menstrual irregularities - a distortion of the rhythm and character of normal menstruation.Violation of the menstrual cycle can not be eliminated without the elimination of its causes, so the primary method of menstrual dysfunction therapy is the treatment of the underlying pathology. For example, if the menstrual dysfunction provoked inflammation in the uterus and appendages, to restore proper rhythm of menstruation is possible only after the elimination of infection by antibiotic therapy.
menstrual cycle - a hormone cyclically repeating the anatomical and physiological processes that provide the ability to bear children.Menstrual cycles are separated by the first day of menstruation, it means the end of the previous cycle and the beginning of the next.The average duration of each normal menstrual cycle is about 28 days, but the allowed fluctuation within 25 - 35 days.
Menstruation - a physiological short uterine bleeding associated with the rejection of the inner
Uniform reliable criteria of "normality" indicators of the menstrual cycle does not exist.It is considered that if the existing healthy woman menstrual cycle does not change, and allows her to have children, it is normal for her.
menstrual cycle is formed as a result of a complex chain of successive changes in many organs and systems:
- the brain.In its structure - the hypothalamus and the pituitary gland, it is important biologically active substances with which the brain "instructs" the ovaries.Pituitary hormones synthesized in controlling menstrual cycle - follicle-stimulating hormone (FSH) and luteinizing (LH).
- ovaries.They are a source of estrogen (estradiol and estriol) and progestogen (progesterone).With ovarian hormones "gave the command" womb.Also in the ovaries the egg is born - the ancestors of human life.
- Uterine (fallopian) tube.To pregnancy could develop, the fertilized egg should fall into the uterus and infiltrate the endometrium.The fallopian tubes carry the transport function: with the help of the tube wall undulations promotes a fertilized egg in the uterine cavity.The day before ovulation, the fallopian tubes several elongate, become more elastic, and their wall thickens.
- uterus.In the endometrium occur monthly cyclical growths and rejection of the internal mucous layer, which "led by" ovarian hormones.
- vagina.Structural changes in the epithelium of vaginal cavity associated with the preparation of the birth canal to the outside potential pregnancy.The mucosa of the vagina in the first half of the cycle becomes thicker, and the vaginal wall becomes more elastic.
- breast cancer.On the eve of the regular monthly breast increase somewhat and become more dense (nagrubayut).
normal menstrual cycle is always a two-phase.First (follicular) phase is controlled by follicle stimulating hormone and is associated with the maturation of the egg in the ovary.The ovary contains a large number of primordial follicles - "bubbles" of liquid, surrounded by a layer of cells of the follicular epithelium within which mature egg.The follicle and egg is mature symmetrically.During the period of the menstrual cycle have time to grow up just one egg.
parallel changes in the ovaries under the control of estrogen in the uterus begin the processes of preparing for a potential pregnancy: endometrium increases in volume due to enhanced proliferation (proliferation) of the inner layer of blood vessels and grows.
the middle of the menstrual cycle, the effect of FSH decreases, the mature follicle ruptures, releasing the egg in a full pelvic cavity.This point is called ovulation.A viable egg can not live more than two days, and then if fertilization does not happen, dies.
death of the egg indicates that pregnancy does not take place, and all occurred "preparatory" to eliminate the need to change, which is what happens next, second, the phase of the cycle: the sprawling inner layer of the endometrium starts to be torn away.All the processes are controlled primarily luteinizing hormone, so the second half of the cycle is called the luteal phase, it begins after ovulation and ends with the beginning of the next menstruation.
reasons for menstrual disorders may be associated with diseases of the genital organs, and with changes in the hypothalamus-pituitary system.Also, the nature of menstruation may affect neginekologicheskie disease.
physiological nature may be of menstrual disorders in menopause or in adolescents.In adolescence marked juvenile bleeding associated with the imperfection of mechanisms of hormonal regulation, and during menopause, menstrual dysfunction associated with functional ovarian extinction.
normal, physiologic situation is a violation of the menstrual cycle during pregnancy as a complete lack of menstruation for 10 - 12 months.
menstrual irregularities include:
- a change in its duration;
- increase or decrease in blood loss;
- intermenstrual bleeding;
- postmenopausal bleeding;
- complete cessation of menstrual function.
urgency of the problem of menstrual dysfunction is defined by its relationship with the reproductive function of patients.Menstrual dysfunction often combined with infertility.
establish reliable cause of menstrual disorders is not always easy.Diagnostic search begins a conversation with the patient and may result in complex instrumental examination.
Therapy menstrual disorders involves the elimination of its causes.
reasons for irregular menstruation
menstrual cycle is formed with the participation of a large number of external and internal factors.On his character affect environmental conditions, diet, stress, excessive physical activity and climate conditions.Not every deviation from the usual menstrual regulations can be regarded as a pathology.In 70% of perfectly healthy women during life does not happen often transitory menstrual irregularities, they are alone and have no negative effects.If the body is healthy, it overcomes the disturbances caused by internal compensatory mechanisms.
to identify the source of menstrual disorders is necessary to establish the presence of normal menstruation, the patient in the past.If those were not menstruating and were always pathological, it is believed that menstrual dysfunction due to congenital causes.
Abnormal menstrual disorders in adolescents occurs in the period of its formation (up to 18) in the form of juvenile uterine bleeding, childbearing age (18-47 years) is often associated with gynecological diseases, and it provokes a natural premenopausal estrogen deficiency.
physiological disorders of the menstrual cycle in menopause is only in the period preceding the counter menopause.If bleeding occurs after the complete absence of menstruation for a year, it is not only considered pathological, but also dangerous, because it may indicate a malignant process.
In some situations appeared menstrual dysfunction is considered the norm.An example is the menstrual cycle during pregnancy as a lack of menstruation.
is normal menstrual cycle and after childbirth only during the first two to three months.During pregnancy, there are significant changes in the endocrine and the body needs a certain time for their compensation.However, if after a specified period of time menstrual function is not restored, the menstrual cycle after birth may indicate the development of neuroendocrine syndromes associated with postpartum suppression of ovarian function.
menstrual irregularities present in the hospital more than a third of all gynecological ailments.There are several options for the development of menstrual dysfunction:
- Ovarian option.The key to a normal menstrual function is biphasic ovulatory menstrual cycles.Any change in the structure or function of the ovaries, resulting in failure of formation of complete ovulation leading to disruption of the normal menstrual cycle (inflammation, malformations, ovarian operation, etc.).
- The stock option.Pathological processes in the endometrium, leading to disruption of the mechanisms for its proliferation and / or rejection, as well as altering the contractile function of the uterus.These include infectious and inflammatory processes in the endometrium, polyps, endometriosis, fibroids, post-diagnostic procedures (curettage, aspiration biopsy, hysteroscopy, and the like).About the causes of menstrual disorders is intrauterine contraception.Sometimes the presence of a foreign body of the uterus (spiral) prevents its full reduction, so there is an increase duration of menstruation and the number of lost blood.
often arise menstrual disorders after abortion due to the traumatic mechanical damage of the endometrium and a sharp change in hormonal levels.However, menstrual disorders after abortion are associated not only with the hormonal causes of injury and endometrium, but also with the development of post-procedural complications - imperforate cervix, delayed fetal parts (incomplete abortion) or infection.
- Central option.It occurs against a background of hormonal regulation of cyclic changes in the genitals by the hypothalamus-pituitary system.
disruption of normal menstrual function often accompany diabetes, liver disease, adrenal gland and thyroid gland.In patients with obesity risk of hormonal dysfunction increases tenfold.
Irregular menstruation can be triggered by improper intake of certain drugs: hormones, anticoagulants, antidepressants, and so on.
Excessive modern women weight loss methods has led to a large number of women with menstrual dysfunction.Underweight (especially the sharp decrease) threatens the normal menstrual cycle is not less than the obese.
Sometimes reliable cause menstrual dysfunction can not be established.
symptoms of menstrual disorders
To study the nature of the violation of menstrual function should be considered cyclical, duration and intensity of menstrual bleeding and blood loss.Typically, during the interview the patient clearly indicate the nature of the emerging changes in the usual menstrual cycle and may help determine the cause of their appearance (stress, hypothermia, abortion, worsening of endocrine diseases and so forth.).Often, in addition to changes in menstrual function in patients with complaints of present infertility.
options menstrual dysfunction conditionally divided into several main (but not necessarily) groups:
- Menorrhagia (menorrhagia).Regular menstrual blood loss with large (greater than 100 ml).There are more common among women with thyroid disorders or diseases of the hematopoietic system.Accompany hyperplastic endometrium state.
- metrorrhagia.Acyclic uterine bleeding of varying intensity and duration with no clear time frame.There may be short or long.The amount of blood lost by bleeding each time differently.
- polimenoreya.Uterine bleeding at intervals of less than 21 days the cyclical nature.
- Gipomenoreya.Regular menstruation while reducing total blood loss.There is a significant decrease in the number of daily lost blood or shortened menstrual period.
- Oligomenorrhea.Rare menstruation.The total number of menstrual periods for the year does not exceed seven.
- Dysfunctional uterine bleeding.Develop in the absence of organic pathology in the genitals.Normally, menstrual disorders in adolescents is dysfunctional nature and refers to the manifestations of the formative period of normal menstrual function, and the resulting dysfunctional bleeding in women after 45 years related to its extinction.
- Amenorrhea.The complete absence of menstruation primary character in overcame 18-year-old girls abroad or termination of the normal monthly for six months or more (secondary amenorrhea).
Sometimes the menstrual cycle can not be attributed to one of these groups, as it is mixed.
During the conversation with the patient paying attention to her age, weight, skin condition, collect information on the presence neginekologicheskih diseases.
Gynecological examination helps to identify concomitant gynecological diseases: inflammatory diseases of genitals, fibroids, cervical pathology, etc.
Laboratory diagnostics provides valuable information about the presence of anemia and genital infection, a state of the blood coagulation system.Determining the level of hormones in the blood (FSH, LH, progesterone, estradiol) helps to understand the nature of hormonal disorders and a way to choose the right therapy for their correction.
Ultrasound scanning is carried out to clarify the status of the uterus and appendages.The method allows to study the structural alterations in the tissues of the ovary, to determine the presence or absence of follicles as well as measure the thickness of the endometrium and relate it to the phase of the menstrual cycle.
in complex clinical situations require a detailed study of the endometrium using hysteroscopy followed by taking the material for histological examination.
menstrual dysfunction involves a huge number of possible reasons why diagnostic search is always on the way from the simple to the complex, so that may take a long time.
Treatment of menstrual disorders
complex therapeutic measures depend on the cause and nature of the violations of the menstrual cycle, and does not necessarily imply a long and complicated treatment.In some cases it is sufficient to eliminate the causes of external triggers - stress, excessive exercise, exhausting diet or overeating, etc..
heavy bleeding, accompanied by a sharp deterioration in the patient's anemia and require hospitalization.Inpatient treatment begins with a stop bleeding and antianemic therapy.When the bleeding stops, starts forming of a normal menstrual cycle by hormones (in the case of hormone causes bleeding).If bleeding occurred due to organic pathology requires its removal (removal of endometrial polyps or fetal parts after incomplete abortion, etc.).
Severe, intractable bleeding medication eliminated surgically (by scraping).
When choosing a method of treatment takes into account the age of the patient.In adolescence to hormonal treatment are very cautious.Girls under 15 years of age, hormonal drugs are prescribed in extreme cases.
If treatment is chosen incorrectly, the menstrual cycle will return.
properly treat persistent menstrual dysfunction alone is almost impossible.You can eliminate the symptoms but not the cause.