Menorrhagia - is coming to a regular menstrual period with abnormal length (sometimes up to 14 days) and a large blood loss.Menorrhagia can occur in young girls during the formation of the correct menstrual cycle in adult women, as well as in entering into menopause patients.
Menorrhagia - it is a symptom, not an independent disease.In fact, it is a long, heavy menstruation, coming every month on time.An important diagnostic criterion for menorrhagia is its regularity, because sometimes the symptoms are confused with other species of menstrual disorders - metrorrhagia, irregular intermenstrual bleeding.
menorrhagia in women is caused by a large number of reasons, but always associated with violations of the right of rejection of the mucous layer of the uterus during menstruation.
In order to properly interpret the nature of menstruation, should determine its normal parameters, which is considered to be the norm.Typically, physiological menstruation comes once in 28 days (allo
determine the validity criteria of menstrual function is not easy.Long-term and heavy menstruation, as well as short and scarce, there may be a woman in his youth, and last a lifetime without causing harm to her health and reproductive capacity.Situations where atypical during menstruation observed in patients lifelong (primary menorrhagia), is not compatible with the disease or reproductive dysfunction, not a pathological, and is taken as the individual rate.
If after a period of normal menstruation occurs menorrhagia, to talk about its secondary origin.
reasons for menorrhagia are not limited to gynecological, since the menstrual cycle is closely related to the central nervous system, the endocrine glands and largely dependent on the state of the immune system.They all lead to the hormonal dysfunction, which is the leading cause menstrual irregularities.
Sometimes the study of the nature and causes of idiopathic menorrhagia indicate its character.Idiopathic menorrhagia - a primary violation of the formation of a normal menstrual period, which takes place on their own, without the involvement of foreign dysfunction.Idiopathic menorrhagia depends only on the pathological processes in the uterus and observed during normal operation of the ovaries (i.e., women with ovulation).
menorrhagia in women is often combined with the symptoms of gynecological diseases, but it can be triggered and temporary factors: stress, acclimatization, excessive exercise, and others.
diagnosis of menorrhagia is never final.In fact, he just finds a violation of normal menstrual function, and requires further examination to determine the cause of its occurrence.Treatment of menorrhagia depends on its cause.
It should be noted that the individual episodes are experiencing menorrhagia and women's health.Over the life of every woman there are situations that are changing during the normal menstrual cycle.However, such a situation is always a good ending, when the body alone restores violations, or they are eliminated by simple therapies.
Pathological menorrhagia always indicate a serious cause and require treatment.
menorrhagia associated with structural changes in the endometrium at the time of menstruation.To understand the mechanism of its development, it is necessary to recall the cyclic physiological processes that occur in the endometrium and functionally related organs.
The menstrual cycle is the time elapsed since the start of menstrual bleeding before the next.The first day of the cycle - it is also the first day of menstruation, and his last day coincides with the beginning of the following month.Through woman's menstrual cycle implements reproductive function, that is, can conceive and bear a child.
menstrual cycle always consists of successive changes of joint uterus and ovary under the control of the central nervous system, or more precisely - the pituitary and hypothalamus.
normal menstrual cycle is always a two-phase.First (follicular) phase is followed by the maturation of the egg in the ovary.It is in the follicle - vials containing follicular fluid.At the end of oocyte maturation (mid-cycle), follicle ruptures and releases it outside the ovary (ovulation).The mucosa of the uterus (the endometrium) at the same time begins the process growths (proliferation) of the inner layer.The endometrium becomes thick, doughy, sprouting blood vessels, as it prepares the uterus for a potential pregnancy: If the egg is fertilized and fall of the fallopian tubes into the uterine cavity, endometrium becomes a place of sprawling development of the fetus.
If, within two days of fertilization occurs, the egg dies, and all changes in the endometrium in the first, follicular, phase of the cycle, beginning to liquidate.The second (luteal) phase of the cycle is accompanied by a rejection of the endometrium and overgrown finishes to evacuate to the outside - menstruation.The regeneration (recovery) of the endometrium begins 36 hours after the onset of bleeding.
All of these changes in the uterus and the ovaries occur when hormones controlling participation.The maturation of the follicle and egg accompanies follicle stimulating hormone (FSH), pituitary hormone and estrogens stimulate the proliferation of the endometrium.After ovulation in the ovaries dominates luteinizing (LH), pituitary hormone, and for changes in the uterus responds progesterone.
All of cyclic action of the pituitary gland, ovaries and uterus, "watching" the hypothalamus, located in the brain.
Thus, changes in the normal functioning of any link in the "hypothalamus - pituitary - ovary - uterus" can lead to a change in the character of menstrual function.
physiological causes of occurrence of menorrhagia are:
- Psychoemotional disorders, fatigue;
- The changing nature of food: sour milk diet causes the liver to produce substances that reduce blood clotting.
- Incorrect dosage exercise.Sports or heavy physical labor during the day before menstruation lead to a breach of uterine contractility and incorrect rejection of the endometrium.
- Abrupt climate change.
- Violation of the liver, endocrine glands, thyroid gland (hypothyroidism) or blood coagulation.
- Vitamin deficiencies involved in the blood coagulation system (G, F, K, calcium, and others).
- The period of the menstrual function (puberty) or extinction (menopause).
- Hormonal agents, aspirin, anticoagulants.
- Intrauterine contraception.
When such causes are removed, normal menstrual function is stabilized.
Pathologic causes of menorrhagia always imply the presence of the disease, accompanied by menstrual disorders, namely:
- Cervical polyps;
- Fibroids uterine body;
- Ovarian dysfunction.
Symptoms and signs of menorrhagia
menorrhagia clinically manifested prolonged (more than a week), menstrual bleeding, sometimes the interval between them can be reduced (less than three weeks).The period of heavy bleeding, usually takes no more than three days.A distinctive feature is the presence of menorrhagia menstrual blood clotted.Since the rejection of the endometrium processes occur irregularly, the blood before to pour out, accumulate in the uterine cavity and the time to clot and form clots.
MBL significant impact on the general state of patients with menorrhagia, in the case of anemia appear weakness, dizziness, possible fainting.
If menorrhagia appear in the background of cervical or uterine polyps, menstruation are not only heavy and prolonged, there is pain in the abdomen.Fibroids uterine body, particularly with a central location in the submucosal layer, also causes pain during menstruation.
diagnosis of menorrhagia involves serial diagnostic search for the cause of its occurrence.Due to the very large number of possible causes for this symptom are executed sequentially:
- conversation.It is important to find out when there menorrhagia, whether it has an obvious reason (stress, fatigue, etc.), the nature of bleeding, and the presence of accompanying symptoms (especially pain).
- Gynecological examination.In the presence of myoma node in the uterine cavity size of the uterus and its consistency can be changed, and cervical polyps visualized on the long leg in the area of the external os when viewed in a mirror.Uterine palpation and displacement can be painful.The presence in the vagina cables point to the infectious-inflammatory process.
- Fencing material (the contents of the vagina and cervix) for laboratory research.
- Hormonal study according to the phases of the cycle.Determined estradiol, FSH, LH, progesterone.
- A blood test to determine the degree of anemia.
- Ultrasound scanning of the pelvic cavity.It allows you to see the follicles in the ovaries (or lack thereof), to assess the condition of the endometrium relative phase of the cycle, see the fibroids, polyps, or tumors of the ovaries.
- Hysteroscopy.It allows you to visually examine the entire uterine cavity, detect and immediately remove polyps and take material (endometrium) for histological examination.
treatment of menorrhagia
Unfortunately, patients seldom promptly seek qualified help at the first menorrhagia.Usually, if the bleeding is not accompanied by a significant deterioration of health, after they try to cope with unwanted symptoms yourself using hemostatic and pain medication.Indeed, symptomatic treatment can often eliminate the symptoms of disease, but it helps only with menorrhagia physiological origin.When based on disruption of menstruation is a disease, menorrhagia persists.If menorrhagia is repeated two - three cycles in a row, you should always consult a doctor.
Treatment depends on the causes of menorrhagia caused it.In fact, it coincides with the therapy of the disease, which provokes menstrual dysfunction.Primarily eliminated all triggers.Then proceed to the elimination of the direct causes of menorrhagia.
Hormonal disorders are corrected by means of appropriately chosen drugs used cyclic oral contraceptives and progestogens.They have a hemostatic, anti-inflammatory effect, as well as restore the correct hormonal balance.Drugs selected according to the age and menstrual function.Most used Utrozhestan, Duphaston, norethisterone.
Uterine fibroids require additional therapeutic measures, and certainly polyps removed during hysteroscopy.
used to reduce blood loss styptics (Traneskam, Vikasol and the like).
Eliminate help anemia drugs containing iron.
Regular menorrhagia of unknown origin sometimes require removal (scraping) of all the mucous layer followed by histological study.
Even the proper treatment of menorrhagia without addressing its immediate cause will not be effective.