Overview of Amenorrhea

Amenorrhea is not a disease, but one of the most common symptoms of gynecological diseases.

The causes of amenorrhea are very complex, including genetic factors, neuropsychiatric factors, immune factors, endocrine factors, tumor factors, trauma and drug effects.

According to the cause of its occurrence, amenorrhea can be divided into physiological and pathological. Pathological amenorrhea is usually divided into primary and secondary. Primary amenorrhea refers to those who are 16 years old and have developed secondary sexual characteristics, or those who are over 14 years old and have not yet developed secondary sexual characteristics and have no menstruation; secondary amenorrhea refers to those who have established normal menstruation in the past, but have stopped menstruating for 6 months due to some pathological reasons, or have stopped menstruating for more than 3 cycles according to their original menstrual cycle.

Generally speaking, primary amenorrhea is mostly caused by congenital diseases and reproductive tract malformations, or dysfunction and secondary diseases, and occurs before puberty; secondary amenorrhea is mostly caused by secondary organ dysfunction or tumors.

Among all the symptoms of amenorrhea, secondary amenorrhea is more common, accounting for about 90% of the total amenorrhea. The main diseases can be divided into the following situations: ① Amenorrhea caused by uterine and lower reproductive tract lesions: such as cervical-uterine adhesions and genital tuberculosis. ② Amenorrhea caused by ovarian lesions: such as ovarian inflammation and damage (radiation, surgery), premature ovarian failure, polycystic ovary syndrome, theca cell hyperplasia, and ovarian masculinizing tumors. ③ Amenorrhea caused by pituitary lesions: such as hypopituitarism, pituitary tumors, empty sella syndrome, and hyperprolactinemia. ④ Amenorrhea caused by hypothalamic lesions: such as psychogenic amenorrhea, exercise-induced amenorrhea, anorexia nervosa, pseudopregnancy, craniopharyngioma, and iatrogenic amenorrhea. ⑤ Amenorrhea caused by thyroid and adrenal diseases.

The complexity of amenorrhea often brings difficulties to diagnosis and treatment. With the widespread application of radioimmunoassay technology and a variety of auxiliary examination technologies in clinical practice, the traditional examination method based on estrogen and progesterone drug withdrawal test combined with sex hormone measurement, chromosome analysis, B-type ultrasound, CT and other examination methods have improved the accuracy of diagnosis. In terms of treatment, systemic treatment, hormone therapy, artificial assisted reproduction, surgical treatment and other aspects can be started according to the cause.

In addition, in some cases, amenorrhea needs to be treated and nursed back to health. In this regard, Chinese medicine has a very good effect. According to the principle of syndrome differentiation and cause seeking, Chinese medicine divides amenorrhea into two ends: deficiency and excess. Deficiency is mostly due to congenital deficiency or acquired damage, resulting in liver and kidney deficiency, or weak qi and blood, leading to blood deficiency and less essence, empty blood sea, and no remaining blood to flow; but there are also amenorrhea caused by yin deficiency and blood dryness. Excess is mostly due to evil qi blocking the diaphragm, such as qi stagnation and blood stasis, phlegm and dampness blocking and other factors, resulting in blocked meridians and hindering the downward flow of menstrual blood. According to the cause, Chinese medicine has prescriptions, acupuncture, massage, diet therapy and other methods.