Amenorrhea
| Classification according to ICD-10 | |
|---|---|
| N91.0 | Primary amenorrhea |
| N91.2 | Secondary amenorrhea |
| ICD-10 online (WHO version 2019) | |
The absence of menstruation is called amenorrhea or new amenorrhea (from ancient Greek ἀ- a- "un-", "without", μήν mēn "month" and ῥοή rhoḗ "flow (flowing)" from ῥέω rhéo "I flow") and is one of the most common menstrual disorders . The absence of menstruation during childhood, pregnancy , breastfeeding and postmenopause is natural, which is why these cases are referred to as physiological amenorrhea. A distinction is made between primary and secondary amenorrhea.
Primary amenorrhea
In gynecology , primary amenorrhea is used when a woman has not yet menstruated after she has reached the age of sixteen.
Secondary amenorrhea
In gynecology , secondary amenorrhea is when a woman who has already menstruated has not menstruated for more than 3 months.
causes
Causes of amenorrhea can include: B. the lack of ovulation ( anovulation / polycystic ovary syndrome ), disorders in the hormonal balance / hormonal malfunctions (e.g. adrenogenital syndrome , increased androgen formation , increased cortisol formation , increased prolactin formation , hypofunction of the adrenal cortex , hypofunction of the thyroid ), diseases of the pituitary gland , certain genetic defects such as complete androgen resistance (see intersexuality ), metabolic diseases , anatomical peculiarities that limit organ functions (e.g. dysfunction of the ovaries , hymenal atresia / impermeability of the hymen ) as well as being underweight (e.g. in anorexia ).
It is questionable whether xy-chromosomal androgen resistance or xy-chromosomal gonadal dysgenesis ( Swyer syndrome ) can even be referred to as primary or secondary amenorrhea, since for an xy-chromosomal - i.e. chromosomally male - organism (even if a uterus is present as in the Swyer syndrome) menstruation in the “female sense” is neither primarily nor secondarily biologically intended.
Long-lasting strong psychological stress, such as B. imprisonment (especially solitary confinement ) can lead to a missed menstrual period.
The menstrual period can also be absent in the case of other physically and / or psychologically stressful events, such as B. stays abroad with climate change , or after childbirth and with prolonged and / or high-dose use of certain drugs (including psychotropic drugs , antihypertensive agents, hormone preparations ).
A special form of secondary amenorrhea is the so-called post-pill amenorrhea , in which menstruation does not start again until three or more months after stopping the birth control pill . This phenomenon occurs with a frequency of up to 2% and is due to a central nervous system malfunction and to hormonal changes in the woman's body. Even if menstrual bleeding occurs in the post-pill phase, it is possible that it is not ovulating. In this case it is called an anovulatory cycle . Targeted cycle monitoring can determine whether menstrual bleeding is associated with ovulation .
The absence of a menstrual period during pregnancy is by definition normal, as is the permanent absence of menstruation after the menopause (menopause).
The metabolic disease hemochromatosis , which causes the body to absorb or store too much iron, can also be the cause of amenorrhea.
treatment
The treatment of this cycle disorder depends on the cause of the amenorrhea and must therefore be individually tailored. After a pregnancy has been ruled out, treatment must be preceded by thorough examinations (e.g. hormone status ) and a comprehensive anamnesis in order to find the reason for the lack of menstrual bleeding. In the case of a hormonal disorder as the cause, appropriate hormonal therapy can be successful; organ dysfunction can in some cases be corrected surgically. If the amenorrhea is due to psychological stress, psychotherapy can be the method of choice in severe cases .
See also
- Dysmenorrhea - period pain
- Lactational Amenorrhea Method - a method of contraception using breastfeeding infertility
Web links
Remarks
- ^ Elisabeth Raith-Paula , Petra Frank-Hermann, Günter Freundl, Thomas Strowitzki: Natural family planning today. 4th, revised and expanded edition. Springer Medicine, Heidelberg 2008, ISBN 978-3-540-73439-0 , p. 63.
