage. Even if the ovaries are healthy and the secretion of estrogen and progesterone is normal, menstruation will not occur.

Third, disease. It mainly includes wasting diseases such as severe tuberculosis, severe anemia, malnutrition, etc., unique endocrine diseases, such as obesity and reproductive incompetent malnutrition, etc .; the impact of some endocrine disorders in the body, such as adrenal, paronychia, pancreas and other functional disorders. The effects of these reasons may not be menstrual.

Fourth, the pituitary or hypothalamus is not functioning properly. The pituitary gland can secrete gonadotropins. Gonadotropin can regulate ovarian function and maintain menstruation. If the function of the pituitary gland is dysfunctional, it will affect the secretion of gonadotropins and affect the function of the ovary. Abnormal ovarian function will cause amenorrhea. ^[2]

1. The patient has no menstruation at the age of 18, and is a primary amenorrhea. After normal menstruation

(1) Remove the cause.

(2) Fertility requirements: induced ovulation (LH-RH, HMG); see amenorrhea of polycystic ovary syndrome.

(3) Does not require fertility: estrogen and progestin supplementation treatment.

The disease is mostly young women between the ages of 20 and 30. It can be caused by mental stimulation, drug action and other diseases. Avoid the inducement to achieve the preventive effect.

Amenorrhea diets are usually available:

1) Madder root 60 grams. Decoction, twice daily.

Efficacy: Activating blood and removing stasis, relieving qi and stagnation.

2) 25 grams of green tea and 100 grams of sugar. Use boiling water to brew green tea and sugar overnight, and drink it the next morning.

Effect: Regulating Qi and Regulating Menstruation.

3) 60 grams of salvia, 60 grams of brown sugar. Cook together, serving once a day, morning and evening.

Efficacy: nourishing and regulating menstruation, promoting blood circulation and removing stasis.

4) 20 grams of fresh turmeric, 50 ml of rice wine, and 2 eggs. After the eggs are cooked and peeled, cook with fresh turmeric for 20 minutes and serve the eggs with rice wine. Once daily for 4 to 5 days.

Efficacy: Wen Gong Xing Yu.

5) 30 grams of hellebore, 20 grams of caster sugar, and 2 eggs. Boil the chicken blood rattan and eggs until the eggs are cooked, then remove the dregs and egg shells. Put sugar in the medicinal solution. After the white sugar dissolves, take it. Once a day.

Effect: Qi and blood.

6) 200 grams of evergreen fruit, 200 grams of wolfberry, and 1500 ml of fine wine. Crush the evergreen fruit and wolfberry, place in a bottle, and pour into the wine for 7 days. Take 1 to 2 cups on an empty stomach, three times a day.

Efficacy: nourishing blood.