Polymenorea
Polymenorea is a cyclically repeated menstrual bleeding with a short interval of no more than 21 days. With the pathology of polymenorrhea is not always associated, as a rule, often repeated menstruation is often not pathological in girls entering puberty, because they are associated with imperfect hormonal function, and when the sexual development of them ends, the correct menstrual rhythm is established independently. Polymenorrhea in menopause can also be provoked by natural causes, namely, attenuation of the hormonal function of the ovaries and entry into the menopause period. In the childbearing period, polymentorrhea is often the first harbinger of a serious disorder of the menstrual cycle due to pathological causes.
For violations of normal menstrual function, many different medical terms are used, sometimes they have the same meaning and differ only in wording. It is not easy for patients to understand this diversity. However, in order to understand the essence of pathological changes in the menstrual cycle, it is not at all necessary to decipher the diagnosis diagnosed by the doctor. It is much more important to know the characteristics of the menstrual cycle, which are conventionally taken as the norm, and to understand how it is formed.
The menstrual cycle consists of cyclical changes in the woman's body from one bleeding to the beginning of the next. The onset of menstrual bleeding is also the last day of the previous and the first - the subsequent menstrual cycle.
For the "norm" the characteristics of the menstrual cycle inherent in most women are accepted, namely:
- Regularity. Monthly should come in a constant rhythm with small permissible deviations of 1-3 days.
- Time interval between menstruations. The majority( 60%) of the monthly repeat every 28-30 days. Permitted to change the boundaries to 21-35 days.
- Duration. Menstrual bleeding should not be too short( less than two days) or prolonged( more than seven days).
- Period of active menstrual bleeding. Typically, "plentiful days" end in two or three days, and then the bleeding subsides, and there are more sparse( sometimes smearing and / or dark) discharge of blood.
- Blood loss. The volume lost with monthly blood is the most difficult parameter, since it is difficult to accurately measure it. For convenience, patients are asked to measure it by the number of pads that they change daily. As a rule, with physiological blood loss( 40-150 ml), no more than four pads are required daily.
- Subjective sensations. Usually unpleasant sensations, which the woman defines as "pulls", "aches a bit", accompany only "plentiful days".Strong pain with menstruation should not be.
The concept of "norms" for the menstrual cycle is very relative, as in some healthy women, menstrual cycles are "wrong" in terms of this norm and do not lead to negative consequences. If after the examination these patients do not show any abnormalities, they are considered healthy, and menstrual abnormalities are taken for an individual physiological norm.
In case of polymenorrhoea, monthly ones come too often - after 21 days. In this case, they can be abundant and / or long. Often they last longer than a week, but if they do not end after 12 days, they are already classified as cyclic bleeding.
It should be noted that polymenorrhea rarely exists in an isolated clinical condition. Much more often it is combined with other menstrual disorders, among which the leading menstrual bleeding( hypermenorrhea) is leading.
Among the causes of frequent menstruation is often diagnosed with hormonal dysfunction, inflammatory diseases of pelvic organs, fibroids and polyps of the endometrium.
To return the monthly habitual, physiological, rhythm, it is necessary to find the cause of the polymenorea first. Diagnostic search includes examination of complaints, gynecological examination, laboratory and instrumental examination.
Therapy of polymenorea implies the elimination of its cause. The physiological causes of polymenorrhoea at 40 years old or in young girls in puberty pore medication do not imply.
Reasons for the polymorphism
Before discussing the reasons for polymorphism, it is necessary to understand the mechanism of the formation of the menstrual cycle, because in this process not only the sexual system takes part. It is a very complex relationship of cyclic changes in the cardiovascular, neuro-metabolic, endocrine, immune and other systems of the female body, and if the relationship of these systems is violated, the character of the menstrual function also changes.
The highest regulating menstrual function of the body is the brain, or rather its two departments - the pituitary and hypothalamus. With the participation of the hypothalamus, follicle stimulating( FSH) and luteinizing( LH) hormones are synthesized in the anterior pituitary gland. They are secreted in a cyclic mode and affect the structural changes in the tissues of the ovaries, where follicles are formed and mature under the influence of FSH.Each follicle is a fluid-filled "vial" inside which an egg grows. By the middle of the cycle, it reaches its maximum maturity, ruptures the follicle and leaves the ovary( ovulation), this completes the first phase. In the second phase, with the participation of LH, a yellow body forms on the site of the destroyed follicle - a temporary hormonal structure capable of producing progesterone.
The largest structural changes during each menstrual cycle undergoes the endometrium. All processes occurring in the mucous layer of the uterus are controlled by the hormones of the ovaries. In the first phase of the ovaries produce estrogens. Endometrium grows, sprouts with new blood vessels and significantly increases in volume, and in the second phase it begins to be rejected under the influence of progesterone. When fragments of exfoliated mucosa and blood accumulate in the uterus, it begins to contract rhythmically to free itself of the contents, so menstrual bleeding occurs.
The reason for polymenorea, like any other irregularity of the menstrual cycle, can be hidden in any part of the menstrual cycle. As a rule, it is based on hormonal dysfunction or violation of the processes of contraction of the uterine wall.
Infection-inflammatory processes( endometritis, salpingoophoritis and others), tumors and tumor-like genital formations, ovarian dysfunction are considered to be the most frequent pathological causes of polymenorrhea.
Very often in patients with polymenorrhea, anovulatory menstrual cycles and an inferior function of the yellow body are recorded.
Polymenorrhea does not always arise due to serious pathological causes, sometimes they are physiological in nature, such as the reasons for polymorphism in 40 years in healthy women entering the climax period, or in adolescents experiencing puberty. The menstrual cycle can become shorter after a sharp change in climate, an excessive physical and psycho-emotional load.
Some patients have a physiological polymenorrhoea with the use of COCs( combined oral contraceptives), it appears if the ratio of hormones in their composition does not agree with the recommended one.
Extragenital pathology is also capable of causing polymorphism. Sometimes patients with menstrual dysfunction have diabetes mellitus, thyroid pathology, liver disease.
Symptoms and signs of polymorphism
It is hardly possible to find a woman who has never had a menstrual cycle during her life. As a rule, the cause of such failures are quite innocuous situations( colds, overwork, etc.), and menstruation returns to the former rhythm on their own. If the violations of the menstrual cycle become permanent, that is, when each incoming menstruation does not conform to the individual norm, it is necessary to consult a specialist and undergo an adequate examination.
Patients with polymenorrhea note shortening of the intermenstrual interval. Monthly begins to come less than 21 days later. The nature of menstruation can be different, since polymentorrhoea is often accompanied by other menstrual irregularities. So, for example, when the function of the yellow body is disturbed, in addition to the abnormal shortening of the menstrual cycle, the patients complain of copious and prolonged menstrual periods, menorrhagia. Since the menstruation lasts a long time( sometimes up to 14 days), the time interval between them also decreases accordingly.
When the function of the yellow body is insufficient, the maturation of the follicle does not change, and the follicular, the first, phase proceeds without deviations, but the yellow body does not function for too long, eventually the monthly ones come earlier.
Sometimes a polymorrhoeic pathologically short menstrual cycle is accepted, when the monthly ones come too often - every two weeks. Although this clinic corresponds to the definition of polymenorrhea, in fact, it is not such and is called a "pseudopolymenorei".
Pseudopolymenorea is very short( 2-3 days) and poor menstrual bleeding, more like smearing spotting in the absence of any precursors of menstruation. A similar cycle disorder is associated with premature rejection of the endometrium due to a short-term reduction in the synthesis of estrogens in the middle of the cycle.
Polymenorea with the use of COC can be accompanied not only by a shortening of the intermenstrual period, but also by a decrease in the volume of lost blood. It should be noted that if the nature of menstruation with the reception of the contraceptives has changed, one should not stop taking them on their own, as this can provoke the uterine bleeding, which is much more difficult to cope with than with poly-menorrhea. The decision on a possible cancellation or change of a hormonal contraceptive is taken only by a doctor.
Treatment of polymorphenia
Polymenorrhea is not an independent isolated pathology, but a symptom of a disease, so for its treatment it is necessary to first discover the underlying ailment and eliminate it.
More often, menstrual irregularity occurs due to hormonal dysfunction. To eliminate it, you must first find out at what stage of the formation of the menstrual cycle a failure occurred. To do this:
- The patient is asked to have a menstrual calendar for 3 to 6 months, where he should mark the beginning of another menstruation and fix its characteristics.
- Functional diagnostics( TDF) tests are carried out: measurement of rectal( "basal") temperature, determination of cervical index, colpocytology.
- The hormonal profile is determined: FSH, LGU prolactin, estradiol, progesterone, testosterone, ACTH, thyroid hormones( TTG, T3, T4).
- The ultrasound examination of the pelvic cavity is being studied.
Treatment of polimenorei depends on the results of the survey. Since in most cases, patients are diagnosed with hormonal disorders, the therapy is aimed at their elimination. Used hormonal drugs with a suitable ratio of estrogens and gestagens, which is selected individually. Treatment is often continued for six months.
The presence or absence of ovulation is of great importance for the determination of therapeutic tactics, since sometimes polymenorrhea is a sign of anovulation and is diagnosed in women with infertility. In this case, all therapeutic measures are directed to restore the normal two-phase ovulatory cycle. When the normal menstrual rhythm is restored, the polymenorea also disappears. If ovulation does not occur, resort to the method of its artificial stimulation with the help of hormones.
