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Violation of the menstrual cycle

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Menstrual cycle disorder photo Disorder of the menstrual cycle of is a distortion of the rhythm and character of normal menstruation. Violation of the menstrual cycle can not be eliminated without eliminating its cause, therefore the main method of treatment of menstrual dysfunction is the treatment of the underlying pathology. So, for example, if a violation of menstrual function provoked an inflammatory process in the uterus or appendages, the proper rhythm of menstruation can be restored only after the infection has been eliminated with antibacterial therapy.

The menstrual cycle is a hormone-dependent, cyclically repeated anatomical and physiological process that ensures fertility. Menstrual cycles are divided among themselves by the first day of menstruation, it means the end of the previous cycle and the beginning of the next. The average normal duration of each menstrual cycle is about 28 days, but fluctuations within 25-35 days are allowed.

Menstruation is a physiological, short uterine bleeding associated with the rejection of the inner layer( endometrium).The duration of normal menstruation should not exceed seven days, and the volume of physiological blood loss at normal monthly should not exceed 150 ml. For obvious reasons, it is difficult for a woman to answer the question of how much blood she loses during menstruation, so it is conventionally considered that if a woman changes no more than four pads a day, blood loss does not exceed the norm.

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There are no single reliable criteria for the "normality" of the menstrual cycle indicators. It is generally believed that if the menstrual cycle that a healthy woman has does not change and allows her to bear children, it is normal for her.

The menstrual cycle is formed as a result of a complex chain of successive changes in many organs and systems:

- the Brain. In its structures - the pituitary and hypothalamus, important biologically active substances are formed, through which the brain "gives the command" to the ovaries. In the pituitary gland the hormones that control the menstrual cycle are synthesized - follicle stimulating( FSH) and luteinizing( LH).

- Ovaries. They serve as a source of estrogens( estradiol and estriol) as well as progestogens( progesterone).With the help of hormones, the ovaries "give the command" to the uterus. Also in the ovaries is the birth of an egg - the ancestor of human life.

- Fallopian tubes. In order for a pregnancy to develop, a fertilized egg needs to get into the uterus and infiltrate the endometrium. Fallopian tubes perform the transport function: with the help of wave-like movements, the tube wall moves the fertilized egg into the uterine cavity. On the eve of ovulation, the fallopian tubes somewhat elongate, become more elastic, and their wall thickens.

- Uterus. In the endometrium, there are monthly cyclic proliferation and rejections of the inner mucus layer, which are "controlled" by the ovarian hormones.

- The vagina. Structural changes in the epithelium of the vaginal cavity are associated with the preparation of external birth canal for potential pregnancy. The vaginal mucosa thickens in the first half of the cycle, and the vaginal wall becomes more elastic.

- Mammary glands. On the eve of the next month's mammary glands increase somewhat and become denser( rough).

The normal menstrual cycle is always two-phase. The first( follicular) phase is controlled by follicle-stimulating hormone and is associated with maturation of the ovum in the ovary. In the ovary is a large number of primordial follicles - "bubbles" with fluid, surrounded by a layer of cells of the follicular epithelium, inside which ripen the ovum. The follicle and the egg mature symmetrically. For the period of one menstrual cycle, only one egg can grow.

In parallel with changes in the ovaries under the control of estrogens in the uterus, the processes of preparation for a potential pregnancy begin: the endometrium increases in volume due to the increased proliferation( proliferation) of the inner layer and germinates by the blood vessels.

By the middle of the menstrual cycle, the effect of FSH decreases, the mature follicle bursts, releasing a full-grown ovule into the pelvic cavity. This moment is called ovulation. A viable egg can live no more than two days, and then, if fertilization does not happen, perishes.

The death of the egg means that the pregnancy has not taken place, and all the "preparatory" changes that have occurred must be eliminated, which occurs in the next, second, phase of the cycle: the enlarged inner layer of the endometrium begins to be rejected. All the processes occurring are controlled primarily by luteinizing hormone, so the second half of the cycle is called the luteal phase, it starts after ovulation, and ends with the beginning of another menstruation.

Causes of menstrual irregularities can be related to both genital diseases and changes in the pituitary-hypothalamus system. Also, the character of menstruation can be affected by non-gynecological diseases.

Physiological character can be a violation of the menstrual cycle with menopause or in adolescents. In adolescence, juvenile bleeding is associated with imperfect mechanisms of hormonal regulation, and during menopause menstrual dysfunction is associated with functional extinction of the ovaries.

Normal, physiological situation is a violation of the menstrual cycle during pregnancy in the form of a complete absence of menstruation for 10 to 12 months.

The violations of the menstrual cycle include:

- change in its duration;

- increase or decrease of blood loss;

- intermenstrual bleeding;

- postmenopausal bleeding;

- complete cessation of menstrual function.

The urgency of the problem of menstrual dysfunction is determined by its relationship to the reproductive function of patients. Menstrual dysfunction is often combined with infertility.

It is not always easy to establish a reliable cause of menstrual irregularities. Diagnostic search begins with a conversation with the patient and can result in complex instrumental examinations.

Therapy of menstrual irregularity implies the elimination of its cause.

Causes of menstrual cycle disorders

The menstrual cycle is formed with the participation of a large number of external and internal factors. Its nature is influenced by environmental conditions, the nature of food, stress, excessive physical activity and climatic conditions. Not every deviation of menstrual function from the usual norm can be regarded as a pathology. In 70% of perfectly healthy women, infrequent transient disorders of the menstrual cycle occur during life, they pass on their own and do not have negative consequences. If the body is healthy, it overcomes the violations due to internal compensatory mechanisms.

To identify the source of menstrual irregularity, it is necessary to establish whether the patient has normal menstruation in the past. If there were none and menstruation always had a pathological character, it is believed that menstrual dysfunction is due to innate causes.

The pathological disorder of the menstrual cycle in adolescents occurs during the period of its formation( up to 18 years) in the form of juvenile uterine bleeding, in childbearing age( 18-47 years) it is more often associated with gynecological pathology, and in premenopause it provokes a natural deficiency of estrogens.

The physiological disturbance of the menstrual cycle with menopause is only in the period preceding the persistent menopause. If bleeding occurs after a complete absence of menstruation for a year, it is considered not only pathological, but also dangerous, as it can indicate a malignant process.

In some situations, menstrual dysfunction appears normal. An example is the violation of the menstrual cycle during pregnancy as a lack of menstruation.

Normal and is a violation of the menstrual cycle after childbirth only within the first two to three months. During pregnancy, significant endocrine changes occur, and the body takes some time to compensate. However, if the menstrual function is not restored within the specified time interval, a violation of the menstrual cycle after childbirth may indicate the development of a neuroendocrinal syndrome associated with postnatal suppression of ovarian function.

Violation of the menstrual cycle is present in the clinic more than a third of all gynecological ailments. There are several options for the development of menstrual dysfunction:

- Ovarian variant. The pledge of a normal menstrual function is a two-phase ovulatory menstrual cycle. Any change in the structure or function of the ovaries, leading to a disruption in the formation of the process of full-fledged ovulation, leads to a disruption of the normal menstrual cycle( inflammation, malformations, ovarian surgery, etc.).

- The uterine version. Pathological processes in the endometrium, leading to disruption of mechanisms of 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, states after diagnostic manipulation( scraping, aspiration biopsy, hysteroscopy and the like).The relative cause of menstrual irregularity is intrauterine contraception. Sometimes the presence of a foreign body( spiral) in the uterine cavity interferes with its full reduction, so there is an increase in the duration of menstruation and the amount of blood lost.

Often, the occurrence of a menstrual cycle after an abortion is associated with traumatic mechanical damage to the endometrium and a sharp change in the hormonal background. However, violations of the menstrual cycle after abortion are associated not only with hormonal causes and trauma to the endometrium, but also with the development of postabortion complications - infection of the cervical canal, delayed parts of the fetus( incomplete abortion), or infection.

- Central variant. It occurs against the background of the violation of hormonal regulation of cyclic changes in the genital organs from the side of the pituitary-hypothalamus system.

Violations of normal menstrual function often accompany diabetes mellitus, diseases of the liver, adrenal and thyroid gland. In patients with obesity, the risk of developing hormonal dysfunction increases tenfold.

Irregular menstruation can be triggered by an incorrect intake of certain drugs: hormones, anticoagulants, antidepressants and so on.

Excessive infatuation of modern women with weight loss techniques led to the emergence of a large number of patients with menstrual dysfunction. Deficiency of weight( especially its sharp decrease) threatens the normal menstrual cycle no less than obesity.

Sometimes the reliable cause of menstrual dysfunction can not be established.

Symptoms of menstrual disorders

To study the nature of menstrual irregularity, it is necessary to take into account the cyclicity, duration and intensity of menstrual bleeding, as well as the amount of blood loss. As a rule, during a conversation, the patients clearly indicate the nature of the changes in the usual menstrual cycle and can help determine the cause of their appearance( stress, hypothermia, abortion, exacerbation of endocrine disease, etc.).Often, in addition to changing menstrual function in patients' complaints there is infertility.

Variants of violations of the menstrual function are conditionally divided into several main( but not necessarily) groups:

- Menorrhagia( hypermenorrhea).Regular menstruation with significant blood loss( more than 100 ml).There are more often among women with thyroid pathology or diseases of the hematopoiesis system. Accompany the hyperplastic state of the endometrium.

- Metrorrhagia. Acyclic uterine bleeding of varying intensity and duration without clear time frames. Can be short or long. The amount of blood lost with each bleeding is not the same.

- Polymenorea. Uterine bleeding with intervals of less than 21 days of a cyclic nature.

- Hypomenorrhoea. Regular menstruation with a reduction in total blood loss. There is a significant daily decrease in the amount of blood lost, or the period of menstruation is shortened.

- Oligomenorrhoea. Rare menstruation. The total number of menstruation for a year does not exceed seven.

- Dysfunctional uterine bleeding. Developed in the absence of organic pathology in the genitals. Usually menstrual irregularity in adolescents is dysfunctional and refers to the manifestations of the period of normal menstrual function, and the resulting dysfunctional bleeding in women after 45 years is associated with its extinction.

- Amenorrhea. The complete absence of menstruation of a primary nature in overcoming the 18-year-old line of girls or the termination of normal menstruation for six months or more( secondary amenorrhea).

Sometimes a menstrual disorder can not be attributed to one of these groups, since it is of a mixed nature.

During the conversation with the patient pay attention to her age, weight, skin condition, collect information about the presence of non-gynecological diseases.

Gynecologic examination helps to identify a concomitant gynecological pathology: inflammatory diseases of the genitals, fibroids, cervical pathology, etc.

Laboratory diagnostics provides valuable information about the presence of anemia and genital infection, the state of the blood coagulation system. Determination of the level of hormones in the blood( FSH, LH, progesterone, estradiol) helps to get an idea of ​​the nature of hormonal disorders and choose the correct therapeutic way of their correction.

Ultrasound scanning is performed to clarify the condition of the uterus and appendages. The method allows to study structural disorders in the tissues of the ovaries, to determine the presence or absence of follicles, and to measure the thickness of the endometrium and correlate it with the phase of the menstrual cycle.

In a complex clinical situation, a detailed study of the state of the endometrium with hysteroscopy is required, followed by taking material for histological examination.

Violations of menstrual function implies a huge number of possible causes, so diagnostic search is always carried out from simple to complex, which can take a long time.

Treatment of menstrual irregularities

The complex of treatment measures depends on the cause and nature of menstrual irregularities and does not always imply long and complex treatment. In some cases it is sufficient to eliminate external provoking causes - stresses, excessive physical activity, debilitating diets or overeating, etc.

Abundant bleeding, accompanied by a sharp deterioration of the patient's condition and anemia, requires hospitalization. Inpatient treatment begins with a stop of bleeding and anti-anemic therapy. When the bleeding stops, begin to form a normal menstrual cycle with the help of hormones( in case of a hormonal cause of bleeding).If bleeding has arisen because of organic pathology, its elimination is required( removal of the endometrial polyp or parts of the fetus after incomplete abortion, etc.).

Severe, non-medicinal therapy bleeding is surgically eliminated( scraping method).

When choosing a method of therapy takes into account the age of the patient. In the adolescent period, hormone treatment is very cautious. In girls under the age of 15, hormonal drugs are prescribed in extreme cases.

If the treatment method is chosen incorrectly, the menstrual irregularity will return again.

It is almost impossible to correctly treat persistent menstrual dysfunction yourself. Symptoms can be eliminated, but not their cause.

Drugs for menstrual disorders

For the treatment of menstrual disorders, several groups of drugs are used:

- Haemostatic( haemostatic) agents: Vikasol, Tranesca, Etamsilate and the like. In a hospital, drugs are administered intramuscularly. If the bleeding is insignificant, you can apply a decoction of nettle leaves.

- Anti-anemic drugs containing iron, folic acid or B vitamins.

- Remedies for muscular wall of the uterus: Oxytocin, shepherd's extract, and the like.

- Hormonal preparations. The most widely used group. With the help of hormones stops bleeding and the subsequent restoration of the normal rhythm of menstruation.

To stop bleeding, depending on the situation, the following are used: monophasic combined hormonal agents( COCs): Marvelon, Femoden, Regividon and similar in composition;Pure gestagens or estrogens.

When bleeding is stopped, hormones are cyclically assigned according to the clinical situation. When ovulatory bleeding is recommended, the use of gestagens in the luteal phase( Utrozhestan, Norkolut, Dufaston and the like).When anovulation is shown, cyclic hormone therapy with a combination of estrogens and gestagens, simulating a normal two-phase menstrual cycle.

Relying on an independent choice of a hormonal drug for the treatment of disruption of the cycle should not be. The large selection and abundance of their names does not mean that they all "help" Often the incorrect reception of combined hormonal contraceptives leads to the development of persistent hormonal dysfunction. In addition, "normal" menstruation with the use of COCs does not mean recovery. Menstrual cycle in a healthy woman should be not only biphasic, but also ovulatory. Persistent anovulation on the background of dyshormonal disorders can lead to structural damage to the tissues of the ovaries. Therefore, if there is a prolonged violation of the menstrual cycle, you should not hesitate to seek advice from a gynecologist.

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