General provisions and etiopathogenesis
Cycle disorders are a frequent cause or manifestation of gynecological diseases, demonstrating an increase in reproductive problems. The variety of forms is explained by the complex regulatory structure, which includes the cerebral cortex, hypothalamus, pituitary gland, peripheral endocrine glands, and extrahypothalamic structures.
Clinical manifestations include amenorrhea, bleeding, and algodysmenorrhea, as well as neuroendocrine syndromes: PCOS, PMS, Cushing's disease, Sheehan syndrome, Turner syndrome, post-hysterectomy, and post-castration syndromes.
Classification of amenorrhea
Amenorrhea is defined as the absence of menstruation for six months or more. Concomitant terms describe other changes: hypomenorrhea (scanty), opsomenorrhea (prolonged intervals), and oligomenorrhea (infrequent). Several types of amenorrhea are distinguished:
- Physiological — normal absence before puberty, during pregnancy, lactation, and postmenopause.
- Pathological — a symptom of diseases, divided into primary (no first menstruation after age 16) and secondary (cessation for 6 months in previously menstruating women).
- False and iatrogenic.
Central disorders and pathogenesis
Central disorders affect the cerebral cortex and subcortical structures. They are mostly functional in nature due to external factors, stress, or overload. The stress mechanism triggers an excess of opioids, a drop in dopamine levels, and a decrease in gonadotropins.
Anatomical disorders include pituitary tumors, stalk damage, and tissue necrosis, leading to Sheehan syndrome and hyperprolactinemia. Congenital pathologies can cause adiposogenital dystrophy. The gynecological consequence is a drop in FSH and LH, estrogen deficiency, and secondary hypoestrogenism with virilizing syndrome.
Clinical forms: anorexia and Cushing's disease
Nervous anorexia develops with rapid weight loss of 15% or more against the background of diets and exertion, leading to a drop in gonadotropin secretion and osteoporosis. Cushing's disease is associated with hypercortisolism due to elevated corticotropin-releasing hormone and pituitary activation, causing steroid diabetes and obesity with a characteristic moon face.
Stress hits the hypothalamus: opioids go up, dopamine goes down — gonadotropins disappear, and the cycle stops.
Class and exam questions
What is pathological primary and secondary amenorrhea?
Primary is the absence of the first menstruation after 16 years of age. Secondary is diagnosed if a previously regularly menstruating woman has had no menstruation for 6 months or longer.
What is the mechanism of development of functional central amenorrhea under stress?
Under the influence of stress, endogenous opioids are released, which reduce dopamine production. This decreases the hypothalamic production of gonadotropins and leads to the cessation of cyclic secretion.
What changes occur in nervous anorexia?
There is rapid weight loss, a decrease in subcutaneous fat, hypoplasia of the genitalia, as well as somatic disorders such as bradycardia and hypotension, with a high risk of osteoporosis.
What else to study on this topic
- Detailed analysis of neuroendocrine syndromes (PCOS, Sheehan syndrome, Turner syndrome)
- Pathogenesis and diagnosis of hyperprolactinemia
- Iatrogenic causes of cycle disorders (effects of reserpine, haloperidol, and other drugs)
- Issues in the differential diagnosis of primary amenorrhea
- Relationship between psychiatric pathologies and menstrual dysfunctions
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