Treatment of patients with primary amenorrhea should be complex, stage, etiological, individual and pathogenetically justified. The purpose of hormonal therapy in the treatment of primary amenorrhea is to simulate, if possible, hormonal homeostasis in accordance with the age of the patient. Treatment is carried out under the control of tests of functional diagnostics, determination of excretion of hormones in urine and their content in blood plasma. To begin therapy it is necessary as soon as possible and with small doses of estrogens (in order to avoid hyperestrogenism). There are several schemes implemented in stages. Scheme № 11-th stage (preparatory), its purpose - to prepare the reproductive system for subsequent cyclic hormone therapy. Variants of estrogen therapy: a) administration of dimestrol - 1 ml of 0.6% solution intramuscularly once every 3-4 weeks for 4-8 months; 2 ml of 0.6% solution intramuscularly once, with repetition after 30 days; b) replenishment of estradiol tablets - 20 mg with repetition after 40-80 days; c) administration of estradiol dipropionate - 1 ml of 0.1% solution after 2 days intramuscularly with courses of 20 days, a break of 10 days, a duration of -3 months. 2 nd stage (cyclic hormone therapy). Several methods of hormone therapy are used: a) at 1, 2, 3, 5, 7 days of the cycle, 10,000. ED of folliculin or 1 ml of a 0.1% solution of estradiol dipropionate; b) on the 9th, 11th, 13th days of the cycle, 10 thousand. ED of estrogens in combination with 1% r-r of progesterone 1 ml intramuscularly in one syringe; c) on the 5th-21st days of the cycle, 1 ml of progesterone is administered intramuscularly. In the absence of menstruation after 10 days begin a new course. In the case of menstruation, the next stage of treatment. 3rd stage. Includes three courses of hormone therapy: for 4, 6, 8, 10, 12 days of the cycle appoint 10 thousand. ED of folliculin; on the 14th, 16th, 18th days of the cycle - 10 thousand. ED of folliculin and 1 ml of a 1% solution of progesterone in one syringe, on the 20-25th days of the cycle - intramuscularly 1 ml of a 1% solution of progesterone. 4th stage. On the 10th, 12th days of the cycle - estrogens, on 14, 16, 18 days - a combination of estrogens and progesterone and on the 21-23th days of the cycle - intramuscularly 30 ml of a 1% solution of progesterone. Scheme No. 21-th stage. Enter estrogens for 10 thousand. ED daily or every other day for 1-2 months; synestrol - 1 mg 2 times a day or 0.1% solution of 1 ml injected intramuscularly daily for 4-6 weeks; Estradiol dipropionate 0.1% solution in 1 ml intramuscularly for 1-2 months. Progesterone is injected with 1 ml of a 1% solution intramuscularly for 6-8 days after preparation with estrogens. 2 nd stage. Assign mifofallin - 0,005 mg orally every day from the 5th to the 24th day of the cycle and norkolut - 1 tab inside from the 16th to the 25th day of the cycle. 3rd stage. Apply microfolline 1 tab (0.05 mg) from the 5th to the 24th day of the cycle. 4th stage. Use synthetic progestins (norkolut) - 1 tab from the 16th to the 25th day of the cycle. Scheme № 3Microfollin is prescribed - 0.01 mg 2 times a day for 3-4 weeks, then gestagens (5-10 mg per day) for 6-8 days. The course of treatment is repeated 5-6 times. In secondary amenorrhea, to determine the level of lesions and develop appropriate treatment tactics, a number of hormonal diagnostic tests. There are three groups of samples: samples for stimulation; suppression tests aimed at detecting the central or peripheral genesis of the disease; samples for the selectivity of the action of the hormone - a variety of samples for stimulation, are shown to address the question of which peripheral endocrine gland is affected. Progesterone, with estrogens and progesterone, with estrogen with gonadotropins, with synthetic progestins, with clomiphene, dexamethasone. If the indices of dysfunction increase (a positive test), this means a violation of the endocrine gland, the activity of which is stimulated by the introduced hormone. The absence of changes (negative sample) indicates a different genesis of the disease. Sample with progesterone Method: Intramuscularly 10-20 mg / day progesterone is administered within 3-5 days or 125 mg 17-hydroxyprogesterone-capro- nate (17-OPC) intramuscularly, or a 10 mg oral anticoagulant is administered per day for 5 days. Evaluation: positive response - with poorly expressed ovarian failure, negative - with uterine, hypothalamic-pituitary, ovarian amenorrhea. A sample with estrogens and progesterone Method: 10-14 days are prescribed estrogens (folliculin 20 thousand. ED, estrone 2 mg, synestrol 2 tab) daily. Then, within 3-5 days, progesterone is administered-10-20 mg per day. Evaluation: a positive test (the appearance of bleeding) indicates ovarian hypofunction, negative-indicates the uterine form of amenorrhoea. Test with estrogensMethodics: 8-10 days are prescribed 2 mg of estrone (2 tab of microfollin). Evaluation:

positive test (bleeding) testify to estrogenic insufficiency, negative - about impaired receptivity of the endometrium. A sample with gonadotropins. Method: 1.5 thousand. ED intramuscularly choriogonine for 3-5 days daily; appoint perhonal - for 5 thousand. ED intramuscularly daily for 6-10 days. Evaluation: positive test - with hypothalamic-pituitary amenorrhea, negative - with ovarian.

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