Theamenorrhea ndikusowa kwa msambo mwa mkazi wa msinkhu wobala. Mawu akuti "amenorrhea" amachokera ku Greek a kwa kukhumudwa, wozingwa kwa miyezi ndi rhea ndi kumira.

Kuchokera pa 2% mpaka 5% ya amayi angakhudzidwe ndi amenorrhea. Izi ndi chizindikiro zomwe ndi zofunika kudziwa chifukwa chake. Kusakhalapo kwa msambo kumakhala kwachilengedwe, mwachitsanzo, ngati mayi ali ndi pakati, akuyamwitsa kapena akuyandikira kusintha kwa thupi. Koma kunja kwa mikhalidwe imeneyi, kungakhale chizindikiro cha kupsinjika maganizo kosatha kapena vuto la thanzi monga anorexia kapena matenda a chithokomiro.

Mitundu ya nthawi yophonya

• Choyamba amenorrhea: pamene muli ndi zaka 16, kusamba kwanu sikunayambe. Makhalidwe ogonana achiwiri (kukula kwa bere, tsitsi mu pubis ndi m'khwapa ndi kugawa minofu yamafuta m'chiuno, matako ndi ntchafu) angakhalepo.
• Secondary amenorrhea: pamene mkazi wayamba kale kusamba ndi kusiya kusamba pazifukwa zina, kwa nthawi yofanana ndi zosachepera zitatu za msambo wam'mbuyo kapena miyezi 3 osasamba.

Ndi nthawi yanji yoti mufunsire ngati mulibe msambo?

Nthawi zambiri, osadziwa chifukwa chake muli ndi amenorrhea ndikuda nkhawa. Anthu otsatirawa ayenera kukaonana ndi dokotala :

- amayi omwe ali ndi amenorrhea yapachiyambi kapena yachiwiri;

- pakachitika kubereka kwa amenorrhea, kuyezetsa kwachipatala ndikofunikira ngati amenorrhea ipitilira miyezi 6 mwa amayi omwe akhala akugwiritsa ntchito mapiritsi olerera, omwe adavala Mirena® hormonal IUD, kapena miyezi yopitilira 12 atalandira chithandizo. jakisoni womaliza wa Dépo-Provera®.

Kuzindikira kwa amenorrhea

Nthawi zambiri,kuyesa mwakuthupi, ya kuyezetsa mimba ndipo nthawi zina ultrasound ya ziwalo zogonana ndi yokwanira kutsogolera matenda.

X-ray ya dzanja (kuyesa kukula kwa msinkhu), kuyesa kwa mahomoni kapena kuyesa kwa chromosomal kugonana kumachitika nthawi zina za amenorrhea yoyamba.

Zifukwa za kusowa kwa msambo

Pali zifukwa zambiri za amenorrhea. Nawa omwe ali otsika kwambiri.

• Mimba. Ambiri chifukwa sekondale amenorrhea, ayenera kukhala woyamba amaganiziridwa mu kugonana mkazi. Chodabwitsa n'chakuti nthawi zambiri zimachitika kuti chifukwa ichi chimachotsedwa popanda kuyang'anitsitsa, zomwe zilibe chiopsezo. Mankhwala ena omwe amaperekedwa kuti athetse amenorrhea amatsutsana ndi mimba. Ndipo ndi mayeso omwe amapezeka pamalonda, matenda ndi osavuta.
• Kuchedwa pang'ono pakutha msinkhu. Ndi chifukwa chofala kwambiri cha primary amenorrhea. Zaka za kutha msinkhu nthawi zambiri zimakhala zapakati pa 11 ndi 13, koma zimatha kusiyana kwambiri kutengera mtundu, malo, zakudya, komanso thanzi.

   

  M’maiko otukuka, kuchedwa kutha msinkhu kuli kofala kwa atsikana amene ali owonda kwambiri kapena othamanga. Zikuoneka kuti atsikana ameneŵa alibe mafuta okwanira m’thupi kuti alole kupangidwa kwa mahomoni a estrogen. Ma Estrogens amalola kuti dzira la chiberekero likhale lolimba, ndipo pambuyo pake kusamba ngati dzira silinagwirizane ndi umuna. Mwanjira ina, matupi a atsikanawa amadziteteza mwachibadwa ndipo amasonyeza kuti thupi lawo silingathe kuthandizira mimba.

   

  Ngati makhalidwe awo achiwiri a kugonana alipo (mawonekedwe a mawere, tsitsi la pubic ndi m'khwapa), palibe chifukwa chodandaula asanakwanitse zaka 16 kapena 17. Ngati zizindikiro za kukula kwa kugonana sizikupezekabe pa zaka 14, vuto la chromosomal (chromosome imodzi ya X yogonana m'malo mwa 2, matenda otchedwa Turner syndrome), vuto la chitukuko cha ubereki kapena vuto la mahomoni.

• Kuyamwitsa. Nthawi zambiri, amayi oyamwitsa sakhala ndi msambo. Komabe, tisaiwale kuti akhoza kukhala ovulation nthawi imeneyi, choncho mimba yatsopano. Kuyamwitsa kumayimitsa kutuluka kwa dzira ndikuteteza ku mimba (99%) pokhapokha ngati:

  - mwana amatenga bere lokha;

  - mwana wosakwana miyezi 6.

• Kuyamba kwa kusintha kwa thupi. Kusiya kusamba ndiko kutha kwachibadwa kwa msambo kumene kumachitika kwa akazi azaka zapakati pa 45 ndi 55. Kupanga kwa estrogen kumachepa pang’onopang’ono, kuchititsa kuti nthaŵi isamakhale yosakhazikika ndiyeno kumapita kotheratu. Mutha kupanga ovulation mocheperako kwa zaka ziwiri mutasiya kusamba.
• Kutenga njira zakulera m'thupi. “Nthawi” zomwe zimachitika pakati pa mapaketi awiri a mapiritsi si nthawi yolumikizidwa ndi nthawi ya ovulatory, koma “kuchotsa” magazi pamene mapiritsi ayimitsidwa. Ena mwa mapiritsiwa amachepetsa magazi, omwe nthawi zina patatha miyezi ingapo kapena zaka zowamwa sizichitikanso. Mirena® hormonal intrauterine device (IUD), jekeseni ya Depo-Provera®, mapiritsi olerera mosalekeza, implants za Norplant ndi Implanon zingayambitse amenorrhea. Sizovuta kwambiri ndipo zimasonyeza mphamvu za kulera: wogwiritsa ntchito nthawi zambiri amakhala "m'thupi la mahomoni" ndipo samatulutsa ovulation. Choncho ilibe kuzungulira kapena malamulo.
• Kusiya kugwiritsa ntchito njira yolerera (mapiritsi olerera, Depo-Provera®, Mirena® hormonal IUD) pambuyo pa miyezi ingapo kapena zaka zogwiritsidwa ntchito. Zitha kutenga miyezi ingapo kuti dzira la ovulation ndi kusamba libwererenso. Amatchedwa post-contraceptive amenorrhea. M'malo mwake, njira zolerera za m'thupi zimachulukitsa kuchuluka kwa mahomoni apakati, motero zimatha kuyimitsa nthawi. Izi zingatenge nthawi kuti zibwerere pambuyo posiya njirayo, monga pambuyo pa mimba. Izi ndizochitika makamaka kwa amayi omwe adakhala ndi nthawi yayitali (kuposa masiku 35) ndi kusadziŵika bwino asanatenge njira ya kulera. Pambuyo pakulera amenorrhea sivuto ndipo sichisokoneza kubereka kotsatira. Azimayi omwe amapeza kuti ali ndi vuto la kubereka pambuyo pa kulera adakhala nawo kale, koma chifukwa cha kulera kwawo, "sanayese" kubereka kwawo.
• Mchitidwe wa mwambo kapena masewera ovuta monga marathon, zomanga thupi, masewera olimbitsa thupi kapena ballet akatswiri. "Sportswoman's amenorrhea" amaganiziridwa kuti amabwera chifukwa cha kuchepa kwa minofu yamafuta komanso kupsinjika komwe thupi limakumana nalo. Pali kusowa kwa estrogen mwa amayiwa. Zitha kukhalanso kuti thupi lisawononge mphamvu mosayenera chifukwa nthawi zambiri limakhala ndi zakudya zochepa zama calorie. Amenorrhea ndi 4-20 nthawi zambiri mwa othamanga kuposa anthu ambiri¹.
• Kupsinjika maganizo kapena kugwedezeka kwamaganizo. Zomwe zimatchedwa psychogenic amenorrhea zimachokera ku kupsinjika maganizo (imfa m'banja, kusudzulana, kutaya ntchito) kapena mtundu wina uliwonse wa kupsinjika maganizo (kuyenda, kusintha kwakukulu kwa moyo, etc.). Izi zimatha kusokoneza kwakanthawi kagwire ntchito kwa hypothalamus ndikupangitsa kuti msambo usiye malinga ngati gwero la nkhawa likupitilirabe.
• Kuwonda mwachangu kapena chikhalidwe chakudya cha pathological. Kutsika kwambiri kwa thupi kungayambitse kutsika kwa estrogen ndi kutha kwa msambo. Azimayi ambiri omwe ali ndi vuto la anorexia kapena bulimia, kusamba kumasiya.
• Kuchuluka kwa prolactin kuchokera ku chithokomiro cha pituitary. Prolactin ndi hormone yomwe imalimbikitsa kukula kwa mammary gland ndi kuyamwitsa. Kuchuluka kwa prolactin kuchokera ku pituitary gland kungayambitsidwe ndi chotupa chaching'ono (chomwe nthawi zonse chimakhala chosaopsa) kapena ndi mankhwala ena (makamaka antidepressants). Pamapeto pake, chithandizo chake ndi chophweka: malamulo amawonekeranso masabata angapo atasiya mankhwala.
• Kunenepa kwambiri kapena kulemera kwambiri.
• Kutenga mankhwala enaake monga oral corticosteroids, antidepressants, antipsychotics, kapena chemotherapy. Kugwiritsa ntchito mankhwala osokoneza bongo kungayambitsenso amenorrhea.
• Zipsera zam'mimba. Pambuyo pa opaleshoni yochizira uterine fibroids, endometrial resection, kapena nthawi zina chigawo cha cesarean, pangakhale kuchepa kwakukulu kwa msambo, kapena ngakhale kusakhalitsa kapena kukhalitsa kwa amenorrhea.

Zotsatirazi ndizochepa kwambiri.

• A chitukuko anomaly ziwalo zogonana zomwe sizimachokera ku chibadwa. Androgen insensitivity syndrome ndi kupezeka, mu mutu wa XY (mwamuna) wa ziwalo zogonana zowoneka ngati zachikazi chifukwa chosowa kukhudzidwa kwa maselo ku mahomoni achimuna. Anthu omwe ali ndi "intersex" awa omwe ali ndi mawonekedwe achikazi amafunsira kutha msinkhu kwa primary amenorrhea. Kuwunika kwachipatala ndi ultrasound kumapangitsa kuti azindikire: alibe chiberekero, ndipo zotupa zawo zogonana (ma testes) zili pamimba.
• Matenda kapena matenda a endocrine. Chotupa cha ovarian, polycystic ovary syndrome, hyperthyroidism, hypothyroidism, etc. Matenda omwe amatsatiridwa ndi kuchepa kwakukulu (chifuwa chachikulu, khansa, nyamakazi kapena matenda ena otupa, etc.).
• Chithandizo chamankhwala. Mwachitsanzo, opaleshoni kuchotsa chiberekero kapena thumba losunga mazira; chemotherapy ndi radiotherapy.
• Anatomical anomaly ziwalo zogonana. Ngati hymen si perforation (imperforation), izi zikhoza kutsagana ndi amenorrhea zowawa mu pubescent msungwana: nthawi yoyamba amakhalabe kutsekeka mu nyini.

Zochitika komanso zovuta

Kutalika kwaamenorrheazimadalira chifukwa chake. Nthawi zambiri, amenorrhea imasinthidwa ndipo imachiritsidwa mosavuta (kupatulapo, ndithudi, ya amenorrhea yokhudzana ndi zovuta za majini, zolakwika zosagwira ntchito, kusintha kwa thupi kapena kuchotsa chiberekero ndi mazira). Komabe, pamene amenorrhea yakhala italiitali itasiyidwa popanda chithandizo, chifukwa chake pamapeto pake chimafika pamakina a wodwalayo. kubereka.

Kuonjezera apo, amenorrhea yokhudzana ndi kusowa kwa estrogen (amenorrhea chifukwa cha masewera olimbitsa thupi kapena vuto la kudya) kumapangitsa kukhala pachiwopsezo cha matenda a mafupa a nthawi yaitali - choncho fractures, kusakhazikika kwa vertebrae ndi lordosis - popeza estrogen imagwira ntchito yofunika kwambiri posunga mafupa. Tsopano zikudziwika bwino kuti othamanga achikazi omwe amadwala amenorrhea amakhala ndi mafupa ochepa kwambiri kuposa momwe amachitira, chifukwa chake amatha kusweka.¹. Ngakhale kuti kuchita masewera olimbitsa thupi pang'onopang'ono kumathandiza kupewa matenda a osteoporosis, kuchita masewera olimbitsa thupi kwambiri kumakhala ndi zotsatira zosiyana ngati sikuli koyenera ndi kudya kwambiri kwa kalori.