The appointment of a rational course of therapy in case of any violation of a woman's cycle is complex. This is primarily due to the presence of multiple causal factors and the severity of violations at any level of the regulatory system. A prerequisite for its effectiveness is a detailed account of the hormonal status of the patient. Treatment of menstrual disorders is primarily directed at eliminating the cause of the pathological condition.

Existing methods of conservative therapy

Achieving clinical recovery against the backdrop of the ongoing course of treatment is only possible in the case of early treatment, and subject to all necessary recommendations for remedial measures .  The patient must gain a certain degree of patience, as the therapy cycle disorders can not be short-term and in some cases it may be a lifetime (in the case of hormone replacement therapy) .  All methods can be divided into hormonal and non-hormonal, and conservative and operational .  Any treatment should be started with the correct organization of work and rest woman .  It attaches great importance, since the role of the nervous system in the event of violations of the cycle is a well-known fact .  It is necessary to exclude the effects of any traumatic nerve factors, stress .  You can not overwork, so it is important to organize your day to be able to combine work and leisure .  If a woman is overweight, should achieve its reduction .  It makes no sense to start carrying out medical treatment of disorders, if a woman is not positive dynamics in terms of normalization of weight .  It must be made a specific diet, the food should be low calorie (caloric content can be reduced from 25% to 50%) can be assigned to the fasting days .  In addition to a balanced diet is necessary to exercise (taking into account health indicators) .

The choice of hormone therapy determined by the shape of violations. With the purpose of treatment is to apply different hormonal agents. This can be combined preparations containing estrogens and progestins (COC), progesterone, as well as centrally acting synthetic hormones (e.g. gonadotropin). If a woman's menstrual dysfunction combined with genital infantilism, ie underdevelopment of its reproductive system, it has a good effect hormone replacement therapy. Then separately administered in the first phase the estrogen hormones, and the second phase is the hormone progesterone Progesterone - norm and pathology . Estrogen drugs during cyclic therapy combined with folic acid and thyroidin and progesterone with tocopherol acetate. Treatment cycles are prescribed for several months, was evaluated as a normalization of hormonal women. Repeated courses after an interval of two or three months. When combined with menstrual disorders endocrine disorders is recommended to treatment in a specialized hospital Endocrinology.

Stages in conducting therapeutic measures

A common form of violations of the cycle is uterine bleeding. This kind of disorders is complex and diverse clinical manifestations, which largely determines the correct choice of a rational complex pharmacological activities. The entire complex can be divided into several stages:

• holding hemostatic therapy to achieve hemostasis
• regulation of the menstrual cycle by hormonal therapy
• a course of rehabilitation measures to restore the fertility of women and the prevention of complications such as malignant tumors

At the first stage the main task is to stop the bleeding .  To this end, a surgical curettage (diagnostic curettage) or appointed by the hormonal homeostasis .  Scraping in this case is not the only method to stop bleeding, and also allows you to diagnose the presence of pathological changes at the level of the endometrium, which can be done on the basis of histological findings obtained by scraping .  Use of hormonal hemostasis based on the fact that the administration of large doses of hormonal agents inhibition achieved pituitary hormone production and is maintained at a high level the content of sex steroids in the body, eventually leading to hemostasis .  The use of hormones for hemostasis is allowed to the extent of blood loss and the severity of anemia in women .  If excessive bleeding must perform curettage Scraping - heavy and unsafe procedure .

To carry regulatory therapy apply hormonal therapy. Proposed many variants cyclic hormone therapy, however in each case can select the most suitable scheme. You can also designate a medical purpose synthetic progestins or contraceptives. Typically, regulation of the cycle of the woman should take three cycles in a row, in the future, you can repeat the treatment after two months. Effect of sex hormones regulating therapy controlled clinical except using hormonal inspection for three cycles after stopping hormones. At the final third stage the therapeutic measures aimed depends on the age of the woman. In the reproductive years, they provide for restoration of fertility by stimulating ovulation Ovulation - How to determine as accurately as possible? . For this purpose, use drugs gonadotropic action (human chorionic gonadotropin), or estrogen Estrogen - the key to bone health -gestagennye drugs (pituitary stimulation of activity by type of rebound effect).

Marina Solovyov

Psychogenic amenorrhea often referred to as amenorrhea wartime prison or amenorrhea. This suggests that it is the psychic effects of playing in the development of this disease is crucial. They can cause short-term or long-term effect on the subcortical structures with full or partial termination of their functions.

Psychogenic amenorrhea - why and how it develops

Psychogenic amenorrhea - is the absence of menstruation for six months or more under the influence of various mental effects - severe stress and nervous and mental stress.

The structure of neurohormonal regulation of the menstrual cycle (ie, reproductive function) includes a mountain woman brain - the hypothalamus - pituitary - ovary. Psychogenic amenorrhea cause various effects on the cerebral cortex. This can be a one-time high stress How to beat stress? Create an oasis   (the death of loved ones, serious injury, fright, and so on). But more often the cause of psychogenic amenorrhea is sufficiently prolonged exposure to stress, for good reason - a disease often called amenorrhea wartime prison or amenorrhea.

When psychogenic effects of the cerebral cortex is trying to reduce its severity by secreting structures of the brain's own (endogenous) opiates - substances that dulls the discomfort during stress.

But under the influence of opiates reduced secretion of the neurotransmitter dopamine, the nerve impulses are slower on the brain cells, thereby reducing the secretion of hormones of the hypothalamus (part of the brain responsible for the operation of the whole endocrine system), responsible for the regulation of pituitary function. The pituitary gland, in turn, regulates the ovaries, so broken and their function.

It develops so-called hypogonadotropic amenorrhea, in which due to lack of hormone from the hypothalamus (gonadotropin-Riesling-hormone) decreases the secretion of gonadotropin-releasing hormone of the pituitary gland (TG, follicle - FSH and luteinizing hormone (LH). Under the influence of FSH comes egg maturation in the ovaries and secretion of female genital estrogen. Under the influence of LH ovulation (release of an egg from the ovary) and secretion of progesterone.

Estrogens in the first half of the menstrual cycle promote widening (proliferation) of the inner cavity of the uterus mucosa (endometrium) and progesterone Progesterone - norm and pathology   in the second half of the menstrual cycle, inhibits proliferation and causes the endometrial cells to allocate necessary for development of pregnancy substances. With a lack of estrogen and progesterone in the endometrium changes do not occur, so the endometrium is not rejected and monthly bleeding does not occur.

How is psychogenic amenorrhea

For psychogenic amenorrhea is characterized by the sudden cessation of menstruation without prior menstrual irregularities. Amenorrhea may be accompanied by a variety of neuro-psychiatric disorders. This can be expressed manifestations of neurosis Neurosis - reaction to the nervous shock   as neurasthenia (increased weakness, fatigue, tearfulness, anxiety), hysteria (conspicuous protrusion of his suffering) or obsessional neurosis (anxiety and mistrust the state, accompanied by the implementation of various protective rituals).

Sometimes the background of psychogenic fatigue can develop serious mental disorders such as depression, leading to suicide Suicide in terms of the psychiatrist - can it be prevented? . Some women are prone to constant search at serious diseases that are not supported by conducting surveys (hypochondriac syndrome).

All the symptoms of the disease can take in addressing the reasons that caused them - stress and emotional stress, but more often the woman needs medical help.

Diagnosis and treatment

In order to make a diagnosis of psychogenic amenorrhea, it is necessary to exclude the presence of organic diseases in the hypothalamic-pituitary system. To do this, conducted a full examination of women: X-ray and magnetic resonance imaging of the brain, ultrasound of the pelvic organs, if necessary - Hysteroscopy (the study of the inner surface of the uterus using a hysteroscope) and laparoscopy (study of the outer surface of the uterus and its appendages using a laparoscope) and so on.

Treatment of psychogenic amenorrhea Policy Pay obstetrician-gynecologist, together with the therapist. It is crucial to relieve stress and nervous and mental stress, a healthy lifestyle, the alternation of moderate physical activity and rest, a good night's sleep, proper nutrition. Hormone therapy is only at long flowing amenorrhea when changes develop in the ovaries.

Galina Romanenko