Thei-amenorrhea iyonaukungabi khona kokuya esikhathini kowesifazane oseminyakeni yokuzala. Igama elithi "amenorrhea" livela esiGrekini a ngokuswela, i-melancholy izinyanga kanye i-rhea ukucwila.

Kusukela ku-2% kuya ku-5% wabesifazane bazothinteka yi-amenorrhea. Lokhu yi uphawu okuyinto ebalulekile ukwazi imbangela. Ukungabikho kokuya esikhathini kungokwemvelo lapho, ngokwesibonelo, owesifazane ekhulelwe, encelisa noma esondela ekunqamukeni kokuya esikhathini. Kodwa ngaphandle kwalezi zimo, kungase kube uphawu olubonisa ukucindezeleka okungapheli noma inkinga yezempilo njenge-anorexia noma ukuphazamiseka kwendlala yegilo.

Izinhlobo zezikhathi ezingabanjwanga

• I-amenorrhea eyinhloko: lapho uneminyaka engu-16 ubudala, isikhathi sakho singakaqalwa. Izici zocansi zesibili (ukuthuthukiswa kwebele, izinwele ku-pubis namakhwapha kanye nokusatshalaliswa kwezicubu ezinamafutha ezinqulwini, ezinqeni nasemathangeni) zingase zibe khona nokho.
• I-amenorrhea yesibili: lapho owesifazane esevele esesikhathini futhi eyeka ukuya esikhathini ngenxa yezizathu ezithile noma kwesinye, isikhathi esilingana okungenani nezikhawu ezintathu zemijikelezo yokuya esikhathini eyedlule noma izinyanga eziyisithupha ngaphandle kokuya esikhathini.

Kunini lapho ungaya esikhathini?

Izikhathi eziningi, ukungazi ukuthi kungani une-amenorrhea kuyakhathaza. Abantu abalandelayo kufanele bonana nodokotela :

- abesifazane abane-amenorrhea eyinhloko noma yesibili;

- uma kwenzeka i-amenorrhea yangemva kokubeletha, ukuhlolwa kwezokwelapha kuyadingeka uma i-amenorrhea iqhubeka isikhathi esingaphezu kwezinyanga eziyisithupha kwabesifazane abake basebenzise iphilisi lokuvimbela inzalo, abagqoke i-Mirena® hormonal IUD, noma ngaphezulu kwezinyanga eziyi-6 ngemuva umjovo wokugcina we-Dépo-Provera®.

Ukuxilongwa kwe-amenorrhea

Ezimweni eziningi,ukuhlolwa ngokomzimba, i ukuhlolwa kokukhulelwa futhi kwesinye isikhathi i-ultrasound yezitho zobulili yanele ukuqondisa ukuxilongwa.

I-x-ray yesihlakala (ukuhlola ukukhula kokuthomba), ukuhlolwa kwehomoni noma ukuhlolwa kobulili be-chromosomal kwenziwa ezimweni ezingavamile ze-amenorrhea eyinhloko.

Izimbangela zokushoda kwezikhathi

Kunezimbangela eziningi ze-amenorrhea. Nazi ezivame kakhulu ngohlelo olwehlayo.

• Ukukhulelwa. Isizathu esivame kakhulu se-amenorrhea yesibili, kufanele kube ngowokuqala ukusolwa kowesifazane ocansini. Ngokumangalisayo, ngokuvamile kwenzeka ukuthi lesi sizathu sikhishwe ngaphandle kokuhlolwa kwangaphambili, okungenayo ingozi. Ezinye izindlela zokwelapha ezikhonjiswa ukwelapha i-amenorrhea ziyavinjelwa ekukhulelweni. Futhi ngokuhlolwa okutholakala ngokwentengiso, ukuxilongwa kulula.
• Ukubambezeleka okuncane ukuthomba. Kuyimbangela evame kakhulu ye-amenorrhea eyinhloko. Iminyaka yokuthomba ivamise ukuba phakathi kweminyaka eyi-11 neyi-13, kodwa ingahluka kakhulu kuye ngobuzwe, indawo, ukudla kanye nesimo sempilo.

   

  Emazweni athuthukile, ukubambezeleka kokuthomba kuvamile kwabesifazane abasebasha abazacile kakhulu noma abasubathi. Kubonakala sengathi laba besifazane abasebasha abanawo amafutha omzimba anele okuvumela ukukhiqizwa kwamahomoni e-estrogen. Ama-Estrogen avumela ulwelwesi lwesibeletho ukuba lujiye, futhi kamuva ukuya esikhathini uma iqanda lingavundiswanga yisidoda. Ngandlela thize, imizimba yalaba besifazane abasebasha izivikela ngokwemvelo futhi ibonise ukuthi isimo sabo somzimba ayanele ukusekela ukukhulelwa.

   

  Uma izici zabo zobulili zesibili zikhona (ukuvela kwamabele, izinwele ze-pubic kanye nemakhwapheni), asikho isidingo sokukhathazeka ngaphambi kweminyaka yobudala eyi-16 noma eyi-17. Uma izimpawu zokuvuthwa ngokocansi zisekhona lapho uneminyaka engu-14, inkinga ye-chromosomal (i-chromosome eyodwa ye-X yocansi esikhundleni se-2, isimo esibizwa nge-Turner syndrome), inkinga ngokukhula kohlelo lokuzala noma inkinga ye-hormonal.

• Ukuncelisa ibele. Imvamisa, abesifazane abancelisayo abanayo isikhathi. Kodwa-ke, kufanele kuqashelwe ukuthi basengaba ne-ovulation ngalesi sikhathi, ngakho-ke ukukhulelwa okusha. Ukuncelisa ibele kumisa amaqanda futhi kuvikela ukukhulelwa (99%) kuphela uma:

  – umntwana uthatha ibele lodwa;

  – ingane ingaphansi kwezinyanga eziyisi-6 ubudala.

• Ukuqala kokunqamuka kokuya esikhathini. Ukunqamuka kokuya esikhathini ukunqamuka kwemvelo kwemijikelezo yokuya esikhathini eyenzeka kwabesifazane abaphakathi kweminyaka yobudala engama-45 nengama-55. Ukukhiqizwa kwe-estrogen kuyehla kancane kancane, kubangele izinkathi ukuba zingalingani bese zihamba ngokuphelele. Ungaqhakaza ngezikhathi ezithile iminyaka emibili ngemuva kokuyeka ukuya esikhathini.
• Ukuthatha ukukhulelwa kwe-hormonal. “Izikhathi” ezenzeka phakathi kwamaphakethe amabili amaphilisi akuzona izikhathi ezixhumene nomjikelezo we-ovulatory, kodwa "ukuhoxa" ukopha lapho amaphilisi emiswa. Amanye ala maphilisi anciphisa ukopha, okuthi kwesinye isikhathi ngemuva kwezinyanga ezimbalwa noma iminyaka yokuwaphuza kungabe kusenzeka. I-Mirena® hormonal intrauterine device (IUD), i-injectable Depo-Provera®, iphilisi eliqhubekayo lokuvimbela inzalo, ukufakelwa kwe-Norplant ne-Implanon kungadala i-amenorrhea. Akuyona into ebucayi futhi ekhombisa ukusebenza ngempumelelo kwezindlela zokuvimbela inzalo: umsebenzisi uvame ukuba “sesimweni sokukhulelwa kwamahomoni” futhi angavusi amaqanda. Ngakho-ke ayinayo umjikelezo noma imithetho.
• Ukuyeka ukuthatha indlela yokuvimbela inzalo (amaphilisi okulawula ukubeletha, iDepo-Provera®, iMirena® hormonal IUD) ngemuva kwezinyanga ezimbalwa noma iminyaka yokusebenzisa. Kungase kuthathe izinyanga ezimbalwa ngaphambi kokuba umjikelezo ovamile we-ovulation nokuya esikhathini ubuyiselwe. Kubizwa ngokuthi i-post-contraceptive amenorrhea. Eqinisweni, izindlela zokuvimbela inzalo zamahomoni zikhiqiza kabusha isimo se-hormonal sokukhulelwa, ngakho-ke zingamisa izikhathi. Ngakho-ke lezi zingase zithathe isikhathi ukubuya ngemva kokumisa indlela, njengangemuva kokukhulelwa. Lokhu kwenzeka ikakhulukazi kwabesifazane ababenomjikelezo omude kakhulu (ngaphezu kwezinsuku ezingama-35) kanye nomjikelezo ongalindelekile ngaphambi kokuthatha indlela yokuvimbela inzalo. I-amenorrhea yangemva kokuvimbela inzalo ayinayo inkinga futhi ayikhiphi inzalo elandelayo. Abesifazane abathola ukuthi banezinkinga zokuzala ngemuva kokuvimbela inzalo, bake baba nazo phambilini, kodwa ngenxa yokuvikela kwabo ukukhulelwa, bebengazange "bahlole" ukuzala kwabo.
• Umkhuba wesiyalo noma umdlalo onzima njengemarathon, ukwakha umzimba, i-gymnastics noma i-ballet yochwepheshe. I-"sportswoman's amenorrhea" kucatshangwa ukuthi ibangelwa ukuntuleka kwezicubu ezinamafutha kanye nengcindezi umzimba obhekene nayo. Kukhona ukuntuleka kwe-estrogen kulaba besifazane. Kungaba futhi ukuthi umzimba ungamoshi amandla kungenasidingo ngoba uvame ukudla ukudla okunekhalori ephansi. I-Amenorrhea ivame kakhulu izikhathi ezi-4-20 kubasubathi kunomphakathi jikelele¹.
• Ukucindezeleka noma ukushaqeka ngokwengqondo. Okubizwa nge-psychogenic amenorrhea kubangelwa ukucindezeleka kwengqondo (ukufa emndenini, isehlukaniso, ukulahlekelwa umsebenzi) noma yiluphi olunye uhlobo lokucindezeleka okukhulu (ukuhamba, ushintsho olukhulu endleleni yokuphila, njll.). Lezi zimo zingaphazamisa okwesikhashana ukusebenza kwe-hypothalamus futhi zibangele ukuthi ukuya esikhathini kume inqobo nje uma umthombo wengcindezi uqhubeka.
• Ukwehla kwesisindo esisheshayo noma ukuziphatha kwe-pathological yokudla. Isisindo somzimba esiphansi kakhulu singaholela ekwehleni kokukhiqizwa kwe-estrogen kanye nokuyeka ukuya esikhathini. Eningi labesifazane abaphethwe i-anorexia noma i-bulimia, ukuya esikhathini kuyayeka.
• Ukweqisa okweqile kwe-prolactin kusuka endleni ye-pituitary. I-Prolactin iyi-hormone ekhuthaza ukukhula kwe-mammary gland kanye ne-lactation. Ukuphuma ngokweqile kwe-prolactin emgodleni we-pituitary kungabangelwa isimila esincane (esihlala siyingozi) noma ngemithi ethile (ikakhulukazi ama-antidepressants). Esimweni sokugcina, ukwelashwa kwayo kulula: imithetho iphinda ivela emasontweni ambalwa ngemva kokumisa umuthi.
• Ukukhuluphala ngokweqile noma isisindo esiningi.
• Ukuthatha imithi ethile njengama-corticosteroids omlomo, ama-antidepressants, ama-antipsychotics, noma i-chemotherapy. Ukulutha kwezidakamizwa nakho kungabangela i-amenorrhea.
• Izibazi zesibeletho. Ngemva kokuhlinzwa ukwelapha i-uterine fibroids, ukukhishwa kwe-endometrial, noma ngezinye izikhathi ukuhlinzwa, kungase kube nokuncipha okukhulu kokuya esikhathini, noma i-amenorrhea yesikhashana noma ehlala isikhathi eside.

Izimbangela ezilandelayo azivamile kakhulu.

• I-anomaly yentuthuko izitho zocansi ezingezona izakhi zofuzo. I-Androgen insensitivity syndrome ubukhona, esihlokweni se-XY (esofuzo), sezitho zobulili ezibukeka njengabesifazane ngenxa yokungabikho kobuzwela bamaseli kuma-hormone abesilisa. Laba bantu "be-intersex" abanokubukeka kwesifazane bathola ukuthomba nge-amenorrhea eyinhloko. Ukuhlolwa komtholampilo kanye ne-ultrasound kuvumela ukuxilongwa: abanaso isibeletho, futhi izindlala zabo zocansi (amasende) zitholakala esiswini.
• Izifo ezingapheli noma ze-endocrine. Isigaxa se-ovarian, i-polycystic ovary syndrome, i-hyperthyroidism, i-hypothyroidism, njll. Izifo ezingamahlalakhona ezihambisana nokuncipha kwesisindo (isifo sofuba, umdlavuza, isifo samathambo noma esinye isifo sokuvuvukala, njll.).
• Imithi yokwelashwa. Isibonelo, ukususwa kokuhlinzwa kwesibeletho noma ama-ovari; i-chemotherapy kanye ne-radiotherapy.
• I-anatomical anomaly izitho zocansi. Uma i-hymen ingagcwalisiwe (i-imperforation), lokhu kungase kuhambisane ne-amenorrhea ebuhlungu entombazaneni ephuzile: izikhathi zokuqala zihlala zibambekile emgodini wesitho sangasese sowesifazane.

Inkambo kanye nezinkinga ezingenzeka

Ubude besikhathii-amenorrheakuya ngombangela oyimbangela. Ezimweni eziningi, i-amenorrhea iyabuyiselwa emuva futhi iphathwe kalula (ngaphandle kwe-amenorrhea ehlobene nokungajwayelekile kofuzo, ukungasebenzi kahle okungasebenzi, ukunqamuka kokuya esikhathini noma ukususwa kwesibeletho namaqanda). Kodwa-ke, lapho i-amenorrhea ehlala isikhathi eside ishiywe ingelashwa, imbangela ingase ifinyelele ezindleleni zesiguli. ukukhiqiza kabusha.

Ngaphezu kwalokho, i-amenorrhea ehlotshaniswa nokuntuleka kwe-estrogen (i-amenorrhea ebangelwa imidlalo enzima noma ukuphazamiseka kokudla) ikwenza kube sengozini enkulu ye-osteoporosis yesikhathi eside - ngakho-ke ukuphuka, ukungazinzi kwe-vertebrae kanye ne-lordosis - njengoba i-estrogen idlala indima ebalulekile ekulondolozeni ukwakheka kwamathambo. Manje sekuyaziwa ukuthi abasubathi besifazane abahlushwa i-amenorrhea banethambo eliphansi kunelejwayelekile, yingakho bevame ukuphuka.¹. Ngenkathi ukuzivocavoca okusesilinganisweni kusiza ukuvimbela i-osteoporosis, ukuzivocavoca ngokweqile kunomphumela ohlukile uma kungalinganiswanga ngokudla okuphezulu kwekhalori.