post-contraceptive amenorrhea syndrome
Introduction
Introduction to amenorrhea after contraception Amenorrhea syndrome after contraception refers to a series of symptoms such as amenorrhea, galactorrhea and rare menstruation after oral contraceptives are stopped. Occurs in women of childbearing age who take contraceptives improperly. Some of the intrinsic patients have symptoms such as nausea, dizziness, headache, fatigue, loss of appetite, breast pain, pigmentation, chloasma, increased vaginal discharge, and pain in the lower extremities. basic knowledge Probability ratio: 5% of specific population Susceptible people: good for women Mode of infection: non-infectious Complications: infertility
Cause
Causes of amenorrhea after contraception
(1) Causes of the disease
In women who take the pill for a long time, their ovaries are suppressed and become smaller, the follicles are small and there is no corpus luteum, and the cortex becomes sclerotic. This is similar to the ovary shape of menopausal women. In the early stage of the menstrual cycle, the contraceptive is passed. In the middle of the hypothalamus and pituitary, the secretion of follicle stimulating hormone is inhibited. In the middle stage, luteinizing hormone and follicle stimulating hormone are inhibited and the release period of luteinizing hormone is changed, thereby inhibiting ovulation, and most women are after stopping the contraceptive pill. After 2 to 3 months of amenorrhea, menstruation can naturally return to normal, but a small number of women still have this syndrome after the withdrawal of the hypothalamic-pituitary-ovarian axis function.
(two) pathogenesis
Intrinsic patients with small ovarian, small follicles, immature, no corpus luteum, cortex more into a sclerotic type, similar to the menopausal ovary.
Oral contraceptives: commonly used oral contraceptives are female, progesterone mixture, female I, II contraceptives used in the country, progesterone dose can inhibit hypothalamic-pituitary-ovarian axis function, inhibit follicular development and ovulation, cycle After sexual deactivation, it can cause withdrawal of uterine bleeding. The second generation of low-dose contraceptives in the 1980s had lower estrogen levels, which made the endometrial proliferation of some patients insufficient, even if progesterone was added. Medicinal bleeding, the third generation of products introduced in the 1980s, with different female and progesterone doses per month, followed by 6 days, 5 days and 10 days, with a large amount of estrogen in the middle of 5 days, and the largest dose of progestogen in the last 10 days. , the incidence of amenorrhea during the medication is less than 1%, usually return to normal menstruation within 3 months after stopping the drug, so after 6 months of oral contraceptives, no menstruation is called "menopause after contraceptives", 95% to 98 % of women who took the drug completely recovered normal ovulation within 1 year after stopping the drug. In women who were still amenorrhea after stopping oral contraceptives, they often found irregular menstrual history.
Long-term use of contraceptives or the use of progesterone-containing devices, implants will also cause endometrial atrophy, no withdrawal bleeding, the reason is the drug for the hypothalamic-pituitary long-term inhibition, so that the body is always in Low estrogen, caused by high progesterone, menopausal women who have stopped taking birth control pills may be accompanied by galactorrhea, which may be related to the excessive use of estrogen in the contraceptive pill, in the inhibition of hypothalamic gonadotropin When the hormone is released, the prolactin inhibitor (dopamine) is reduced, and the secretion function of the pituitary prolactin cells is no longer inhibited, thereby increasing the prolactin in the blood and causing galactorrhea. Another possibility is the original pituitary PRL. Adenoma does not produce clinical symptoms, so it has not been discovered that after taking the contraceptive for many years, the pituitary prolactin microadenomas gradually grow up, and the prolactin is too high, so there is galactorrhea, therefore, simple amenorrhea or galactorrhea after the contraceptive FSH, LH, PRL and E2 should be measured first, excluding pituitary prolactinoma, confirmed to be low gonadotropin, low estrogen, and then symptomatic treatment, young people in use Sequential female, progesterone or clomiphene treatment can induce follicular development and restore ovulation function. If the age has passed the menopause, only follow-up can be done.
Prevention
Prevention of amenorrhea after contraception
Prevention: Rational use of contraceptives. Occurs in women of childbearing age who take contraceptives improperly. After the drug was stopped, the amenorrhea accounted for 0.8% to 1%, and the incidence rate was similar to the incidence of amenorrhea between the normal groups.
Complication
Complications of amenorrhea after contraception Complications infertility
Concurrent infertility.
Symptom
Symptoms of amenorrhea syndrome after contraception Common symptoms of vaginal discharge increased breast pain, menstrual period, abdominal pain, menstrual scarcity, amenorrhea, fatigue, prepubertal amenorrhea, nausea, pregnancy, chloasma
1. Some of the intrinsic patients have nausea, dizziness, headache, fatigue, loss of appetite, breast pain, pigmentation, chloasma, increased vaginal discharge, lower limb pain and other symptoms.
2. The patient stopped taking the contraceptive for more than 3 months, still had amenorrhea, or menstrual scarcity, the cycle was obviously irregular, there was galactorrhea, and accompanied by infertility.
Examine
Examination of amenorrhea after contraception
The levels of estrogen and progesterone were low, and the luteinizing hormone and follicle stimulating hormone were at the lowest level. After Gn-RH injection, there was no peak reaction between the two hormones, which indicated that the hypothalamus and pituitary were at the same level. Suppress the state.
Hysteroscopy, laparoscopy.
Diagnosis
Diagnosis and differentiation of amenorrhea after contraception
diagnosis
1. Women in the reproductive period, taking the contraceptives before the body health, normal menstruation, may have normal pregnancy, history of production, no galactorrhea symptoms, the above clinical signs and signs after taking birth control pills, especially prominent amenorrhea - galactorrhea and no Symptoms of childbirth, most patients within six months after stopping the drug, the symptoms of galactorrhea can gradually disappear, menstruation recovers, other symptoms disappear, and there is no atrophy of uterus and ovary; a small number of patients have symptoms.
2. Laboratory tests for estrogen, progesterone, luteinizing hormone and follicle stimulating hormone.
3. Gonadotropin-releasing hormone (GnRH) stimulation test does not show a peak in luteinizing hormone and follicle stimulating hormone.
Differential diagnosis
Differentiation from pituitary prolactinoma and other causes of amenorrhea.
