Amenore
Özet
Amenore, menstrüel döngünün sağlıklı işlemesini sağlayan hipotalamus-hipofiz-over aksı ile genital organlardaki aksamalar sonucu oluşan adet görememe durumudur. Başlangıç zamanına göre primer ve sekonder olmak üzere ikiye ayrılır. Primer amenore, 16 yaşında hiç adet görmeme veya meme gelişiminden üç yıl sonra adet görememe durumudur; hipotalamik-hipofizer fonksiyon bozuklukları, Swyer ve Turner sendromu gibi genetik faktörler, müllerian agenezisi gibi anatomik defektler ile enzim eksikliklerinden kaynaklanır. Sekonder amenore ise düzenli adet görenlerde üç ay, düzensiz olanlarda altı ay adet görememe durumudur; en sık nedeni gebelik olup, polikistik over sendromu, endometrial yapışıklıklar, tiroid bozuklukları ve prematür overyen yetmezlik diğer etkenler arasındadır. Teşhiste detaylı anamnez, fiziksel muayene, ultrasonografi, MR ve hormon testleri (FSH, LH, prolaktin, TSH) kullanılır. Tedavi ise nedene yönelik planlanır; anatomik engeller ve hipofiz tümörleri için cerrahi müdahale uygulanırken, hormon eksikliklerinde siklik östrojen-progesteron tedavisi veya tiroid replasmanı tercih edilir; hiperprolaktinemide dopamin agonistleri kullanılır, stres veya egzersiz kaynaklı durumlarda ise yaşam tarzı değişiklikleri ve psikolojik destek önerilir.
Amenorrhea is the absence of menstruation caused by disruptions in the hypothalamus-pituitary-ovarian axis and genital organs that ensure the healthy functioning of the menstrual cycle, and it is classified into primary and secondary categories based on the onset time. Primary amenorrhea is defined as the complete absence of menstruation by age 16 or three years after breast development, originating from hypothalamic-pituitary dysfunctions, genetic factors such as Swyer and Turner syndromes, anatomical defects like müllerian agenesis, and enzyme deficiencies. Secondary amenorrhea is the absence of menstruation for three months in women with regular cycles or six months in those with irregular cycles; while pregnancy is the most common cause, polycystic ovary syndrome, endometrial adhesions, thyroid dysfunctions, and premature ovarian insufficiency are among other factors. Diagnosis involves a detailed medical history, physical examination, ultrasonography, MRI, and hormone testing including FSH, LH, prolactin, and TSH. Treatment is tailored according to the underlying etiology; surgical options are utilized for congenital anatomical defects and pituitary tumors, whereas cyclic estrogen-progesterone therapy or thyroid replacement is preferred for hormonal deficiencies; dopamine agonists are prescribed for hyperprolaktinemia, and lifestyle modifications along with psychological support are recommended for stress or intensive exercise-induced cases.
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