Hypogonadotropic amenorrhea is caused by a decrease in the secretion of pituitary gonadotropins (TG). This in turn leads to a reduction of ovarian function and menstrual irregularities by type of amenorrhea. The reason for reducing the secretion of TG can be associated both with the pituitary gland and the hypothalamus.

What hypogonadotropic amenorrhea and why it develops

Neurohormonal system supporting the woman's menstrual cycle and her fertility, consists of the following units: the cerebral cortex - the hypothalamus - pituitary - ovary. Failure of any of these links leads to disruption of the entire system.

So, stress, severe physical and mental stress, intoxication caused by chronic foci of infection experienced in childhood severe infections, as well as family history (changes in the chromosome apparatus) can lead to the fact that disrupted the cerebral cortex and the hypothalamus, the main task a rhythmic release of its own hormones that stimulate the synthesis and secretion of pituitary THG. When a pacemaker fails, the work of the pituitary gland are also broken, it produces less THG - FSH and LH (FSH and LH).

Lack of FSH leads to the fact that sustained oocyte matures and released from the ovary, as well as to reduce isolation ovariectomized female hormone estrogen. The lack of estrogen causes a lack of proliferation (proliferation) of the mucous membrane of the uterus.

A small amount of LH is unable to trigger ovulation and provide hormonal support of the second half of the menstrual cycle, as it does not stimulate the production of progesterone. The secretion of progesterone is not possible yet because ovulation has not occurred, and on-site ruptured follicle is not formed corpus luteum secretes progesterone. Thus, broken all phases of the menstrual cycle, resulting in no menstruation - amenorrhea.

The reason hypogonadotropic amenorrhoea can also diseases and tumors that occur in the hypothalamus and in the pituitary. In these lesions sometimes is not so much reduced secretion of TG and female sex hormones, as a violation of the right rhythm of their allocation - that is what leads to a lack of ovulation and the development of amenorrhea. All this leads to the formation of persistent infertility.

Symptoms of hypogonadotropic amenorrhea

The main symptom of hypogonadotropic amenorrhea is the absence of menstruation. In addition, a distinctive feature of girls with primary hypogonadotropic amenorrhea The absence of menstruation (amenorrhea) - ambiguous symptom   is their appearance: the disproportionate figure, tall, long arms and legs, short torso, underdeveloped breasts and vulva. On examination it turns out that the internal genitals of girls, too, are underdeveloped.

Depending on what was the cause of the disease, there may be other symptoms.

Diagnostics

For the correct diagnosis studied blood on hormones (TG, prolactin, estrogen, progesterone Progesterone - norm and pathology , Testosterone, thyroid hormones Thyroid hormones: mechanism of action and physiological effects , Adrenal hormones) and hormonal tests are carried out with progesterone hormonal contraceptives, glucocorticoid hormones. Always conducted genetic research to identify genetic mutations.

Always carried ultrasound, X-ray examinations of the hypothalamus, pituitary and female genitals. The purpose of these studies is to identify tumors, hemorrhages, diseases in these organs.

Treatment

For the treatment of hypogonadotropic amenorrhea used human menopausal gonadotropin, for example, pergonal. The composition of this formulation consists of FSH and LH in a ratio of 1: 1. Get pergonal from human urine of post-menopausal. It has the effect of FSH and LH - stimulates the growth and maturation of the egg, increases the level of estrogen stimulates proliferation of the mucous membrane of the uterus and ovulation Ovulation - How to determine as accurately as possible? . Pergonal contraindicated in all tumors of the reproductive system and breast. In some cases, the appointment pergonal combined with the appointment of hormones of the hypothalamus or human chorionic gonadotropin (prophase).

Such treatments lead to a correction of hormonal, oocyte maturation, ovulation and restore regular menstrual bleeding.

Modern methods of treatment of various types of amenorrhea allow most women to experience the joy of motherhood.

Galina Romanenko

The reproductive system of a woman, her menstrual function are complex biological processes that are dependent on the state of the whole organism. In each menstrual cycle Menstrual cycle and its characteristics   occur periodically recurring cyclical processes, which ultimately focused on the implementation of the basic functions of a female, that is generative or reproductive. Hormonal regulation of the menstrual cycle allows the interaction between the major systems and organs that are involved in this complex system of regulation.

The role of central structures in the regulation

The most pronounced changes during the menstrual cycle are the processes that occur with the reproductive system. The culmination of the menstruation cycle is starting at the end of the second phase (or the luteal phase) of the cycle. Those physiological processes, which should provide menstrual function of women, are under the influence of multi-level regulatory neurohormonal system. Hormonal regulation occurs at certain levels of the system. In total there are five such levels, and they are in close mutual connection of positive and negative, without which it is impossible to implement a unified process of regulation.

The dominant role belongs to the central level of the system .  The first are the highest level of the nervous system and its central departments - cortex and the limbic system structures .  These structures of the nervous system perceive various internal and external stimuli and response, synthesize, secrete specific regulatory substances - neurotransmitters, neuropeptides, neuromodulators .  From them will further depend on how the cyclic flow variations in women in the reproductive system .  The next level of regulation is the area of ​​the hypothalamus, or rather its gipofizotropnaya area .  Cells that produce a band regulating hormones (gonadotropin releasing hormone), which act on the pituitary region and control its secretory activity .  The ability to secrete releasing hormones in women genetically programmed .  Hormone secretion occurs in pulsed mode (also called tsirhoralnym mode) .  This means that within a few minutes hormone is synthesized and then sets an interval low secretory activity, which lasts for one to three hours .

At the third level, the central hormonal regulation of the cycle is the pituitary gland (the region of its front portion). Here, under the influence of regulating the synthesis of hypothalamic gonadotropin-releasing hormone, which ensure the normal operation of the whole entire reproductive system. The main hormones are follicle stimulating, luteinizing, adrenocorticotropic, somatotropic, thyroid hormones, and prolactin Prolactin - effect on the body is not fully known . The most important feature of the hormonal relationship of the female body is a cyclical process associated with a periodic repetition of follicular development, ovulatory changes and formation of a new endocrine gland the corpus luteum. These processes are regulated directly by the pituitary hormones.

The peripheral part of the regulatory system

The system of relations of hormonal release as peripheral parts. There are peripheral endocrine organs, which belong to the fourth level of the system (adrenal, thyroid gland The thyroid gland - is responsible for your hormones   and ovaries). Over the past decade, made significant changes in the assessment of the role in the regulation of ovarian menstrual cycle. Ovarian Hormones regulate processes in the ovary, in the hypothalamic-pituitary and peripheral organs. It is proved that for normal growth and maturation of the dominant follicle and ovulation at a specific content in the blood hormones. Processes cyclical secretion of hormones in the female reproductive period as determined by the level of ovarian hormones. Estradiol is the main hormone that is involved in providing functional connections honey all links neurohumoral system. In the ovary mature follicles, ovulation and corpus luteum matures. During the growth of the follicular unit can distinguish several stages:

• primordial follicles with immature egg inside. With the start of each cycle starts to grow from three to thirty of these follicles
• preantralny follicle. There is an increase oocyte growth hormone and increased activity of the cells that form one of the layers of the follicle
• preovulatory follicles or dominant. Its distinguishing feature is the size (the maximum size can be up to 20 mm at the time of ovulation). As the dominant follicle in the ovary there are processes of reverse development of other follicles, which are initially entered into growth
• antral follicles or secondary

Under the influence of hormonal changes taking place in the central and peripheral parts, the dominant follicle ruptures at ovulation Ovulation - How to determine as accurately as possible? While the egg is released into the abdominal cavity.

Sensitivity of the changes to the body's hormonal saturation are the target organs, which include the uterus and tubes, vaginal mucosa and breast cancer. All of them belong to the fifth final level of neurohormonal regulation. Most vividly hormonal changes affect the mucous membrane of the uterus. In the uterus observed cyclic processes of transformation of the endometrium, which contribute to creating the necessary conditions for the implantation of a fertilized egg cell and development pregnancy. During the menstrual cycle of women undergoing complex neurohormonal processes throughout the body, which depend on the functional activity of the departments of a single regulatory system.

Marina Solovyov