Violation of the menstrual cycle - Causes, Symptoms and Treatment .MF .
Violation of the menstrual cycle (NMC) - one of the most frequent causes of treatment of women to obstetrician-gynecologist.According to different authors, in one way or another it appears in 35% of gynecological patients.In addition, more than 70% of women during the life there are certain symptoms (irregular cycle after menstruation, more abundant periods than normal under stress, etc.).
irregular periods - one of the most common symptoms of gynecological diseases, as well taking place and extragenital diseases in women.Another major manifestation of menstrual disorders is bleeding, the nature and scope of which may vary considerably.For frequent bleeding in and out monthly are without any organic study - in this case we speak of distsirkulyatronyh uterine bleeding.For menstrual disorders characterized by the following clinical manifestations: irregular cycles, pain and heavy bleeding.
The normal menstrual cycle is controlled by the release of pituitary hormones and ovaries.In the first phase domina
duration of the menstrual cycle in women is on average 21 to 31 days.Typically, monthly set at the age of 12 to 14 years and often almost immediately become regular.Less commonly, they become regular after the first pregnancy.Recurrent abnormalities are possible, within a few days / weeks.So if a particular monthly cycle come a few days earlier or later, then talk about the abuse is not entitled.If the break between periods of 40-60 days, or on the contrary it is less 21-25 days, with it, so that monthly flows have this woman for a long time - it is possible to speak of an irregular cycle.
Why does the female monthly cycle is accompanied by bleeding?Uterus, as is known, is composed of three layers of which the inner layer - endometrium in turn also be divided into two parts: functional and basal.The first serves as a place where the implanted fertilized egg begins to develop, and where pregnancy.During each menstrual cycle, due to the basal layer it grows and thickens, preparing the groundwork for a possible implantation.In the event that did not happen fertilize an egg "lush" functional layer "superfluous" to exfoliate, under the influence of cyclically varying the concentration of hormones in the blood-ovary the pituitary gland, causing bleeding.Bleeding is quite plentiful, which is associated primarily with a rich system of blood supply of the endometrium.The endometrium penetrate the so-called spiral arteries, which when damaged tissue detachment, they actually entertained.Their damage leads to dilation (expansion) of spiral arterioles, and then starts the actual menstruation.Initially adhesion (sticking) of platelets in the blood vessels of the endometrium is suppressed, but then, the ends of the damaged vascular zapechaty-vayutsya intravascular thrombus composed of platelets and fibrin.Within 20 hours after the onset of menstruation, when most of the endometrial already has stolen, develops pronounced spasm of spiral arterioles, due to what is achieved and hemostasis.Regeneration endometrial begins 36 hours after the onset of menstruation, despite the fact that the exclusion of the endometrium is not yet fully completed.
Causes of mentrualnogo cycle
What causes menstrual irregularities?In principle are the following:
- external (physiological) - in this case, there is no direct physiological effects on the process, but there is indirect factors such as stress, changes in diet, climate change, etc.Therefore, the elimination of external causes leads to the normalization process.
- Pathological - here include a huge group of diseases and conditions for which will be characterized by a violation of the regularity of the cycle.
- Medication - the appointment or revocation of certain drugs
What could be a violation of the menstrual cycle in nature:
- Dysfunctional uterine bleeding - abnormal uterine bleeding without defeat genitals.
- menorrhagia - heavy bleeding (more than 100 ml), arising from a well-defined frequency.
- Metrorrhagia - irregular bleeding, no clear time intervals.
- Polimenorreya - bleeding occurring at intervals of less than 21 days.
- intermenstrual bleeding - bleeding between periods.Number of lost blood during this varies.
- postmenopausal bleeding - bleeding in a year (or more) after the menopause;
pathological condition in which the menstrual cycle:
- ovarian pathology - here are: violations of the functional connection pituitary-ovary, ovarian tissue damage, iatrogenic (drug) effects, degeneration of ovarian Cancer.It should be mentioned such as the pathology of ovarian insufficiency yellow body (on the site of the follicle from which "leaves" the egg for fertilization normally developed corpus luteum, which is able to produce progesterone necessary for implantation of membranes) - insufficient amount of progesterone is not able to support the process at a normal level.This is one of the main causes of menstrual disorders.
- Pathology of the hypothalamic-pituitary system - interferes with the normal regulation of the cycle, due to inadequate allocation of FSH and other hormones;Cancer tissue regeneration.
- Pathology of the adrenal glands and other tissues estrogensekretiruyuschih - disrupted the normal synthesis of estrogen, the process "will not start."This may also include tumors of the adrenal glands.
- endometrial polyps
- Chronic inflammatory diseases of the uterus - is no normal growth of the endometrium and its timely maturation.
- Endometriosis (genital and ektsragenitalny) - is treated separately, due to the fact that the poorly understood reasons for its occurrence.
- Oncology - the appearance of abnormal hormone-secreting tissue can also lead to the occurrence of violations of regularity.
- abortion and curettage of the uterus - can be accompanied by both the mechanical damage and the possible accession of inflammatory processes.
- operated ovary - after surgery on the ovaries, especially with the use of coagulation, can develop impairment of organ function, manifested primarily irregular periods.
- Liver disease - usually for cirrhotic liver tissue degeneration characterized by violation of conjugated estrogens.As a result - increased levels of estrogen and menstrual bleeding stanovjatsja more frequent (and more abundant).
- Dysfunctional uterine bleeding - without organic lesion of organs and systems.In 20% of cases occur right after puberty, 50% in women older than 40 years.Diagnosis is made when sisklyuchenii other pathologies.
- Violation svertyvayushey system of blood - can cause prolonged bleeding and without disrupting the regularity of the cycle.
- Other reasons - surgery, duration of the current illness, etc.
In addition, you must allocate irregular periods associated with the intake of drugs.These include: hormone replacement therapy drugs, corticosteroids, anticoagulants, tranquilizers, antidepressants, digitalis drugs, Dilantin and intrauterine devices.Therefore, the purpose of any of these drugs should be administered only by a physician, as well as their cancellation.If necessary - consultation with a specialist to prescribe.
menstrual cycle in mind the huge number of reasons, diagnostic search should be started from the simple to the complex:
- Medical history - the doctor should know about the received patient drugs, the presence of it has a history of recent pregnancy (after pregnancy periods maynot only normalized, as discussed above, but also violated), all of the external factors that can contribute to the disruption of the cycle.Pay attention to the condition of the patient's psyche.
- Inspection women - attention is drawn to the depletion of the patient, changes in skin color, mucous and sclera patient, the presence of her manifestations extragenital (enlarged liver, thyroid gland, the appearance of nipple discharge is not related to the pregnancy, etc.).
- Gynecological examination - to pay attention to the appearance of pain during the inspection, especially in cervical palpation, the nature and amount of secretions, the presence of space-occupying lesions in the pelvis and the infiltration.
- Taking all strokes - eliminates infection, long-term persistence which can also cause irregular cycles.
- pelvic ultrasound or abdominal cavity - pay attention primarily on the state of the uterus and ovaries, when otsutsvtii pathology in them - the US of all organs and systems, target thyroid ultrasound (for possible causes of the pituitary) and liver.When viewed from ovarian pay attention to their size, the presence of follicles and their size, the blood supply to tissue, etc.
- Clinical and biochemical blood tests, coagulation - is necessary for the differentiation of pathological conditions of the hematopoietic tissue pathology and blood clotting.
- Determination of hormone levels in the blood - an important factor.Standards:
Estradiol - 0.17 ± 0,1nmol / l - follicular phase, 1,2 ± 0,13nmol / L-ovulation, 0.57 ± 0,01 nmol / L - luteal phase.
Progesterone - 1.59 ± 0,3 nmol / l - follicular phase, 4.77 ± 0.8 nmol / n- ovulation, 29.6 ± 5.8 nmol / l - luteal phase LH
- follicular phase - 1.1 - 11.6 mIU / L,ovulation 17 - 77 mIU / l, luteal phase 0 14.7 mIU / l
FSH - follicular phase-2,8-11,3 mIU / l, ovulation - 5.8 - 21 mIU / l, luteal phase - 12 - 9.0 mIU / l
- MRI - a method by which a patient can be inspected in detail, for tumors and diseased tissue.Dear, it is rarely used.
- Hysteroscopy - allows a detailed study of the endometrium, the presence or absence of a polyp.It allows you to perform inspection after scraping to send material for histological examination.Of the minuses - the cost and the need to give anesthesia.
combination of medical history, clinical manifestations and methods laboratono instrumental surveys allows to determine the cause of the irregularities of the menstrual cycle, pain and abnormal bleeding and to eliminate them.
violations of the menstrual cycle in the first place here is necessary to include the removal of all external influence factors.As the craze for many women, weight loss can be a major cause of menstrual disorders, should correctly choose the diet for patients and encourage them to give up excessive exercise.
If heavy bleeding, after eliminating the pathology of blood coagulation should start symptomatic treatment.These include:
- Hemostatic agents - vikasol, etamzilat, troneksam.In the hospital they are appointed usually by intramuscular injection (menadione, etamzilat) or drip (Tranexam) + in tablet form to enhance the effect (usually 2 tablets 3 times a day -. Troneksam, 2 tablets 2 times a day and vikasol etamzilat).
- ε-aminocaproic acid - reduces bleeding in 60% of women
- If heavy bleeding - compensation of blood loss due to plasma infusion, sometimes (rarely) blood.
- Surgical treatment - an extreme method of treatment, for example with heavy bleeding, over the age of 40 years, in the presence of resistant anemizatsii patient when the cause of bleeding and can not be established reliably.Perhaps:
- uterus scraping.
- Endometrial ablation - the endometrial laser burning.
- balloon endometrial ablation (injected into the uterine cavity of the balloon with a liquid, which is then heated to 87.5 degrees).
- Gisterektomiya (removal of the uterus).
- sure combination with hormonal therapy, especially oral contraceptives.This not only allows you to enhance the hemostatic effect, but can also become the first and sometimes the main treatment of irregular menstruation.Usually they use a combination of drugs that contain high doses of estrogen and progesterone.
One of the most popular drugs in the Russian Federation progesterone used in the treatment of disorders of the menstrual cycle, and Duphaston are Utrozhestan.Usually their appointment depends on the hospital, the real proof of the advantages of one over the other is not.The doses depend on the assignment situation of, on average: Djufaston - 1 tablet 1-2 times a day with a 11 to 25 day cycle, one capsule Utrozhestan 2-3 times a day.
addition to hormonal treatment may include the following drugs:
- Norethisterone - oral prgesteron, 5 mg 3 times a day from 5th to 26th day of the cycle.
- Medroxyprogesterone Acetate - 10 mg per day, from 5 to 26 days.
6. With all the benefits of these drugs have a number of contraindications to the same long-term use or withdrawal of oral contraceptives often arise hormonal disorders.The duration and frequency of menstruation is reduced or increased, and discharge may be too scarce or abundant, accompanied by pain in the abdomen.A beneficial effect on the function of the female reproductive system complex of biologically active substances - "Time Factor".It includes herbal extracts, B9 vitamins C, E and PP, minerals, Fe, Mg and Zn - diminish muscle cramps, pain during menstruation and are involved in restoring the hormonal balance, including the background, or after the use of contraceptives.
In women older than 40 years is allowed the use of drugs in whole or in part "tripping" of menstruation.These include:
- Danazol - 200-400 mg / day.It reduces the volume of blood is lost with each menstrual period by 87%.Gestrinone
- - one capsule of 2.5 mg two times a week.It leads to the atrophy of the endometrium.
- Agan GnRH - cause complete cessation mesyatsnyh, amenorrhea.Treatment is necessary to limit the 6 months to prevent osteoporosis.Used rare and quite expensive.
However, primary in the treatment of menstrual disorders is a cure the underlying disease. without removing the main focus to achieve a complete cure is not possible.For example if revealed endometrial polyp - necessary to make diagnostic curettage of the uterus, chronic inflammation - antibiotics, etc.I repeat once again - in most cases, disruption of the menstrual cycle is only a symptom of a primary disease process and its treatment should be prevalent.Only after eliminating the main focus and the most acute clinical manifestations, can be engaged in restoration of disturbed cycle.
violations of the menstrual cycle should not be considered a violation of the menstrual cycle minor problems.That's at least a few reasons why you should consult your doctor:
irregular cycle may be accompanied by persistent anovulation therefore lead to infertility
Frequent intermenstrual bleeding can cause serious complications - from fatigue to full disability.