Metrorrhagia - is any irregular uterine bleeding, provided that it is not menstruation.Metrorrhagia may occur in the period between menses, menstruation or laminated to be the continuation of her.
menstrual cycle is the number of days elapsed between menstrual bleeding.Most often it is 26-30 days.A small error is allowed, if the cycle is constant.The first day of the cycle - is the beginning of the next menstruation.
throughout the menstrual cycle under the influence of certain hormones cyclic changes occur in the inner mucosal layer of the uterus (the endometrium) and ovaries.The menstrual cycle is important to prepare the uterus for a potential pregnancy.Figuratively we can say that each menstruation - is the result of unfulfilled dreams nature of pregnancy.
All cyclic changes in the structure of the endometrium can be divided into two phases, separated by a short period of ovulation.In the first phase of the cycle the inner mucosal layer (functional layer) grows, so that
Parallel to this, in the ovaries of the foundation of the future is born a new life - the egg.Immature egg surrounded by a special casing consisting of the elements of connective and epithelial tissue, it is called a follicle.If the egg is ripe, the shell of the follicle is destroyed.Ovum follicles leaves migrates from the ovary into the abdominal cavity.The whole process takes about an hour and called ovulation.During the following days the egg retains the ability to fertilize.Period of ovulation menstrual cycle divides in half and is the most favorable time for conception.
If unfertilized egg dies, endometrial secretion phase begins - the second phase of the cycle.As a consequence of the fact that the functional layer of the endometrium sprawling loses its purpose, starts the process of its rejection to form a large wound surface within the cavity of the uterus.Rejection of the functional layer of the endometrium, accompanied by bleeding is called menstruation, and self bleeding - menstruation.
Metrorrhagia not associated with menstruation.Menstruation - this is a normal physiological process, and metrorrhagia - it is always pathological.It can not be ignored.
acyclic metrorrhagia always, occur in women of any age.Metrorrhagia independent value has not, as it is a symptom of a disease or a consequence of a breach of the production of sex hormones.
Metrorrhagia inherent in women of different age groups - from the girls at puberty to old ladies.Regardless of the cause of intermenstrual bleeding, it is always a source of damage to the surface of the endometrium, is not related to cyclical rejection of the basal layer.This may be an ulcer, erosion, disturbance of vascular integrity, hyperplastic processes in the endometrium and so on.In such a situation it is important to have a long menstrual-related physiological processes in the endometrium, bleeding from collateral other genesis.
neuroendocrine abnormalities lead to improper production of sex hormones, and, as a consequence, a change in the rhythm and character of menstruation in the form of acyclic bleeding.At the heart of the process is a violation of communications centers of the cerebral cortex, responsible for the production of sex hormones (pituitary and hypothalamus), the ovaries and the uterus.No other reason metrorrhagia is not detected.When it comes to such bleeding, the term "dysfunctional metrorrhagia".Since the system of hormonal regulation more unstable in the period of formation and during its decline, the highest number of cases of dysfunctional metrorrhagia occurs during puberty and menopause.If metrorrhagia occurs in women under 18 - years of age, it is called a juvenile.
dysfunctional metrorrhagia lead in the number of cases of uterine bleeding.It is of two kinds - ovulatory and anovulatory.About ovulatory metrorragii say that if there is a process of ovulation, but proceeds with disabilities.The cycle is biphasic, but the duration of each phase varies depending on which link hormonal regulation damaged.All violations occur shortening type I or phase II or type II extension phase of the menstrual cycle.Defective ovulation during such violations is the cause of infertility.
anovulatory metrorrhagia much more common.In fact it is menstruation without ovulation with single-phase cycle.The cause of anovulatory metrorrhagia is a violation of the process of oocyte maturation:
- if immature egg follicles to regress (follicle atresia), the egg dies with him, did not finish the ripening process;
- when the follicle matures, but the destruction of its walls with the subsequent release of a mature egg does not occur, the egg dies, and the follicle continues to exist in the ovary (persistence follicle) to grow and evolve on the type of cyst.
Both mechanisms lead to the prolongation of the phase of proliferation (in fact, the cycle becomes a single-phase), the widening of the endometrium and heavy bleeding.
anovulatory metrorrhagia among dysfunctional uterine bleeding is quite common in all age groups.
reasons for hormonal disorders in the body can serve:
- stress and fatigue;
- shortages of vital vitamins and other biological substances;
- psychiatric diseases;
- chronic inflammatory genitals;
- diseases of the endocrine glands;
- acute and chronic infections;
- diseases and injuries of the nervous system.
Metrorrhagia in the menopause may have a hormonal or indicate the nature of oncological causes.Sometimes it can provoke the stagnation in the pelvic area.
deserves special attention in postmenopausal metrorrhagia, when the waning hormone function has been completed.The cause of bleeding can be serious diseases, including malignant processes of sexual sphere.
diseases of the uterus and appendages may cause metrorrhagia.The most common ones are:
- polyps of the mucous membrane of the uterus;
- hormone producing tumors of the ovary;
- uterine fibroids (especially submucosal localization);
- cervical disease, accompanied by a violation of the integrity of the surface epithelium;
- oncological processes.
Uterine bleeding may be the result of a miscarriage, abortion, ectopic pregnancy, hydatidiform mole and some other states.
Neginekologicheskie disease can also provoke metrorrhagia.The list of such diseases include diabetes, heart disease and vascular diseases of the circulatory system, hypertension and others.
To effectively treat uterine bleeding, first you need to determine as precisely as possible the cause.
inherent acyclic metrorrhagia, irregular and unequal blood loss.In addition to the uterine bleeding during menstruation is metrorragii may experience symptoms of the disease, which is caused by it.
If significant blood loss, women feel a general weakness, dizziness, nausea, fatigue.Sometimes there is a decrease in blood pressure, tachycardia (rapid heartbeat).
Metrorrhagia may occur with severe pain and fever, if the bleeding is caused by acute conditions, such as such as submucous (submucosal) myoma node or an ectopic pregnancy.
dysfunctional metrorrhagia associated with the menstrual cycle and shows the different options of deviation from the usual norm for every woman.Menstruation may begin early or delayed, have different duration and intensity.
lack of ovulation cycle makes single-phase - the phase of proliferation lasts a long time, the functional layer is not torn away in time, and continues to grow uncontrollably.When anovulatory metrorrhagia next menstruation comes with a delay (sometimes more than one month) and is accompanied by copious prolonged bleeding.In small number of women delayed menstruation does not occur, but the duration of bleeding increased.
metrorrhagia in postmenopausal women can be both scarce and significant.Regardless of the amount of blood loss, they should merit particular attention because of the risk for malignancy.Only after eliminating the most terrible diseases can begin to look for other, less dangerous reasons.Especially dangerous are postmenopausal metrorrhagia.
Diagnostics metrorrhagia due to the presence of a single leading symptom is difficulty is not.It is more difficult to find out the causes of uterine bleeding, which is especially important in the case of disfunkktsionalnoy metrorrhagia.
diagnosis of dysfunctional metrorrhagia called "diagnosis of exclusion".The initial diagnostic stage gradually eliminate all possible causes of bleeding, if necessary, this is done in conjunction with physicians, hematologists, surgeons, and other narrow specialists.In terms of diagnosis, the following activities:
- history (poll) the patient, including information on the nature of menstruation, fertility, availability of gynecological and other diseases, etc .;
- general inspection;
- gynecological examination, specifying the size and consistency of the uterus and appendages, the nature of discharge, etc .;
- blood count for the presence of anemia, clotting disorders, biochemical blood analysis;
- hormonal examination;
- ultrasound, allows to determine the size of the uterus and appendages, as well as to estimate the thickness of the endometrium;
- to exclude ectopic pregnancy hormonal examination is carried out;
- diagnostic curettage of the endometrium followed by histological examination;
- in rare cases, can be carried out hysteroscopy or diagnostic laparoscopy.
volume of diagnostic measures and their order are determined individually by the attending physician.
Treatment metrorragii always complex.The basic and primary task of the doctor - to stop the bleeding.The methods of hemostasis depend on the volume of blood loss and condition of the patient.If the blood loss is small, and the overall health of patients is satisfactory, you can restrict the use of outpatient treatment with conservative treatment:
- normalization of blood coagulation;
- elimination of anemia;
- recovery of the contractile function of the uterus;
- restorative measures.
If there is a positive effect, carried out hormonal hemostasis (stop) bleeding using hormones.Apply hormones on the basis of missing links in the hormonal regulation.The spectrum of hormonal methods is very wide.The drug is chosen according to a study of hormonal disorders in the individual woman to offset its existing abnormalities.As an integrated hemostatic use a combination of hormonal therapy with the imitation of the normal menstrual cycle or combined oral contraceptives with a suitable ad-hoc composition of hormones.
in juvenile uterine bleeding after the age of 12 are appointed by the estrogens.
If the bleeding is profuse, accompanied by a deterioration of general condition the patient requires hospitalization.Inpatient treatment metrorragii may lie in the use of hormone therapy, if the effect is negative, surgical treatment - curettage, or (rarely) its removal.
After stopping the bleeding begin to eliminate its causes.It is necessary to restore normal menstrual cycle, eliminate anemia, provide treatment of diseases that cause bleeding.The treatment plan drawn up for each patient individually.
Dysfunctional metrorrhagia tend to relapse, so all women with this pathology are subject to dispensary observation.