Menopause transition and postmenopausal amenorrhea
Introduction
Introduction Amenorrhea is usually divided into primary and secondary amenorrhea. The symptoms of amenorrhea in the primary disease are: at least 14 years of age without menstrual cramps and secondary sexual development; or at the age of 16 without menstruation, regardless of whether the second sexual development is normal, are primary amenorrhea. Symptoms of secondary amenorrhea are: after menstruation and menstrual cycle, no menstruation for more than 6 months. 1
Cause
Cause
Physiological menopause is the result of a natural decline in ovarian function, which means that ovarian reproductive function is terminated.
1. The age of menopause: The age of menopause reflects the reproductive life of the ovary. Cell senescence is the result of menopause. The factors affecting the age of menopause are genetic nutrition, altitude and altitude in the area of fat and thin living.
2. The influence of genetic factors on postmenopausal women: The DNA sequence and its variation of the human body reflect the evolutionary process of human beings. Studying the DNA sequence variation (polymorphisms) of different populations and different individuals helps to understand the physiological changes of human beings. The development of the disease and the response to drug treatment.
Examine
an examination
Related inspection
Vaginal gynecological routine examination gynecological ultrasound examination gynecological routine examination
The diagnosis of natural menopause is based on the continuous menopause of menopausal women for one year to retrospectively judge, with or without peri-menopausal symptoms, most of which do not require auxiliary examination, artificial menopause is not difficult to diagnose by analyzing the causes of menopause .
For women with shorter menopause time, pelvic examination should be performed to understand the size of the uterus; if necessary, urine pregnancy test and B-ultrasound should be performed to exclude early pregnancy. Because perimenopausal women also have occasional ovulation and conceive, it should not be taken for course.
Diagnosis
Differential diagnosis
If LH is significantly elevated, FSH is normal or slightly higher, FSH/LH<1 should pay attention to secondary amenorrhea caused by polycystic ovary syndrome. This patient has higher androgen level E2 is early and middle follicular phase But there is no periodic fluctuation. Prolactin levels in patients with premature ovarian failure are normal or slightly lower, such as increased significantly, should consider the pituitary secretion of breast cancer patients with Sheehan syndrome patients with low FSHLH, E2, and may be associated with decreased function of other endocrine organs, hypothyroidism can also be Following amenorrhea, attention should be paid to the levels of T3, T4 and TSH in the blood.
Care should also be taken to rule out organic diseases or to determine if there are concurrent organic diseases such as:
1. Hyperthyroidism: This disease can occur at any age and the age is very common. The symptoms are often atypical. For example, the thyroid gland is not swollen, the appetite is not fast, the heart rate is not fast, and the state of depression is not excited, and depression, apathy, anxiety, and so on. Identification method: Determination of thyroid function indicators, such as TSH lower than normal T4, T3 at normal high limit or even normal should be diagnosed with hyperthyroidism.
2. Coronary atherosclerotic heart disease: When patients with palpitations caused by arrhythmia and chest tightness, first consider CHD. The identification method is that when the physical examination and the electrocardiogram are difficult to identify, the estrogen test can be used.
3. Hypertension or pheochromocytoma: When headache, blood pressure fluctuations or persistent hypertension should be considered, the method of identification is repeated blood pressure measurement and pheochromocytoma related examination, such as abdominal mass, squeezing Whether blood pressure is elevated during mass, whether there is headache, flustered sweating, etc. Blood catecholamine determination is associated with menopause and blood pressure changes are often mild.
4. Neurasthenia: Insomnia as the main manifestation may be caused by neurasthenia. The identification method is mainly based on the medical history, that is, the time of insomnia and the change of menstruation. For patients who are difficult to identify, estrogen can also be used for experimental treatment or neurological consultation.
