Dysfunctional uterine bleeding is an abnormal discharge from the genitals of a woman who has no connection with menstruation. They arise as a result of changes in the structure of the endometrial layer of the uterus in violation of the production of sex hormones. Such bleedings indicate pathological processes and require immediate treatment.
Causes and mechanism of development of DMK
Spotting a healthy woman of reproductive age occurs only during menstruation. They are the result of natural biological processes. With menstrual blood, the endometrium and the non-viable egg are rejected. When DMK bleeding occurs on the background of the irregularity of the menstrual cycle. This happens as a result abnormalities in the secretion of gonadotropic hormones.
For dysfunctional uterine bleeding characteristic follicle atresia. This is a phenomenon in which ovum does not mature. In some cases, the follicle grows to the required size, but does not break, as a result of which the yellow body does not form, therefore, the progesterone level does not increase either. Due to hormone insufficiency, the cycle does not end, there is a long delay of menstruation. In the meantime, the endometrium becomes overgrown, leading to heavy bleeding.
MQD formed on the background of serious diseases. The provoking factors of the appearance of the disease include:
- deviations in work pituitary gland,
- violation thyroid functionexpressed in excessive formation of thyroid-stimulating hormones,
- polycystic ovary syndrome,
- uterine pathology (polyps, tumors, endometriosis),
- malfunctions adrenal glands,
- hormonal abuse or anti-inflammatory drugs.
Abnormal bleeding ovulatoryand and anovulatory. If in the first case the egg cell enters the abdominal cavity, in the second case it does not even mature. By age MQM is divided into the following subspecies:
- Juvenile (from 11 to 18 years).
- Reproductive (from 18 to the onset of menopause).
- Climacteric (aged 45 to 55).
By the nature of the intensity MQM is usually divided into the following types:
- Polymenorrhea - a phenomenon that occurs during critical days and differs profusion.
- Menometerorrhagia - bleeding, indicating the development of gynecological disease.
- Metrorrhagia - The process by which blood appears before or after menstruation.
- Hypermenorrhea - monthly discharges exceeding admissible norms by volume.
At puberty, gynecological diseases occur in 20% of cases. Disruption of hormone production occurs due to psychological trauma, lack of vitamins, adverse living conditions or physical fatigue. Sometimes, such diseases as chickenpox, whooping cough, measles, rubella, etc. affect the work of the genitals.
MQR reproductive period
At this age, the formation of pathological uterine bleeding is affected stressful situations, climate changetransferred infectious diseasesuncontrolled taking toxic drugs. Sometimes violations occur after surgery or as a result of abortions. In this case, the possibility of the presence of genital tumors or an inflammatory process in the pelvis is not excluded.
Uterine bleeding during menopause is associated with depression of ovarian function. The pituitary gland gradually stops the production of hormones. Ovulation occurs less frequently than usual, respectively, menstruation takes a chaotic character, there is metrorrhagia. In adulthood, they talk about malignant and benign formations.
Preventive measures in relation to the menstrual cycle is carried out during the period when the child is in the womb. Conducting pregnancy has an impact on the formation of organs of the reproductive system. A woman in position must stick healthy lifestyleregularly visit a gynecologist and monitor hygiene.
With heavy bleeding is necessary call an ambulance. The big loss of blood threatens not only health, but also the life of a woman. Initially, in-hospital diagnostics. It includes taking the necessary tests (for hCG to exclude pregnancy or a test that determines the hormone in the urine) and an ultrasound examination of the pelvis. After receiving the results, the doctor selects the optimal method of treatment. The principle of therapy is based on the following aspects:
- stopping bleeding and preventing the inflammatory process,
- restoration of hormonal levels,
- ovulation stimulation with medication or laparoscopy.
In order to prevent the inflammatory process nonsteroid drugs are prescribed. To improve the strength of the vessel walls is taken Detralex or Askorutin. If a woman is diagnosed with reduced blood clotting, she is indicated to receive aminocaproic acid. Oral contraceptives are used to normalize hormonal levels and prevent bleeding in the future: Silhouette, Jess, Yarin, Rigevidon other. The choice of means is determined by the level of hormones of the woman.
Treatment with hormonal drugs that suppress ovarian function is carried out in the usual way: 3 weeks of intake and a 7-day break. Tablets are taken from 3 to 12 months. Duration depends on the severity of the disease. After hormonal treatment is repeated diagnosis. Therapy with OK allows you to achieve the following:
- reducing the likelihood of developing genital cancer
- endometrial growth suppression,
- decrease in breast sensitivity,
- restoring cycle regularity,
- decreased menstrual flow.
Solving the problem by surgery is carried out if a woman has pathological lesions or the structure of the ovaries is changed. In gynecology, laparoscopy is most often practiced. It is a diagnostic operation, during which painful lesions are removed. When polycystic on the ovaries make incisions that provide the release of the egg from the follicle. With endometrial hyperplasia spend curettage of the uterus. This procedure helps prevent bleeding in the future.
If the operation was performed to stimulate the work of the ovaries, then in the first six months the woman is recommended to plan the conception of the child. Under unfavorable circumstances, fertility decreases after six months. In the event of pregnancy, the patient must take medications based on progesterone. They contribute to the successful carrying of the child.
Diet during therapy
During the treatment of gynecological diseases a woman needs to monitor nutrition. Excessive bleeding affects the state of the body, weakening its protective function. To prevent anemia, it is necessary to focus on foods high in gland. These include beef liver, buckwheat, fish, pomegranate, etc. Calcium interferes with the absorption of this substance, therefore it is desirable to refuse dairy products. It is equally important to enrich the diet with protein and vitamin b (chicken, eggs, legumes, nuts and seeds).
Possible consequences and complications
MQM is a dangerous condition. In the absence of timely assistance, excessive blood loss can be fatal as a result of hemorrhagic shock. But the following complications are also possible:
- Iron-deficiency anemia It affects the well-being of women. With its development, performance decreases significantly, dizziness and dyspnea are observed. These symptoms are the result of oxygen starvation of tissue cells.
- This ailment almost always leads to the development of an inflammatory process caused by prolonged blood stagnation. In this case, the woman is suffering severe pain in the lower abdomen. Increases the likelihood of education adhesionsthat causes ectopic pregnancy.
- With DMK, ovulation is most often absent. In this case impossible to conceive a child.
In case of dysfunctional bleeding, it is important to consult a specialist in time. This pathology can affect women of any age. Therefore it is necessary to keep a calendar where the duration and intensity of the menstrual flow will be marked. After stopping the bleeding and rehabilitation therapy, the patient should be regularly monitored by the gynecologist to prevent relapse. If the principles of treatment and prevention are observed, the risk of complications is reduced to a minimum.
Causes of dysfunctional uterine bleeding
DQMs are acyclic abnormal (heavy, frequent or / and long-term) bleeding, which result from dysregulation of the function of the reproductive system and manifest morphological changes in the uterine mucosa (endometrium). They are not associated with diseases of the genital organs themselves or with any systemic diseases of the whole organism.
Mechanisms of regulation of the menstrual cycle
The menstrual cycle is a very complex biological process, which is regulated by the nervous and hormonal systems of the body. Its external manifestation is regular menstrual blood secretion from the genital tract, resulting from the rejection of the superficial membrane (functional layer) of the uterine mucosa.
The essence of the menstrual cycle is the exit from the follicle of a mature egg, ready to merge with the sperm cell, and the formation of a lutein (yellow) body in its ovary in its place. The latter produces the female sex hormone progesterone.
The regulation of ovarian function is carried out by the anterior pituitary through the synthesis and secretion of gonadotropic hormones into the blood:
- Follicle-stimulating hormone (FSH), which affects the growth and maturation of the next follicle and the ovulatory process. FSH, together with luteinizing hormone (LH), stimulates the production of estrogen. In addition, it helps to increase the number of receptors that perceive the action of LH. They are located in the layer of granulosa cells of the follicle, turning into a yellow body.
- Luteinizing hormone that controls the formation of the luteal body.
- Prolactin is involved in the synthesis of the yellow body hormone progesterone.
The amount of estrogen and progesterone is variable. It changes depending on the activity of the luteal body and corresponds to the phases of the menstrual cycle: during the follicular phase, the amount of all sex hormones increases, but mostly estrogens, and during ovulation and before the onset of menstruation, progesterone is produced more.
The production of FSH and LH by the pituitary gland in a constant biological clock rhythm, which is ensured by the appropriate functioning (in this mode) of the nuclei of the hypothalamic brain. The latter secrete gonadoliberins, or gonadotropin-releasing hormones (GnRH).
The functioning of the hypothalamus and the frequency of secretion of hormones in the blood, in turn, depends on the influence of biologically active substances, neurotransmitters (endogenous opiates, biogenic amines) secreted by higher brain structures. In addition, the regulation of the secretion of all hormones is also carried out according to the type of universal negative feedback: the higher the concentration of ovarian hormones in the blood, the more they inhibit the release of the corresponding stimulating hormones by the pituitary and hypothalamus, and vice versa.
Schematic representation of feedback mechanisms
The causes and mechanism of DMK
Thus, the regular menstrual cycle is a complex biological process consisting of many links. Pathological factors can affect any link. However, as a rule, as a result of its impact, the entire chain (hypothalamus - pituitary - ovaries - uterus) of the regulatory mechanism is involved in the pathological process. Therefore, violations in any of its areas lead to dysfunction of the reproductive system of the woman’s body as a whole.
In 20-25% there are juvenile or juvenile dysfunctional uterine bleeding of anovulatory nature. They usually occur in the first two years after the onset of menstruation. But sometimes abundant ovulatory DMK occur at the end of adolescence by the type of polymenorrhea (8 days with a break of 3 weeks), which is due to the inferiority of the corpus luteum or insufficient LH secretion.
Such disorders are explained by the still incomplete formation of the teenager’s hormonal system and its instability. In this regard, any, even minor pathological or simply negative impact can lead to severe dysfunctional disorders. With heavy bleeding lasting more than a week, girls quickly develop anemia, accompanied by pallor of the skin, weakness and lethargy, headaches, loss of appetite, and increased heart rate.
In the involutive period, the system of hormonal regulation is disturbed due to the extinction of the endocrine organs and is easily susceptible to disruptions. As in the period of youth, and at the stage of extinction, it is also easily influenced by negative factors. Anovulatory dysfunctional uterine bleeding menopause occurs in 50-60%. It occurs due to age-related changes in the hypothalamic region of the brain. As a result, the cyclical secretion of gonadotropin-releasing hormones is disturbed, which means that the maturation and function of the follicles are disturbed.
Bleeding in women of this period of life is often associated with oncological diseases of the genital area. Therefore, differential diagnosis with DMK and treatment must be carried out in a gynecological hospital.
The remaining 15-20% of cases are dysfunctional uterine bleeding of the reproductive period. They develop on the background of persistent follicles with excessive secretion of estrogen and progesterone deficiency, which contributes to the development of endometrial glandular-cystic growth.
So, as still insufficiently formed, and already “dying out” the system of hormonal regulation represent an easily vulnerable background for unfavorable factors of influence, provoking DMS.
Causes and provoking factors
Among all causal factors and provoking DMK factors, the main ones are:
- Occupational hazards, intoxication, infectious and inflammatory diseases of a general nature.
- Inflammation of the pelvic organs, as well as the administration of antipsychotic drugs. All this leads to impaired ovarian receptor function.
- Mental or physical exhaustion.
- Frequent psychological stress and stress.
- Malnutrition due to a lack of proteins, vitamins and trace elements.
- Rapid change (moving) locations in areas with different time and climate zones.
- Dysfunction of the endocrine organs due to the presence of brain tumors, hyper or hypothyroidism, Cushing disease or Itsenko syndrome, the presence of ectopic hormone-secreting tumors, etc.
- Pregnancy and abortion, with complications.
- Rearrangement of the endocrine system during puberty and involution,
- Genetic diseases of the endocrine and reproductive systems.
Disorders of the regulation system function lead to disruption of the cyclicity and rhythm of rejection and regenerative-secretory processes in the uterine endometrium. Estrogenic stimulation with prolonged and excessive secretion of this hormone contributes to increased uterine contractile activity, uneven blood supply and nutrition of the mucous membrane due to spastic contractions of the walls of its vessels.
The latter causes the almost uninterrupted and non-simultaneous damage and rejection of different parts of the endometrial intrauterine layer, accompanied by abundant and long-lasting bleeding from the uterus.
In addition, the increased concentration of estrogen increases the rate of cell division, which is the cause of hyperplasia - growth and increase in the thickness of the mucous membrane, polyposis, adenomatosis and atypical cell transformation.
The ovulatory phase of the menstrual cycle is the most vulnerable link in the mechanism of regulation of the neuro-endocrine system. For this reason, dysfunctional uterine bleeding can occur:
- against the background of the lack of maturation and release of the egg from the follicle (anovulation) - in most cases, this is due to the lack of ovulation, in some women the dominant (prepared) follicle still reaches the necessary degree of maturity, but does not ovulate and continues to function (persists), secreting estrogens and progesterone constantly and in large quantities,
- in other cases, one or more follicles, before reaching full maturity, overgrow (atresia) and undergo reverse development (atretic follicles), they are replaced by new follicles, which also undergo atresia, all these yellow bodies secrete a moderate amount of progesterone and estrogen, but during long time
- against the background of normally passing ovulation — DMK occurs due to premature rejection of the functional endometrium due to a short-term decrease in the production and secretion of sex hormones,
- before the start of the normal period of menstruation, which is evidence of insufficient functioning of the corpus luteum,
- prolonged menstrual bleeding with follicle inferiority.
Classification of dysfunctional uterine bleeding
Thus, anovulatory bleeding occurs due to changes in the ovaries in two types - by type of persistence and by type of atresia. In most cases, both options are characterized by delayed menstruation, followed by bleeding. In the case of the persistence of the follicle, the delay time of menstruation is from 1 to 2 months, and with atresia - up to 3-4 months or more. The duration of bleeding ranges from 2-4 weeks to 1.5-3 months, and with a persistent follicle, they are shorter and more abundant. Ovulatory hemorrhages are manifested mainly by hemorrhage before and after the end of menstruation.
Principles of treatment
Comprehensive treatment of dysfunctional uterine bleeding should take into account the severity of symptoms, age, cause of the disease, if it can be established, and the mechanism of the disease. Tactics of treatment consists of three stages:
- Stopping bleeding and carrying out hemostatic and restorative therapy.
- Restoration of the menstrual cycle.
- Stimulation of ovulation or surgical treatment.
In reproductive age and in women in menopausal period, in order to stop bleeding, the uterus cavity is scraped, which also has diagnostic value. In adolescent patients, the treatment of bleeding is intensive hormone therapy. For these purposes, estrogens are prescribed by injection (estradiol dipropionate) or a course of tablet preparations (estrol). If the bleeding is moderate, without signs of anemia, then after estrogen therapy, progesterone is administered in a daily dose of 10 ml during a week.
Recovery of menstruation
Restoration of the menstrual cycle in juvenile age is carried out by the course administration of progesterone with a normal estrogenic background, and with a reduced one - with progesterone in combination with estrogen.
Women of reproductive age are usually assigned to receive combined oral contraceptives for 1 year, in menopause - continuous taking of prolonged progesterone.
Clomiphene is used to stimulate ovulation at reproductive age. If in the premenopausal DMK, adenomatous polyps, focal adenomatosis or atypical endometrial cell hyperplasia are detected, even if adenomatous polyps are detected, uterine hysterectomy (amputation) or extirpation is recommended.
If pathology is detected in the brain, etc., appropriate treatment or elimination of provoking factors leading to dysfunctional uterine bleeding is carried out.
Dysfunctional uterine bleeding
Dysfunctional uterine bleeding (adopted abbreviation - DMK) are the main manifestation of ovarian dysfunction syndrome. Dysfunctional uterine bleeding is characterized by acyclicity, prolonged menstruation delay (1.5-6 months) and prolonged blood loss (more than 7 days). There are dysfunctional uterine bleeding juvenile (12-18 years), reproductive (18-45 years) and menopausal (45-55 years) age periods. Uterine bleeding is one of the most frequent hormonal pathologies of the female genital.
Juvenile dysfunctional uterine bleeding is usually caused by the lack of formation of the cyclic function of the hypothalamus-pituitary-ovary-uterus. In childbearing age, inflammatory processes of the reproductive system, diseases of the endocrine glands, abortion, stress, etc., are common causes causing ovarian dysfunction and uterine bleeding.
On the basis of the presence or absence of ovulation, there are ovulatory and anovulatory uterine bleeding, the latter being about 80%. The clinical picture of uterine bleeding at any age is characterized by prolonged bleeding that appears after a significant delay in menstruation and is accompanied by signs of anemia: pallor, dizziness, weakness, headaches, fatigue, a decrease in blood pressure.
MQD development mechanism
Dysfunctional uterine bleeding develops as a result of impaired hormonal regulation of the ovarian function of the hypothalamic-pituitary system. Impaired secretion of gonadotropic (follicle-stimulating and luteinizing) hormones of the pituitary gland, stimulating follicle maturation and ovulation, leads to disruptions in folliculogenesis and menstrual function. At the same time, the follicle in the ovary either does not mature (follicle atresia), or matures, but without ovulation (follicle persistence), and, consequently, the corpus luteum is not formed. And in fact, and in another case, the body is in a state of hyperestrogenia, i.e., the uterus is influenced by estrogens, since progesterone is not produced in the absence of the yellow body. The uterine cycle is violated: there is a long-term, excessive growth of the endometrium (hyperplasia), and then its rejection, which is accompanied by abundant and prolonged uterine bleeding.
The duration and intensity of uterine bleeding is influenced by hemostatic factors (platelet aggregation, fibrinolytic activity and spastic vascular capacity), which are impaired by DMK. Uterine bleeding can stop on its own after an indefinitely long time, but, as a rule, it recurs, therefore the main therapeutic task is to prevent recurrence of MQD. In addition, hyperestrogenism in dysfunctional uterine bleeding is a risk factor for the development of adenocarcinoma, uterine fibroids, fibrocystic mastopathy, endometriosis, and breast cancer.
In the diagnosis of juvenile uterine bleeding are taken into account:
- history data (date of menarche, last menstruation and onset of bleeding)
- development of secondary sexual characteristics, physical development, bone age
- hemoglobin level and blood coagulation factors (complete blood count, platelets, coagulogram, prothrombin index, clotting time and bleeding time)
- levels of hormones (prolactin, LH, FSH, estrogen, progesterone, cortisol, testosterone, T3, TSH, T4) in blood serum
- expert opinion: consultation with a gynecologist, endocrinologist, neurologist, ophthalmologist
- indicators of basal temperature in the period between periods (single-phase menstrual cycle is characterized by a monotonous basal temperature)
- the state of the endometrium and ovaries on the basis of ultrasound data of the pelvic organs (using a rectal sensor in virgins or vaginal - in girls who have sex). The echogram of the ovaries in juvenile uterine bleeding shows an increase in the volume of the ovaries during the intermenstrual period
- state of the regulating hypothalamic-pituitary system according to radiography of the skull with a projection of the Turkish saddle, echoencephalography, EEG, CT scan or MRI of the brain (in order to exclude tumor lesions of the pituitary)
- Ultrasound of the thyroid gland and adrenal glands with dopplerometry
- Ultrasound control of ovulation (for the purpose of visualization of atresia or persistence of the follicle, mature follicle, ovulation, formation of the corpus luteum)
The first priority in the treatment of uterine bleeding is hemostatic measures. Further treatment tactics aimed at preventing recurrent uterine bleeding and normalization of the menstrual cycle. Modern gynecology has in its arsenal several ways to stop dysfunctional uterine bleeding, both conservative and surgical. The choice of hemostatic therapy method is determined by the general condition of the patient and the magnitude of blood loss. In case of moderate anemia (with hemoglobin above 100 g / l), symptomatic hemostatic (menadione, etamzilat, ascorutin, aminocaproic acid) and uterine-reducing (oxytocin) drugs are used.
In the case of the ineffectiveness of non-hormonal hemostasis, progesterone preparations are prescribed (ethinyl estradiol, ethinyl estradiol, levonorgestrel, norethisterone). The bleeding usually stops 5-6 days after the end of the medication. Abundant and prolonged uterine bleeding leading to progressive deterioration (severe anemia with Hb less than 70 g / l, weakness, dizziness, fainting) are an indication for performing hysteroscopy with separate diagnostic curettage and pathological examination of scraping. Contraindications for curettage of the uterus is a violation of blood clotting.
In parallel with hemostasis, antianemic therapy is carried out: iron preparations, folic acid, vitamin B12, vitamin C, vitamin B6, vitamin P, erythrocyte transfusion and fresh frozen plasma. Further prevention of uterine bleeding includes the use of low-dose gestagen preparations (gestodene, desogestrel, norgestimate in combination with ethinyl estradiol, didrogesterone, norethisterone). In the prevention of uterine bleeding is also important general hardening, rehabilitation of chronic infectious foci and proper nutrition. Adequate prevention and treatment measures for juvenile uterine bleeding restore the cyclic functioning of all parts of the reproductive system.
Causes and mechanism of development of dysfunctional uterine bleeding
Menstruation is a hormone-dependent and multi-stage phenomenon involving several organs at once:
Malfunction of at least one link can cause dysfunction of the genital organs and, as a result, DMK. But the reason may be hidden in the pathologies of the appendages, and in severe stress, and in diseases of the thyroid gland. The “adjusted hours” of the menstrual cycle are vulnerable to many factors, ranging from inadequate nutrition to complex endocrine problems.
What provokes the occurrence of DMK
Inflammatory processes, the use of neuroleptic drugs. This causes problems with ovarian receptor function. And:
Hormonal restructuring of the body in adolescence and involution.
Endocrine diseases, brain tumors, Itsenko-Cushing syndrome.
Physical and mental overload.
Frequent intoxication, systemic chronic diseases.
Deficiency in the diet of proteins, vitamins, minerals.
Change of time zones, geographic latitudes.
Difficult pregnancy, abortion.
Genetic diseases of the endocrine and reproductive systems.
Improper alternation of two processes (rejection and restoration of the mucous membrane) leads to endometrial morphological changes. There is an uneven growth of the inner layer of the uterus, the blood supply of the organ changes. A high estrogen level causes an increase in the rate of cell division. Endometrium is affected by hyperplasia - an increase in the thickness of the mucous membrane, polyps appear.
Depending on the patient's age and the causes of the pathology, dysfunctional uterine bleeding is divided into the following types:
bleeding at reproductive age,
These secretions are in violation of ovulation and with its preservation. According to statistics, 4 out of 5 cases of MQD occur with anovulation.
Treatment and emergency care
The treatment of dysfunctional uterine bleeding of all three varieties is primarily aimed at stopping blood loss. With a small blood loss, homeostatic drugs are prescribed:
Gestagen drugs are prescribed, such as: gestogen, ethinyl estradiol and others. Prescribe oxytocin to reduce the uterus. If blood loss continues, hormone therapy with progesterone is performed. The doctor may prescribe drugs that help with anemia, vitamins (folic acid, vitamin C, B12, B6, P, iron supplements). In the treatment and prevention of juvenile and DMC of reproductive age, the normalization of the psychological background plays an important role. Recommended mild sedatives, counseling therapist. A woman is recommended to avoid stressful situations, if possible not to overwork.
It is important to treat chronic inflammatory processes. Of great importance is the general hardening of the body, good nutrition and abundant drinking.
In the case of extremely heavy blood loss, blood and plasma transfusions are performed.
Progressive deterioration is an indication for hysteroscopy. In this case, the surgeon makes curettage of the uterus, scraping sent to the pathological study. With DMK of climacteric type, hysteroscopy is a priority method of treatment. It is recommended to do the operation 2 times: before and after curettage. After curettage, polyps, endometriosis, and uterine fibroids become visible. Endometrial cryodestruction and amputation of the uterus are often performed in women of this age group. This operation is contraindicated in women with bleeding disorders.
Diet during the treatment period
Serious loss of blood requires such nutrition, which would level its effects. First of all, a woman should consume more foods rich in iron: red meat, liver, buckwheat. To restore vitamin deficiency, it is necessary to consume fruits and fresh vegetables, especially those rich in vitamin C: cabbage, beets, citrus fruits. To normalize the work of the nervous system, it is good to eat wholemeal rich in vitamin B12, cereal, bran. Drinking plays an important role: it must be abundant. Soups, fruit drinks, jelly, juice, not strong tea can be included in the diet.
Clinic for juvenile bleeding
The frequency of juvenile bleeding (GC) among gynecological diseases in adolescence reaches 10%.
It should be noted that at pubertal age, hyperestrogenism and, consequently, severe endometrial hyperplasia are less common than in other age periods. In the ovaries, the process of atresia takes place more often than the persistence of follicles that have reached preovulatory size.
The clinical picture is typical for MQD in all age periods: the delay of menstruation by 1.5 months or more, followed by bleeding.
Symptomatology is determined by the severity of anemization, which is manifested by symptoms such as pallor of the skin, mucous membranes, tachycardia, headache, dizziness, weakness, drowsiness with a lot of blood loss.
Criteria for medical non-interference
Criteria for medical non-interference in juvenile bleeding are:
- The interval between the month is not more than 45 days,
- bleeding time not more than 7 days,
- the nature of blood loss: the absence of clots in the excreted blood,
- normal hemoglobin and hematocrit, erythrocyte and platelet counts.
Treatment and prevention of juvenile bleeding
Tactics of treatment is determined by the clinical picture, the degree of blood loss and anemization.
In case of severe anemia (hemoglobin is below 7.5 g / l, hematocrit is less than 20%), surgical hemostasis should be used - curettage of the uterus. This is the fastest way of hemostasis, which also allows you to judge the state of the endometrium (proliferation, hyperplasia, etc.). When scraping, in order to avoid defloration, the hymen is cut off with a solution of novocaine with lidaza and use small (child) mirrors.
With mild anemization, hormonal hemostasis is used. The most commonly prescribed COC containing estrogens and progestins. Low-dose and three-phase contraceptives are ineffective. Recommended single-phase preparations containing ethinyl estradiol in a dose of 0.05 mg and progestins of the norsteroid group of any dosage.
Since estrogens have a hemostatic effect, only progestins should not be used. The drug is prescribed in a dose of 4-6 tablets per day, gradually reducing the dose by one tablet per day, and continue taking for 3 weeks. Generally, bleeding stops during the first two days.
During the time until the response of the menstrual reaction, which occurs 2-3 days after the end of hormonal contraceptive use, anti-anemic therapy is carried out: iron preparations, blood substitutes, vitamins, treatment of hypovolemia. For hormonal hemostasis, you can use drugs based on natural estrogens (not synthetic), for example, “Proginova” (estradiol valerate), “Estrofem” (17p-estradiol). These drugs are prescribed in the same way as hormonal contraceptives, but after the onset of hemostasis and the use of these drugs, progestins should be prescribed for another 2 weeks (Duphaston, Utrozhetsan, Norkolut, Medroxyprogesterone) for 10 days. Occurs secretory transformation of the endometrium, proliferated under the influence of estrogen therapy. 2-3 days after the end of progestin use, a menstrual-like reaction begins, sometimes quite abundant, during which uterotonic and hemostatic agents can be used.
The second stage of therapy - prevention of recurrence of bleeding.
Worldwide, clinicians have concluded that the best method of prevention is cyclic hormonal contraceptives, in the first three months - single-phase. The effectiveness of treatment is based on the normalization of gonadotropin release and suppression of endometrial proliferation. The next three months, you can only use progestin - from the 16th to the 25th day of the formed cycle. During this time, the girl should be under the supervision of a doctor. According to indications hemostimulating therapy is carried out, vitamin therapy, an optimal diet is observed, a cosmetic diet should be avoided. The control of the effectiveness of the therapy is ultrasound on the 20-22nd day of the “cycle”, in which the thickness and structure of the endometrium are recorded.
Of the progestins, preference should be given to Duphaston or Utrogestan, which are devoid of androgenic and metabolic effects. The drug is prescribed from the 16th to the 25th day of the cycle of 20 mg per day for 3-6 months.
The fear of hormone therapy, unfortunately, still prevailing among parents of patients and doctors, is completely unfounded. The beneficial effect of hormone therapy on the regulation of ovarian function has been proven by numerous studies and clinical observations.
It must be remembered that long-term symptomatic treatment of juvenile bleeding with uterotonic and hemostatic agents is not only ineffective, but also leads to further anemization.
Juvenile bleeding is bleeding with clots, anemization, lasting more than 7 days after the amenorrhea period from 1.5 to 3 months. Conducting symptomatic therapy in such patients is a medical mistake.
Prevention of relapse of the UK and the normalization of the menstrual cycle are mandatory. In women with a history of UK, more often than in the population, anovulatory infertility, endometrial adenocarcinoma and malignant tumors of the mammary glands are noted.
Treatment of dysfunctional uterine bleeding in the reproductive age
Therapy consists of two stages:
Stage I - hemostasis, for which only therapeutic and diagnostic curettage is used. Scraping also allows you to determine the subsequent therapy aimed at preventing recurrence of bleeding. Hormonal hemostasis without prior curettage is a mistake.
- Stage II - after curettage, hysteroscopy should be carried out, which allows to make sure that the entire mucous membrane is removed and to diagnose comorbidities: adenomyosis, uterine fibroids, polyps, “escaped” from the curette.
Remote scraping is subjected to histological examination, the result of which determines the tactics of further treatment. In most cases, the removed endometrium is in a state of hyperplasia. Subsequent treatment is described in the Endometrial Hyperplasia section.
Treatment of dysfunctional uterine bleeding in the perimenopausal period
Therapy depends on the morphological structure of the endometrium, established during curettage, and the presence or absence of a combined anatomical pathology of the uterus and appendages (fibroids, adenomyosis, hormonally active ovarian tumors).
Therapy at this age is aimed at suppressing menstrual function. Conservative hormonal therapy is aimed at suppressing proliferative processes in the endometrium, suppressing the hormonal function of the ovaries, that is, at the onset of menopause. Therapy is discussed in the section on endometrial hyperplasia. In case of climacteric bleeding, hemostasis is performed only surgically, by scraping under the control of hysteroscopy.
Hormonal or any other conservative hemostasis is a medical mistake.
On our site you can read an article about fibrous mastopathy and treatment of endometrial hyperplasia.
Prognosis and prevention
The prognosis for health and life with timely treatment is favorable.
The main preventive measures that are aimed at preventing the development of dysfunctional uterine bleeding:
- preventive visits to the gynecologist twice a year,
- ultrasound examination of the pelvic organs once a year
- taking combined oral contraceptives,
- complete exclusion of abortion,
- regular sex life
- Vumbilding classes are useful,
- leading an active lifestyle with regular sports,
- weight loss,
- Correction of serious endocrinological diseases
- rehabilitation of foci of chronic infection.
What it is
Dysfunctional uterine bleeding is a functional condition of the body, characterized by the absence of a violation of the structure of the genital organs, systemic diseases and complications of pregnancy. The main reason is the lack of cyclic release of ovarian hormones into the blood. Spontaneous endocrine glands.
By age parameters are distinguished:
In 80% of cases, bleeding is associated with impaired ovulation (anovulatory). Lead to hormonal dysfunction. But in 20% of women, ovulatory function is preserved.
Clinical picture of DMK
Change of periods of absence of menstruation from 2 to 6 months with copious and prolonged discharge is characteristic of dysfunctional uterine bleeding. Monthly lasts longer than a week. The volume of blood loss is over 150 ml per period.
On feeling during bleeding and a week after the end dizziness, palpitations, shortness of breath, weakness. Symptomatic due to acute blood loss, oxygen starvation of tissues, metabolic disorders. Feel cramps in the abdomen, periodic cramping pain.
The main role in the development of dysfunctional uterine bleeding is played by the weakening of the connections between the hypothalamic-pituitary-adrenal system and the ovaries.
In the hypothalamus, hormones are produced that act on the ovaries, stimulate follicle development and ovulation in them. These are follicle-stimulating and luteinizing hormones. With a lack of them in the blood does not develop the corpus luteum of the ovary, producing progesterone.
Progesterone affects the growth and maturation of the endometrium - the inner lining of the uterus. For the development and rejection of the endometrium takes time. The duration of exposure to the uterine hormone explains the delayed menstruation. The bleeding begins with a jump in estrogen and a drop in progesterone levels.
Hormonal imbalance slows down blood clotting time. A blood clot forms a long time. His bleeding is washed away from the uterus.
MQD of reproductive age
Dysfunctional uterine bleeding of reproductive age is a menstrual disorder that occurs at the age of 18 - 45 years.
The causes of pathology are:
- exercise stress,
- climate change
- inflammatory diseases,
- systematic medication
Diagnosis is standard. It starts with finding out the moment of occurrence and duration of bleeding, the volume of blood loss, the time of violation of the menstrual cycle. It is important to exclude the pathology of other organs: uterus, liver, blood.
During clinical and laboratory examination draws attention to the clinical analysis of blood. Of particular importance is the level of hemoglobin, red blood cells, hematocrit, platelets, leukocytes.
An important diagnostic study is hysteroscopy. It allows you to find out the condition of the uterus, sighting take a suspicious area for research.
In the reproductive period, the main place in the treatment is curettage of the uterus. It helps to get rid of clots. The uterus is reduced, the vessels are clamped. Bleeding stops.
As a rehabilitation treatment is used:
- hemostatic therapy (Tranexam intravenously, Dicynon intramuscularly),
- iron preparations (sorbifer, totem),
- infusion therapy (blood plasma, ringer's solution, saline),
- vitamins (group B, vitamin C),
- sedatives (Valerian, Sedavit, Novopasid).
For the recovery period, you need good nutrition, rejection of bad habits, reduced physical activity.
MQD during premenopause and menopause
Bleeding in the premenopausal and menopausal periods account for 15% of gynecological pathology. Dysfunctional uterine bleeding in the premenopausal period is an irregular spotting that occurs between the ages of 45 and one year after the end of the last menstruation.
Menopausal bleeding is a condition that occurs no earlier than a year after the last menstrual period.
The reason for the appearance of irregular secretions is the spontaneous activity of the ovaries. Estrogen is released into the blood. The state of hyperestrogenia leads to the proliferation of the endometrium. This entails proliferative diseases of the reproductive system - uterine cavity polyps, leiomyoma, ovarian tumors.
For the diagnosis using transvaginal ultrasound of the genital organs. Find out the state of the endometrium, the muscles of the uterus, ovaries.
Dysfunctional uterine bleeding is diagnosed using hysteroscopy, examining the uterus twice: before and after scraping. Mandatory therapeutic and diagnostic procedure is curettage of the uterus. The resulting material is sent for histological examination. Hysteroscopy after scraping allows you to see the state of the deep endometrial layer and the inner walls of the uterus.
The first step in the treatment is curettage of the uterus. After receiving the results and data of hysteroscopy, hormone treatment is carried out (Differelin, 17-OPK). If the examination results are unsatisfactory, the removal of the uterus with appendages is indicated.
Dysfunctional uterine bleeding is fraught with complications. The most dangerous cause of bleeding is death as a result of acute abundant blood loss. It comes as a result of hemorrhagic shock and multiorgan failure. But this is extremely rare.
Dysfunctional uterine bleeding can cause anemia, leading to a general bad feeling: heartbeat, fatigue, shortness of breath. It develops against the background of chronic iron deficiency in the body. It is a consequence of oxygen starvation of tissues.
Long-term hormonal imbalance, lack of follicle and full ovulation leads to infertility. Ovarian capsule thickens. Oocytes become more difficult to exit. A woman is not able to conceive a child.
How to determine uterine bleeding?
To distinguish uterine bleeding from normal menstruation, there is a special method used by gynecologists. A woman should determine the period of time for which the blood is completely soaked with a tampon or pad.
It is a matter of uterine bleeding if the hygienic is soaked with blood in one hour, and this happens for several hours in a row. You should also be alarmed by the need for a night replacement of the gasket, the duration of the month more than one week, the feeling of tiredness and weakness. If the results of the complete blood count indicate anemia, and with the described symptoms, a woman should consult a doctor with suspected development of uterine bleeding.
Features and causes of dysfunctional uterine bleeding
Dysfunctional uterine bleeding is predominantly anovulatory character. Their occurrence is associated with toxic and infectious effects on structures. hypothalamusthat have not yet reached maturity. It is extremely unfavorable in this regard, affects the female body tonsillogenic infection. In addition, among the factors affecting the development of bleeding, there are physical and mental overload, an unbalanced diet, provoking hypovitaminosis. The reasons for the manifestation of this pathology also become previously transferred abortionstaking certain medications. Uterine bleeding also occurs due to impaired function.
thyroid gland (in patients with hypothyroidism, hyperthyroidism).
In adolescence, juvenile bleeding is most often observed in the first two years after the girl had her first menstruation. According to medical statistics, uterine bleeding of this type makes up about 30% of all diseases from the gynecological field, which are diagnosed in women aged 18–45 years.
During the menstrual period, dysfunctional uterine bleeding is the most frequently occurring gynecological disease. If a woman in menopausal women has uterine bleeding, the reasons for its development are mainly determined by the age of the patient. It is changes in the age of the hypothalamic structures that provoke the manifestation of such bleeding. Indeed, in the premenopausal period women develop much more often. adenomatosis, hyperplasia and other pathologies.
Symptoms of this disease are determined mainly by the severity of anemia and, accordingly, the intensity of blood loss during bleeding. A woman in the period of uterine bleeding feels a strong general weakness and fatigue, she has no appetite, the skin and mucous membranes turn pale, manifests tachycardia and headache. Changes also occur in the coagulation and rheological properties of blood.
If the bleeding continues for a long period, development occurs. hypovolemia. Dysfunctional uterine bleeding in women in the menopausal period is more difficult, since in such patients bleeding develops against the background of other gynecological ailments and disorders - hypertension, obesity, hyperglycemia.
They are united by the absence of ovulation and the second phase of the cycle.
If there are bleeding similar to menstruation, but proceeding randomly, with different durations and with different time intervals between them, then a woman of childbearing age may have rhythmic persistence or follicle activity, but for a short time.
In this case, nevertheless, sometimes spontaneous, normal ovulation may occur, and a woman may become pregnant and even give birth, but rarely. In this case, the follicle continues to release estrogens and this occurs within 20 or even 40 days, and the corpus luteum does not develop and progesterone is not synthesized.
In the diagnosis will be important increased concentration of estrogen, low levels of progesterone in serum and the determination of metabolites in the urine. The basal temperature will correspond to the anovulatory cycle, and the level of gonadotropins will be high.
If a woman has a strong and prolonged uterine bleeding, which is repeated in a month or two and a half, and moreover, then we are talking about the long persistence of the follicle. Perhaps this occurs with the development of symptoms of anemia - pallor, dizziness, shortness of breath on exertion, a low level of hemoglobin appears, and most often a woman of 45 - 55 years old, she is in the premenopausal period.
Usually, before the development of this process, there is a long time, a disturbed rhythm of production and secretion of the hormones of the hypothalamus and pituitary, and atrophic changes in the epiphysis.
The woman has an excess of estrogen, which acts for a very long time, the endometrium is in the first phase and grows to such size that its vascular nutrition is disturbed. Endometrial vessels are injured, necrosis and rejection of this tissue occurs.
Similarly, high estrogen levels and low progesterone levels, elevated levels of pituitary gonadotropic hormones will be present in the blood, and luteinizing hormone will prevail. The rhythm of hormone secretion will be disrupted.
During the ultrasound, an increase in the uterus and ovaries is often determined with polycystic processes, and during hysteroscopy any endometrial hyperplasia is detected. Functional tests show the absence of a second phase of the cycle.
Dysfunctional uterine bleeding, the symptoms of which are metrorrhagia of varying intensity, reminiscent of menstruation, but first occurring after 10-15 days, and then after a month or even two, speak about the atresia of many follicles.
And while it comes more often about adolescence. All follicles end their development at the stage of pre-ovulatory maturity. В результате возникает суммарная и продолжительная стимуляция эндометрия эстрогенами, которая препятствует нормальной секреторной трансформации этого клеточного слоя.
Often it is the multiple atresia of the follicles that leads to severe anemia and occurs in girls immediately after the first menstruation or menarche. If this condition is not treated, then in the future this form of MQD is easily transformed into a similar, but reproductive, age.
In the event that a woman suffered from follicle atresia in adolescence and in fertile, then the high risk of developing this pathology will be in premenopausal. In the analysis, despite the long-term estrogen load, not only progesterone can be low, but also estrogen, because the follicles, although they release a hormone, are subject to rapid involution. The basal temperature will also be monotonous.
There may be a combination of atresia with persistence, both long-term and short-term. Therefore, sometimes a woman may develop such forms of hemorrhages that are not similar to the above.
Anovulatory cycles, with rare exceptions, occur with the absence of a mature egg cell and most often leads to impaired fertilization. Speaking of ovulatory cycles, the main role is no longer assigned to the maturation of the egg, but to the pathology of the restructuring or transformation of the endometrium, which proceeds under the action of progesterone.
It also leads to miscarriages, or miscarriages, or infertility. In the event that a woman has a spotting on the spot before the menstruation begins within 3-5 days, this may indicate a weak work of the corpus luteum.
The duration of his life is too small, and the ovarian cycle "shrinks". The follicle with this type of pathology matures without deviation, and the yellow body turns out to be short-lived and produces little progesterone. It is rejected prematurely.
Sometimes it happens that corpus luteum (as the yellow body is officially called) is inactive and lives shortly because the persistence of the follicle exists, although there is no anovulatory process. Then most often hemorrhages will occur once every few months or two or three times a year, copious.
If a woman has menstruation after a delay of several days, abundant and painful, then we can talk about hyperfunction (enhancement of progesterone synthesis) of the corpus luteum.
Since this enlarges the ovary due to cystic transformation of the corpus luteum, this condition can be confused with an ectopic pregnancy. In some cases, hyperfunction occurs with a delay of menstruation, even for several weeks. Also, there are often situations associated with incomplete rejection of the endometrium.
Hormonal "disorder" leads to the fact that the beginning of the maturation of the follicle falls on the stage of the still persistent yellow body. As a result, progesterone, which remains in the blood when not needed, interferes with the rapid and normal rejection of the endometrium.
In this case, a histological examination helps to diagnose, in which both types of glands are found, both secreting under the influence of progesterone and proliferating, under the influence of estrogens.
If a woman has bleeding in the middle of a cycle, then she may mistakenly consider it a short cycle occurring every two weeks.
This is caused by a sharp drop in estrogen levels in the middle of the cycle. Hemorrhage can be anything: from lustrous to abundant. Also, during ovulatory cycles, there can be prolonged menstruation, in the first two or three days it can be abundant, and then blood smears are given up to a week. This is caused by the inferiority of the follicles and the drop in estrogen levels from the first days of the cycle, but against the background of ovulation.
Diagnostic search in gynecology is quite complicated and is not limited to the above standard symptoms. For example, if the violation of gonadotropin production is primary, then the alternation of the ovulatory cycle can go along with anovulatory ones, while the menses become abundant, and the menstrual cycle itself is very long.
If the concentration of follicle-stimulating hormone increases and the decrease in estrogen concentration falls, then the menstrual cycle, on the contrary, shortens. Such “volleys” from long and short cycles can occur even with juvenile bleeding.
Treatment of dysfunctional uterine bleeding varies significantly depending on whether it is ovulatory bleeding or not. But regardless of the nature of functional metrorrhagia, all women need to conduct:
- bracing activities
- normalization of work, sleep and rest;
- eliminate the influence of stress factors, anxiety and depression,
- provide proper nutrition.
Care should be taken to treat anemia, including the use of symptomatic drugs. An important place is occupied by physiotherapy treatment, which is prescribed in the absence of concomitant gynecological pathology, for example, electrophoresis, electrostimulation of the uterus, magnetic therapy, laser irradiation. But the most important treatment for these hemorrhages, which is recognized worldwide, is hormone therapy.
Clinical guidelines for the treatment of dysfunctional uterine bleeding with hormones include the treatment of:
- The use of estrogens with anovulatory cycles, which are used both in injection form and in the form of tablets, as a candle, helps to stop the process already on the first day.
In the event that it was not possible to reach a stop in three days, it is necessary to revise the diagnosis. The use of estrogens in mature and childbearing age is most justified, and in adolescent and premenopausal bleeding, they should be used only in patients with severe blood loss.
- Progestin therapy stops hemorrhages through endometrial transformation. Progesterone or synthetic progesterone analogues are used. This is a slower hemostasis, often bleeding gradually decreases, and then resumes, but in a much weaker form.
But almost always after the cancellation of the course of gestagen “blood” is strong: artificially induced menses arise. These drugs are widely used in premenopause and in the childbearing period. But you need to appoint them carefully, given the possibility of anemia.
- The combination of sex hormones, both estrogen and gestagen.
Older gynecologists remember how even the administration of 3 hormones was practiced, with the addition of androgenic drugs, for example, folliculin, progesterone and testosterone. Currently it is practiced very rarely. The combination of estrogen with gestagens should be in the ratio of 10% estrogen or 5% estrogen. Usually, the bleeding stops for 2-3 days after administration.
- A completely separate topic is the treatment of metrorrhagia with synthetic progestins or estrogen-progestin drugs.
There are many generations of these drugs, and even a brief analysis of these funds requires a separate article. One can only say that they act through neuroendocrine regulation and reduce the hyperplastic processes inside the uterus, which stops bleeding.
After hormonal hemostasis, the next stage of treatment is the stabilization of the monthly cycle. And after its recovery, at the third stage, the reproductive function is restored with the use of anti-estrogen drugs, gonadotropins and releasing hormones.
In conclusion, it must be said that during ovulatory cycles, in some cases, emergency hormonal hemostasis is not indicated at all, since the persistence of the corpus luteum, for example, passes spontaneously, with a complete restoration of the cycle. Such patients are shown to use combined oral contraceptives for several cycles.
Diagnostics and treatment of DMK are difficult, and even masterly, work that cannot be done in 5 minutes using only the template schemes given above. Here, you need to take into account a lot of different physiological processes that can fade, become more active, take place simultaneously, and the treatment of this pathology is best done by gynecologists and endocrinologists who have experience and special knowledge.
What is dysfunctional uterine bleeding?
Dysfunctional uterine bleeding is a pathological bleeding that is associated with impaired functioning of the endocrine glands during the production of sex hormones. Such bleeding can be of several types: juvenile (in the process of puberty) and climacteric (in the process of decay of the functionality of the ovaries), as well as bleeding of the reproductive period.
Dysfunctional types of bleeding are expressed by a sharp increase in blood loss during menstruation (menstruation begins abruptly) or when the menstruation period increases noticeably. Dysfunctional bleeding can replace the period of amenorrhea (the period when bleeding continues from 5-6 weeks) to the period of cessation of bleeding for a certain time. The latter can lead to anemia.
If we talk about the clinical picture, then no matter what kind of uterine bleeding is inherent in the patient, it is characterized by abundant bleeding after a long delay in menstruation. Dysfunctional bleeding is accompanied by dizziness, general weakness, paleness of the skin, prolonged headache, low blood pressure, and so on.
The mechanism of development of dysfunctional uterine bleeding
Any uterine type of dysfunctional bleeding and its development basically has a malfunction of the hypothalamic-pituitary system, namely, a violation of ovarian function. Impaired secretion of gonadotropic hormones in the pituitary gland, which affect the maturation of the follicles and the ovulation process, leads to a failure of menstruation, which means that the menstrual cycle changes completely. The ovary is not able to provide the proper environment for the full maturation of the follicle. The development of the follicle either does not pass at all, or passes in part (without ovulation). The formation and development of the yellow body is simply impossible. The uterus begins to experience increased effects of estrogen, because in the absence of the corpus luteum, progesterone cannot be developed. The body of a woman, like her uterus, is in a state called hyperestrogenic. The uterine cycle is broken. Such a violation leads to the spread of the endometrium, after which rejection occurs, the main symptom of which will be abundant bleeding, continuing for a significant period. Usually, how much uterine bleeding will last is affected by various hemostasis factors, namely platelet aggregation, spastic vascular capacity and fibrinolytic activity. Their violation and characterizes dysfunctional uterine bleeding.
Of course, any kind of uterine bleeding can also stop on its own after a certain time. However, if the bleeding recurs again and again, you should immediately consult a doctor.
If we talk about the causes of the development of a particular type of DMK, the juvenile uterine form of bleeding can be caused by the incompletely formed function of one of the sections: the uterus-ovary-pituitary-hypothalamus. Reproductive bleeding can be caused by various inflammatory processes of the reproductive system, as well as surgery (for example, abortions) or one of the diseases of the endocrine glands. The uterine menopausal type of bleeding is affected by dysregulation of menstruation (the menstrual cycle changes) because the ovary begins to fade and the hormonal type of function fades.
Juvenile dysfunctional uterine bleeding
Uterine bleeding of the juvenile period occurs in 20% of cases among all pathologies in the field of gynecology. The causes of such a deviation can be anything: mental or physical trauma, overwork, stress, poor living conditions, the problem of dysfunction of the adrenal cortex (or thyroid gland), hypovitaminosis, and more. Children's infections (measles, chicken pox, whooping cough, rubella) can also cause bleeding to occur soon. Moreover, chronic tonsillitis or acute respiratory infections are the causative agents of juvenile hemorrhage.
Dysfunctional uterine bleeding of the reproductive period
The factors that cause dysfunctional uterine bleeding, as well as the process of ovarian dysfunction, can be physical and mental fatigue, stress, harmful work, climate change, various infections, medication, and abortion. The ovary fails during inflammatory or infectious processes. Malfunctions of the ovary entail thickening of its capsule, lowering the level of sensitivity of the ovarian tissue.
Dysfunctional uterine bleeding premenopausal (menopausal) period
In the premenopausal period, uterine bleeding occurs in 16% of cases. It is known that with age a woman decreases the number of gonadotropins that are secreted by the pituitary gland. The release of these substances from year to year becomes irregular. The latter causes a violation of the ovarian cycle, which implies a violation of ovulation, the development of the corpus luteum and folliculogenesis. Progesterone deficiency usually leads to hyperplastic proliferation of the endometrium or to the development of hyperestrogenia. In most cases, menopausal uterine bleeding runs in parallel with menopausal syndrome.