Polymenorrhea mkb 10. Abundant frequent menstruation with a regular menstrual cycle. N28 Other diseases of kidney and ureter, not elsewhere classified

Uterine bleeding during puberty (Uterine bleeding) - functional disorders that occur during the first three years after menarche, caused by deviations in the coordinated activity of functional systems that maintain homeostasis, manifested in the violation of correlations between them under the influence of a complex of factors.

SYNONYMS

Uterine bleeding during puberty, dysfunctional uterine bleeding, juvenile uterine bleeding.

ICD-10 code
N92.2 Heavy menstruation in puberty (profuse bleeding with the onset of menstruation, pubertal cyclical bleeding - menorrhagia, pubertal acyclic bleeding - metrorrhagia).

EPIDEMIOLOGY

The frequency of ICPP in the structure of gynecological diseases of childhood and adolescence ranges from 10 to 37.3%.
Manual transmission is a common reason for adolescent girls' visits to a gynecologist. They also account for 95% of all uterine bleeding during puberty. Most often, uterine bleeding occurs in adolescent girls during the first three years after menarche.

SCREENING

It is advisable to conduct screening of the disease with the help of psychological testing among healthy patients, especially excellent students and students of institutions with a high educational level (gymnasiums, lyceums, professional classes, institutes, universities). The risk group for the development of manual transmission should include adolescent girls with deviations in physical and sexual development, early menarche, heavy menstruation with menarche.

CLASSIFICATION

There is no officially accepted international classification of the ICIE.

Depending on the functional and morphological changes in the ovaries, there are:

• ovulatory uterine bleeding;
• anovulatory uterine bleeding.

In puberty, the most common anovulatory acyclic bleeding caused by atresia or, less often, persistence of the follicles.

Depending on the clinical features of uterine bleeding, the following types are distinguished.

• Menorrhagia (hypermenorrhea) - uterine bleeding in patients with a preserved rhythm of menstruation, with a duration of bleeding for more than 7 days and blood loss above 80 ml. In such patients, a small number of blood clots in abundant blood secretions, the appearance of hypovolemic disorders on menstrual days and signs of moderate to severe iron deficiency anemia are usually observed.
• Polymenorrhea - uterine bleeding that occurs against the background of a regular shortened menstrual cycle (less than 21 days).
• Metrorrhagia and menometrorrhagia are uterine bleeding that does not have a rhythm, often occurring after periods of oligomenorrhea and are characterized by a periodic increase in bleeding against the background of scant or moderate bleeding.

Depending on the level of concentration of estradiol in the blood plasma, manual transmissions are divided into the following types:

• hypoestrogenic;
• normoestrogenic.

Depending on the clinical and laboratory features of the manual transmission, there are typical and atypical forms.

ETIOLOGY

MKPP is a multifactorial disease; its development depends on the interaction of a complex of random factors and the individual reactivity of the organism. The latter is determined by both the genotype and the phenotype, which is formed in the process of ontogenesis of each person. As risk factors for the occurrence of manual transmission, conditions such as acute psychogenias or prolonged psychological stress, unfavorable environmental conditions in the place of residence, hypovitaminosis are most often called. Alimentary insufficiency, obesity, and body weight deficiency can also serve as trigger factors for manual transmission. It is more correct to regard these unfavorable factors not as causal, but as provoking phenomena. The leading and most likely role in the occurrence of bleeding belongs to various kinds of psychological overload and acute psychological trauma (up to 70%).

PATHOGENESIS

Homeostasis imbalance in adolescents is associated with the development of nonspecific responses to stress, i.e. some circumstances (infection, physical or chemical factors, social and psychological problems), leading to the tension of the body's adaptive resources. As a mechanism for the implementation of the general adaptation syndrome, the main axis of hormonal regulation is activated - "hypothalamus-pituitary-adrenal glands". A balanced multiparametric interaction of regulatory (central and peripheral) and effector components of functional systems is characteristic of a normal adaptive response to a change in the external or internal environment of the body. Hormonal interactions between individual systems provide correlations between them. When exposed to a complex of factors, in terms of their intensity or duration, exceeding the usual conditions of adaptation, these connections can be disrupted. As a consequence of such a process, each of the systems that provide homeostasis begins to work in one way or another in isolation, and the afferent information about their activity is distorted. This, in turn, leads to disruption of control connections and deterioration of the effector mechanisms of self-regulation. And, finally, the long-existing low quality of the self-regulation mechanisms of the system, the most vulnerable for any reason, leads to its morphofunctional changes.

The mechanism of ovarian dysfunction is inadequate stimulation of the pituitary gland with gonadoliberin and may be directly related to both a decrease in the concentration of LH and FSH in the blood, and a persistent increase in the level of LH or chaotic changes in the secretion of gonadotropins.

CLINICAL PICTURE

The clinical picture of the manual transmission is very heterogeneous. Manifestations depend on the level (central or peripheral) at which self-regulation disorders have occurred.
If it is impossible to determine the type of manual transmission (hypo, normo or hyperestrogenic) or there is no correlation between clinical and laboratory data, we can talk about the presence of an atypical form.

In the typical course of manual transmission, the clinical picture depends on the level of hormones in the blood.

• Hyperestrogenic type: outwardly, such patients look physically developed, but psychologically they can show immaturity in judgments and actions. The hallmarks of the typical form include a significant increase in the size of the uterus and the concentration of LH in the blood plasma relative to the age norm, as well as an asymmetric increase in the ovaries. The greatest likelihood of developing a hyperestrogenic type of manual transmission is at the beginning (11-12 years) and the end (17-18 years) of puberty. Atypical forms can occur up to 17 years of age.
• The normoestrogenic type is associated with the harmonious development of external signs according to anthropometry data and the degree of development of secondary sexual characteristics. The size of the uterus is less than the age norm, therefore, with such parameters, patients are more often referred to the hypoestrogenic type. Most often, this type of manual transmission develops in patients aged 13 to 16 years.
• The hypoestrogenic type is most often found in adolescent girls. Usually, such patients are of a fragile physique with a significant lag behind the age norm in the degree of development of secondary sexual characteristics, but a rather high level of mental development. The uterus lags significantly behind the age norm in all age groups, the endometrium is thin, the ovaries are symmetrical and in volume slightly exceed normal values.

The level of cortisol in blood plasma is much higher than the normative values. With the hypoestrogenic type, manual transmissions almost always proceed in a typical form.

DIAGNOSTICS

Criteria for the diagnosis of manual transmission:

• the duration of bleeding from the vagina is less than 2 or more than 7 days against the background of a shortening (less than 21-24 days) or lengthening (more than 35 days) of the menstrual cycle;
• blood loss of more than 80 ml or subjectively more pronounced compared to normal menstruation;
• the presence of intermenstrual or postoital bleeding;
• lack of structural pathology of the endometrium;
• confirmation of the anovulatory menstrual cycle during the onset of uterine bleeding (the level of progesterone in the venous blood on days 21-25 of the menstrual cycle is less than 9.5 nmol / l, monophasic basal temperature, the absence of a preovulatory follicle according to echography).

During a conversation with relatives (preferably with the mother), it is necessary to find out the details of the patient's family history.
They evaluate the characteristics of the mother's reproductive function, the course of pregnancy and childbirth, the course of the neonatal period, psychomotor development and growth rates, find out the living conditions, dietary habits, past diseases and operations, note data on physical and psychological stress, emotional stress.

PHYSICAL EXAMINATION

It is necessary to conduct a general examination, measure growth and body weight, determine the distribution of subcutaneous fat, note the signs of hereditary syndromes. Determine the compliance of the patient's individual development with age norms, including Tanner's sexual development (taking into account the development of mammary glands and hair growth).
In most patients with manual transmission, a clear advance (acceleration) in height and body weight can be observed, but relative underweight is noted in terms of body mass index (kg / m2) (with the exception of patients aged 11–18 years).

An excessive acceleration in the rate of biological maturation at the beginning of puberty is replaced by a slowdown in development in older age groups.

On examination, you can find symptoms of acute or chronic anemia (pallor of the skin and visible mucous membranes).

Hirsutism, galactorrhea, thyroid enlargement are signs of endocrine pathology. The presence of significant deviations in the functioning of the endocrine system, as well as in the immune status of patients with manual transmission may indicate a general violation of homeostasis.

It is important to analyze the girl's menstrual calendar (menstrual cycle). According to his data, one can judge the formation of menstrual function, the nature of the menstrual cycle before the first bleeding, the intensity and duration of bleeding.

The debut of the disease with menarche is more often noted in the younger age group (up to 10 years), in girls 11–12 years after menarche, irregular menstruation is more often observed before bleeding, and in girls over 13 years of age - regular menstrual cycles. Early menarche increases the likelihood of manual transmission.

The development of the clinical picture of the ICPP with atresia and persistence of follicles is very characteristic. With persistence of follicles, menstrual-like or more abundant than menstruation, bleeding occurs after a delay of the next menstruation by 1–3 weeks, whereas with follicle atresia, the delay is from 2 to 6 months and is manifested by scant and prolonged bleeding. At the same time, various gynecological diseases can have identical bleeding patterns and the same type of menstrual irregularities. Spotting bleeding from the genital tract shortly before and immediately after menstruation can be a symptom of endometriosis, endometrial polyp, chronic endometritis, HPE.

It is necessary to clarify the psychological state of the patient with the help of psychological testing and consultation with a psychotherapist. It has been proven that signs of depressive disorders and social dysfunction play an important role in the clinical picture of typical forms of manual transmission. The presence of a relationship between stress and hormonal metabolism in patients suggests the possibility of primary disorders in the neuropsychic sphere.

Gynecological examination also provides important information. When examining the external genital organs, the pubic hair growth lines, the shape and size of the clitoris, labia majora and labia minora, the external opening of the urethra, features of the hymen, the color of the mucous membranes of the vestibule of the vagina, and the nature of discharge from the genital tract are assessed.

Vaginoscopy allows you to assess the state of the vaginal mucosa, estrogen saturation and exclude the presence of a foreign body in the vagina, genital warts, lichen planus, neoplasms of the vagina and cervix.

Signs of hyperestrogenism: pronounced folding of the vaginal mucosa, juicy hymen, cylindrical cervix, positive pupil symptom, abundant streaks of mucus in the blood discharge.

Signs of hypoestrogenemia: the vaginal mucosa is pale pink in color, the folding is poorly expressed, the hymen is thin, the cervix is ​​subconical or conical, bleeding without mucus.

LABORATORY RESEARCH

Patients with suspected manual transmission undergo the following studies.

• Complete blood count with determination of hemoglobin level, platelet count, reticulocyte count. A hemostasiogram (aPTT, prothrombin index, activated recalcification time) and an assessment of the bleeding time will exclude a gross pathology of the blood coagulation system.
• Determination of β-hCG in blood serum in sexually active girls.
• Microscopy of a smear (Gram stain), bacteriological examination and PCR diagnostics of chlamydia, gonorrhea, mycoplasmosis, ureaplasmosis in scraping of the vaginal walls.
• Biochemical blood test (determination of glucose, protein, bilirubin, cholesterol, creatinine, urea, serum iron, transferrin, calcium, potassium, magnesium levels) ALP, AST, ALT activity.
• Carbohydrate tolerance test for polycystic ovary syndrome and overweight (body mass index 25 and above).
• Determination of the level of thyroid hormones (TSH, free T4, AT to thyroid peroxidase) to clarify the function of the thyroid gland; estradiol, testosterone, DHEAS, LH, FSH, insulin, Speptide to exclude PCOS; 17-OP, testosterone, DHEAS, circadian rhythm of cortisol to exclude VHKN; prolactin (at least 3 times) to exclude hyperprolactinemia; serum progesterone on the 21st day of the cycle (with a menstrual cycle of 28 days) or on the 25th day (with a menstrual cycle of 32 days) to confirm the anovulatory nature of uterine bleeding.

At the first stage of the disease in early puberty, activation of the hypothalamo-pituitary system leads to a periodic release of LH (primarily) and FSH, their concentration in blood plasma exceeds normal levels. In late puberty, and especially with recurrent uterine bleeding, the secretion of gonadotropins decreases.

INSTRUMENTAL RESEARCH METHODS

Sometimes x-rays of the left hand and wrist are taken to determine bone age and to predict growth.
Most patients with manual transmission are diagnosed with an advance in biological age compared to chronological, especially in younger age groups. Biological age is a fundamental and multifaceted indicator of the rate of development, reflecting the level of the morphological and functional state of the organism against the background of the population standard.

X-ray of the skull is an informative method for diagnosing tumors of the hypothalamo-pituitary region, deforming the sella turcica, assessing cerebrospinal fluid dynamics, intracranial hemodynamics, osteosynthesis disorders due to hormonal imbalance, transferred intracranial inflammatory processes.

Echography of the pelvic organs allows you to clarify the size of the uterus and endometrium to exclude pregnancy, the size, structure and volume of the ovaries, uterine malformations (two-horned, saddle uterus), pathology of the body of the uterus and endometrium (adenomyosis, MM, polyps or hyperplasia, adenomatosis and endometrial cancer, endometritis , intrauterine synechiae), assess the size, structure and volume of the ovaries, exclude functional cysts and volumetric formations in the uterine appendages.

Diagnostic hysteroscopy and curettage of the uterine cavity in adolescents is rarely used and is used to clarify the state of the endometrium when echographic signs of endometrial or cervical canal polyps are detected.

Ultrasound of the thyroid gland and internal organs is performed according to indications in patients with chronic diseases and endocrine diseases.

DIFFERENTIAL DIAGNOSTICS

The main goal of the differential diagnosis of uterine bleeding during puberty is to clarify the main etiological factors that provoke the development of manual transmission.

Differential diagnosis should be made with a variety of conditions and diseases.

• Complication of pregnancy in sexually active adolescents. Complaints and anamnesis data, allowing to exclude interrupted pregnancy or bleeding after an abortion, including in girls who deny sexual contact. Bleeding occurs more often after a short delay of more than 35 days, less often when the menstrual cycle is shortened for less than 21 days or at a time close to the expected menstruation. In the history, as a rule, there are indications of sexual intercourse in the previous menstrual cycle. Patients note engorgement of the mammary glands, nausea. Blood discharge, as a rule, copious with clots, with pieces of tissue, often painful. The results of pregnancy tests are positive (determination of β-hCG in the patient's blood serum).
• Defects of the blood coagulation system (von Willebrand disease and deficiency of other plasma factors of hemostasis, Werlhof's disease, thrombosis of Glanzmann, Bernard-Soulier, Gaucher). In order to exclude defects in the blood coagulation system, the family history (a tendency to bleeding in parents) and life history (nosebleeds, prolonged bleeding time during surgical procedures, frequent and unreasonable occurrence of petechiae and hematomas) are ascertained. Uterine bleeding that developed against the background of diseases of the hemostatic system, as a rule, has the character of menorrhagia with menarche. Examination data (pallor of the skin, bruising, petechiae, yellow color of the palms and upper palate, hirsutism, striae, acne, vitiligo, multiple birthmarks, etc.) and laboratory research methods (hemostasiogram, complete blood count, thromboelastogram, determination of the main coagulation factors ) allow to confirm the presence of pathology of the hemostasis system.
• Other blood diseases: leukemia, aplastic anemia, iron deficiency anemia.
• Polyps of the cervix and uterine body. Uterine bleeding, as a rule, is acyclic with short light intervals, the discharge is moderate, often with cords of mucus. Echographic examination often diagnoses HPE (the thickness of the endometrium against the background of bleeding is 10-15 mm), with hyperechoic formations of various sizes. The diagnosis is confirmed with the help of hysteroscopy data and subsequent histological examination of the remote endometrial formation.
• Adenomyosis. For manual transmission on the background of adenomyosis, severe dysmenorrhea is characteristic, prolonged spotting bleeding with a brown tint before and after menstruation. The diagnosis is confirmed using echography data in the 1st and 2nd phases of the menstrual cycle and hysteroscopy (in patients with severe pain syndrome and in the absence of the effect of drug therapy).
• PID. As a rule, uterine bleeding is acyclic in nature, occurs after hypothermia, unprotected sexual intercourse in sexually active adolescents, against the background of exacerbation of chronic pelvic pain, discharge. Patients complain of pain in the lower abdomen, dysuria, hyperthermia, profuse pathological leucorrhoea outside of menstruation, acquiring a sharp unpleasant odor against the background of bleeding. In a recto-abdominal examination, an enlarged softened uterus is palpated, the pasty tissues in the region of the uterine appendages are determined, the study is usually painful. The data of bacteriological examination (microscopy of smears according to Gram, PCR diagnostics of vaginal discharge for the presence of STIs, bacteriological culture from the posterior fornix of the vagina) help to clarify the diagnosis.
• Injury to the vulva or a foreign body in the vagina. For diagnosis, it is necessary to clarify the anamnestic data and conduct vulvovaginoscopy.
• PCOS. With manual transmission in girls with PCOS, along with complaints of delayed menstruation, excessive hair growth, simple acne on the face, chest, shoulders, back, buttocks and hips, there are indications of late menarche with progressive menstrual irregularities of the oligomenorrhea type.
• Hormone-producing formations. MKPP may be the first symptom of estrogen-producing tumors or ovarian tumors. Verification of the diagnosis is possible after determining the level of estrogen in the venous blood and ultrasound of the genital organs with the specification of the volume and structure of the ovaries.
• Thyroid dysfunction. MKPP occurs, as a rule, in patients with subclinical or clinical hypothyroidism. Patients with manual transmission on the background of hypothyroidism complain of chilliness, swelling, weight gain, memory loss, drowsiness, depression. In hypothyroidism, palpation and ultrasound with determination of the volume and structural features of the thyroid gland reveal its enlargement, and examination of patients reveals the presence of dry subecteric skin, puffiness of the face, glossomegaly, bradycardia, and an increase in the relaxation time of deep tendon reflexes. To clarify the functional state of the thyroid gland, it is possible to determine the content of TSH, free T4 in venous blood.
• Hyperprolactinemia. To exclude hyperprolactinemia as a cause of manual transmission, it is necessary to examine and palpate the mammary glands to clarify the nature of the discharge from the nipples, to determine the content of prolactin in the venous blood, an X-ray examination of the skull bones with a targeted study of the size and configuration of the Turkish saddle or MRI of the brain is shown.
• Other endocrine diseases (Addison's disease, Cushing's disease, post-pubertal form of VHKN, adrenal tumors, empty Turkish saddle syndrome, mosaic variant of Turner's syndrome).
• Systemic diseases (liver disease, chronic renal failure, hypersplenism).
• Iatrogenic causes (mistakes in taking medications containing female sex hormones and glucocorticoids, prolonged use of high doses of NSAIDs, antiplatelet agents and anticoagulants, psychotropic drugs, anticonvulsants and warfarin, chemotherapy).

It is necessary to distinguish between manual transmission and uterine bleeding syndrome in adolescents. Uterine bleeding syndrome can be accompanied by almost the same clinical and parametric attributes as with manual transmission. However, the syndrome of uterine bleeding is characterized by pathophysiological and clinical specific signs, which must be taken into account when prescribing preventive measures.

INDICATIONS FOR CONSULTING OTHER SPECIALISTS

An endocrinologist's consultation is necessary if there is a suspicion of a thyroid gland pathology (clinical symptoms of hypo or hyperthyroidism, diffuse enlargement or nodules of the thyroid gland on palpation).

Consultation with a hematologist - with the debut of a manual transmission with menarche, indications of frequent nosebleeds, the occurrence of petechiae and hematomas, increased bleeding with cuts, wounds and surgical manipulations, identification of a prolonged bleeding time.

Consultation with a phthisiatrician - with manual transmission on the background of prolonged persistent subfebrile condition, acyclic bleeding, often accompanied by pain, the absence of a pathogenic infectious agent in the discharge of the urogenital tract, relative or absolute lymphocytosis in a general blood test, positive results of a tuberculin test.

Consultation of a therapist - with manual transmission on the background of chronic systemic diseases, including diseases of the kidneys, liver, lungs, cardiovascular system, etc.

Consultation with a psychotherapist or psychiatrist is indicated for all patients with manual transmission for correction of the condition, taking into account the peculiarities of the traumatic situation, clinical typology, and the reaction of the individual to the disease.

EXAMPLE FORMULATING A DIAGNOSIS

N92.2 Heavy menses during puberty (heavy bleeding with menarche or pubertal menorrhagia
or pubertal metrorrhagias).

OBJECTIVES OF TREATMENT

The general goals of treating uterine bleeding during puberty are:

• stopping bleeding to avoid acute hemorrhagic syndrome;
• stabilization and correction of the menstrual cycle and the state of the endometrium;
• antianemic therapy;
• correction of the mental state of patients and concomitant diseases.

INDICATIONS FOR HOSPITALIZATION

Patients are hospitalized with the following conditions:

• profuse (profuse) uterine bleeding, which is not stopped by drug therapy;
• life-threatening decrease in hemoglobin (below 70–80 g / l) and hematocrit (below 20%);
• the need for surgical treatment and blood transfusion.

MEDICAL TREATMENT

In patients with uterine bleeding at the first stage of treatment, it is advisable to use inhibitors of the transition of plasminogen to plasmin (tranexamic acid or aminocaproic acid). The drugs reduce the intensity of bleeding by reducing the fibrinolytic activity of blood plasma. Tranexamic acid is prescribed orally at a dose of 4–5 g during the first hour of therapy, then 1 g every hour until the bleeding stops completely. Perhaps intravenous administration of 4-5 g of the drug for 1 hour, then drip administration of 1 g per hour for 8 hours. The total daily dose should not exceed 30 g. When taking large doses, the risk of developing intravascular coagulation syndrome increases, estrogen, there is a high likelihood of thromboembolic complications. It is possible to use the drug in a dosage of 1 g 4 times a day from the 1st to the 4th day of menstruation, which reduces the volume of blood loss by 50%.

It has been reliably proven that with the use of NSAIDs, monophasic COCs and danazol, blood loss in patients with menorrhagia is significantly reduced. Danazol in girls with manual transmission is used very rarely due to pronounced adverse reactions (nausea, coarsening of the voice, hair loss and increased greasiness, the appearance of acne and hirsutism). NSAIDs (ibuprofen, nimesulide), by suppressing the activity of COX1 and COX2, regulate the metabolism of arachidonic acid, reduce the production of PG and thromboxanes in the endometrium, reducing the volume of blood loss during menstruation by 30–38%.

Ibuprofen is prescribed 400 mg every 4–6 hours (daily dose 1200–3200 mg) on ​​the days of menorrhagia. Nimesulide is prescribed 50 mg 3 times a day. An increase in the daily dosage can cause an undesirable increase in prothrombin time and an increase in the serum lithium content.

The effectiveness of NSAIDs is comparable to that of aminocaproic acid and COCs.

In order to increase the effectiveness of hemostatic therapy, the simultaneous administration of NSAIDs and hormonal therapy is justified and advisable. The exception is patients with hyperprolactinemia, structural anomalies of the genital organs and thyroid gland pathology.

Methyl ergometrine can be prescribed in combination with ethamsylate, but in the presence or suspicion of an endometrial polyp or MM, it is better to refrain from prescribing methylergometrine because of the possibility of increased blood discharge and the occurrence of pain in the lower abdomen.

Physiotherapy can be used as alternative methods: auto-mammalianization, vibromassage of the peri-ocular zone, electrophoresis with calcium chloride, galvanization of the upper cervical sympathetic ganglia region, electrical stimulation of the cervix with low-frequency pulsed currents, local or laser therapy, acupuncture.

In some cases, hormone therapy is used. Indications for hormonal hemostasis:

• lack of effect from symptomatic therapy;
• moderate or severe anemia with prolonged bleeding;
• recurrent bleeding in the absence of organic diseases of the uterus.

Low-dose COCs containing 3rd generation progestogens (desogestrel or gestodene) are the most commonly used drugs in patients with profuse and acyclic uterine bleeding. Ethinylestradiol in the composition of COCs provides a hemostatic effect, and progestogens stabilize the stroma and the basal layer of the endometrium. To stop bleeding, only monophasic COCs are used.

There are many schemes for the use of COCs for hemostatic purposes in patients with uterine bleeding. The most popular is the following: 1 tablet 4 times a day for 4 days, then 1 tablet 3 times a day for 3 days, then 1 tablet 2 times a day, then 1 tablet a day until the end of the second package of the drug. Outside bleeding for the purpose of menstrual regulation cycles of COCs are prescribed for 3 cycles of 1 tablet per day (21 days of taking, 7 days off). Duration hormone therapy depends on the severity of the initial iron deficiency anemia and the rate of recovery of the level hemoglobin. The use of COCs in this regimen is associated with a number of serious side effects: increased blood pressure, thrombophlebitis, nausea, vomiting, allergies.

The high efficiency of the use of low-dose monophasic COCs (Marvelon©, Regulon ©, Rigevidon ©, Janine ©) 1/2 tablet every 4 hours until complete hemostasis occurs. The appointment under this scheme is based on evidence that the maximum concentration of COCs in the blood is reached 3-4 hours after oral administration the drug and significantly decreases in the next 2-3 hours. The total hemostatic dose of ethinylestradiol at this ranges from 60 to 90 mcg, which is less than the traditionally used dose. In the following days, a decrease is carried out the daily dose of the drug is 1/2 tablet per day. As a rule, the duration of the first COC cycle should not be less than 21 days from the first day from the onset of hormonal hemostasis. The first 5-7 days of taking COCs is possible a temporary increase in the thickness of the endometrium, which regresses without bleeding with continued treatment.

In the future, in order to regulate the rhythm of menstruation and prevent recurrence of uterine bleeding, the drug are prescribed according to the standard scheme of taking COCs (courses for 21 days with intervals of 7 days between them). For all the sick taking the drug according to the described scheme, good tolerance was noted in the absence of side effects. If necessary, an accelerated stop of a life-threatening patient bleeding with drugs of the first line of choice are conjugated estrogens administered intravenously at a dose of 25 mg every 4-6 hours until completely stopped bleeding if it occurs during the first day. It is possible to use a tablet form conjugated estrogens 0.625-3.75 mcg every 4-6 hours until bleeding stops completely with gradual reducing the dose over the next 3 days to 1 tablet (0.675 mg) per day or preparations containing natural estrogens (estradiol), according to a similar scheme with an initial dose of 4 mg per day. After stopping bleeding progestogens are prescribed.

Outside of bleeding, in order to regulate the menstrual cycle, 1 tablet of 0.675 mg per day is prescribed for 21 days with mandatory addition of gestagens within 12-14 days in the second phase of the simulated cycle.

In some cases, especially in patients with severe adverse reactions, intolerance or contraindications to the use of estrogens, the appointment of progestogens is possible.

In patients with heavy bleeding, high doses of progestogens (medroxyprogesterone 5-10 mg, micronized progesterone 100 mg or dydrogesterone 10 mg) every 2 hours or 3 times a day for a day until stopping bleeding. With menorrhagia, medroxyprogesterone can be prescribed at 5–20 mg per day for the second phase (in cases with NLF) or 10 mg per day from the 5th to the 25th day of the menstrual cycle (in cases of ovulatory menorrhagias).

In patients with anovulatory uterine bleeding, progestogens should be prescribed in the second phase. menstrual cycle against the background of constant use of estrogens. It is possible to use micronized progesterone in a daily dose of 200 mg 12 days a month against the background of continuous estrogen therapy. With a view to follow-up regulation of the menstrual cycle progestogens (natural micronized progesterone 100 mg 3 times a day, dydrogesterone 10 mg 2 times a day) is prescribed in the second phase of the cycle for 10 days. Continued bleeding against the background of hormonal hemostasis is an indication for hysteroscopy with the aim of clarification of the state of the endometrium.

All patients with manual transmission are shown the appointment of iron preparations to prevent and prevent the development of iron deficiency anemia. The high efficiency of the use of iron sulfate in combination with ascorbic acid has been proven. acid, providing the patient with 100 mg of ferrous iron per day (Sorbifer Durules ©).

The daily dose of ferrous sulfate is selected taking into account the level of hemoglobin in the blood serum. As a criterion correct selection and adequacy of ferrotherapy for iron deficiency anemias, the presence of a reticulocytic crisis, those. 3 or more fold increase in the number of reticulocytes on the 7-10th day of taking the iron-containing drug.

Antianemic therapy is prescribed for a period of at least 1-3 months. Iron salts should be used with caution in patients with concomitant gastrointestinal pathology. In addition to this option, there may be Fenuls©, Tardiferon ©, Ferroplex ©, FerroFolgamma ©.

SURGERY

Separate scraping of the mucous membrane of the body and cervix under the control of a hysteroscope in girls is performed very rarely. Indications for surgical treatment can be:

• acute profuse uterine bleeding that does not stop with drug therapy;
• the presence of clinical and ultrasound signs of endometrial and / or cervical polyps.

If it is necessary to remove an ovarian cyst (endometrioid, dermoid follicular or cyst yellow body persisting for more than three months) or clarification of the diagnosis in patients with a volumetric formation in the area appendages of the uterus, diagnostic laparoscopy is indicated.

APPROXIMATE FAILURE TIME

With an uncomplicated course, the disease does not cause permanent disability. Possible periods of disability from 10 to 30 days may be due to the severity of clinical manifestations iron deficiency anemia against the background of prolonged or heavy bleeding, as well as the need for hospitalization for surgical or hormonal hemostasis.

FURTHER INTRODUCTION

Patients with uterine bleeding during puberty need constant dynamic observation 1 time in a month before the stabilization of the menstrual cycle, then it is possible to limit the frequency of the control examination to 1 time per 3-6 months Echography of the pelvic organs should be performed at least once every 6–12 months.

Electroencephalography after 3-6 months. All patients should be trained in the rules of maintaining the menstrual calendar. and assessment of the intensity of bleeding, which will allow assessing the effectiveness of the therapy. Patients should be informed about the advisability of correction and maintenance of optimal body weight (as in
deficiency and overweight), normalization of work and rest.

PATIENT INFORMATION

For the prevention of the onset and successful treatment of uterine bleeding during puberty, you need:

• normalization of the work and rest regime;
• good nutrition (with the obligatory inclusion of meat, especially veal in the diet);
• hardening and physical education (outdoor games, gymnastics, skiing, skating, swimming, dancing, yoga).

FORECAST

Most girls-adolescents respond favorably to drug treatment, and during the first year they have full ovulatory menstrual cycles and normal menstruation are formed. Forecast for manual transmission, associated with the pathology of the hemostasis system or with systemic chronic diseases, depends on the degree of compensation for the existing disorders. Girls, preserving excess body weight and having relapses of manual transmission in aged 15-19 should be included in the risk group for developing endometrial cancer.

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Technically speaking, a woman is a rather complex mechanism. If a problem arises with any organ, then it will pull a lot of others along with it.

The female genital organs are a very complex system, so you need to pay attention even to the little things, since they sometimes play a key role. Ignoring gynecological diseases can lead to infertility.

Very often, during menstruation, a woman experiences discomfort. Of course, there is nothing pleasant about menstruation, but some women experience severe pain. This disease is called algodismenorrhea.

The cause of painful sensations is most often the incorrect position of the uterus, or its very small size, endometriosis, and inflammation of the reproductive organs can also affect pain.

As a rule, the disease has several symptoms - abdominal pain, headache, nausea, dizziness. All symptoms disappear as soon as menstruation begins.

Algodismenorrhea has two types - primary and secondary. Usually the primary is not associated with anatomy, it manifests itself in girls with the very first menstruation. Although there are times when it appears in women. The pain is very strong, so you can't do without analgesics or tranquilizers. By its nature, it resembles labor, whoever gave birth will understand how much it hurts!

Unfortunately, secondary algodismenorrhea is usually a manifestation of another disease. As a rule, it is a symptom of fibroids or anteflexia of the uterus, inflammatory processes. Sometimes this disease occurs after a difficult childbirth, or an abortion.

ICD-10 codes

N94.0 Pain in the middle of the menstrual cycle;
N94.1 Dyspareunia;
N94.2 Vaginismus;
N94.3 Premenstrual tension syndrome;
N94.4 Primary dysmenorrhea;
N94.5 Secondary dysmenorrhea;
N94.6 Dysmenorrhea, unspecified;
N94.8 Other specified conditions associated with female genital organs and menstrual cycle;
N94.9 Conditions associated with female genital organs and menstrual cycle, unspecified

Treatment

It is generally accepted that secondary algomenorrhea will pass if the underlying disease is cured, since it is a symptom. However, one should not endure terrible pain. It is necessary to use anti-inflammatory drugs a couple of days before menstruation. You can also try medicinal fees, hardware physiotherapy. Primary algodismenorrhea most often passes after the first birth, until this moment the woman takes analgesics and anti-inflammatory drugs.

In any case, the help of an experienced gynecologist is essential! When it comes to gynecological problems, self-medication can lead to infertility, which is a terrible diagnosis for any woman. Therefore, it is better not to take risks without a reason!

CLASS XIV. DISEASES OF THE Urogenital System (N00-N99)

This class contains the following blocks:
N00-N08 Glomerular diseases
N10-N16 Kidney tubulointerstitial disease
N17-N19 Renal failure
N20-N23 Urolithiasis disease
N25-N29 Other diseases of the kidney and ureter
N30-N39 Other diseases of the urinary system
N40-N51 Diseases of the male genital organs
N60-N64 Breast diseases
N70-N77 Inflammatory diseases of the female pelvic organs
N80-N98 Non-inflammatory diseases of the female genital organs
N99 Other disorders of the genitourinary system

The following categories are marked with an asterisk:
N08* Glomerular lesions in diseases classified elsewhere
N16* Tubulointerstitial renal disease in diseases classified elsewhere
N22* Urinary tract stones in diseases classified elsewhere
N29* Other disorders of the kidney and ureter in diseases classified elsewhere
N33* Disorders of the bladder in diseases classified elsewhere
N37* Disorders of the ureter in diseases classified elsewhere
N51* Lesions of the male genital organs in diseases classified elsewhere
N74* Inflammatory lesions of the pelvic organs in women with diseases classified elsewhere
N77* Ulceration and inflammation of the vulva and vagina in diseases classified elsewhere

GLOMERULAR DISEASES (N00-N08)

If necessary, identify an external cause (class XX) or in the presence of renal failure ( N17-N19) use additional code.

Excludes: hypertension with predominant kidney damage ( I12. -)

With headings N00-N07 the following fourth characters may be used to classify morphological changes: Subcategories. 0- .8 should not be used unless specific studies have been performed to identify lesions (eg, renal biopsy or autospy). The triple-digit headings are based on clinical syndromes.

0 Minor glomerular disorders. Minimal damage
.1 Focal and segmental glomerular lesions
Focal and segmental:
hyalinosis
sclerosis
Focal glomerulonephritis
.2 Diffuse membranous glomerulonephritis
.3 Diffuse mesangial proliferative glomerulonephritis
.4 Diffuse endocapillary proliferative glomerulonephritis
.5 Diffuse mesangiocapillary glomerulonephritis. Membranoproliferative glomerulonephritis (type 1 and 3 or NOS)
.6 Disease of dense sediment. Membranous-proliferative glomerulonephritis (type 2)
.7 Diffuse sickle glomerulonephritis. Extracapillary glomerulonephritis
.8 Other changes. Proliferative glomerulonephritis NOS
.9 Unspecified change

N00 Acute nephritic syndrome

Included: acute:
glomerular disease
glomerulonephritis
nephritis
renal disease NOS
Excludes: acute tubulointerstitial nephritis ( N10)
nephritic syndrome NOS ( N05. -)

N01 Rapidly progressive nephritic syndrome

Included: rapidly progressive (s):
glomerular disease
glomerulonephritis
nephritis
Excludes: nephritic syndrome NOS ( N05. -)

N02 Recurrent and persistent hematuria

Included: hematuria:
benign (familial) (children)
with morphological lesion, specified v.0- .8
Excludes: hematuria NOS ( R31)

N03 Chronic nephritic syndrome

Included: chronic (s):
glomerular disease
glomerulonephritis
nephritis
renal disease NOS
Excludes: chronic tubulointerstitial nephritis ( N11. -)
N18. -)
nephritic syndrome NOS ( N05. -)

N04 Nephrotic syndrome

Includes: congenital nephrotic syndrome
lipoid nephrosis

N05 Unspecified nephritic syndrome

Includes: glomerular disease)
glomerulonephritis) NOS
jade)
nephropathy NOS and renal disease NOS with morphological lesion, specified v.0- .8
Excluded: nephropathy NOS for unknown cause ( N28.9)
renal disease NOS for unknown cause ( N28.9)
tubulointerstitial nephritis NOS ( N12)

N06 Isolated proteinuria with specified morphological lesion

Includes: proteinuria (isolated) (orthostatic)
(persistent) with morphological lesion, specified
v.0- .8
Excludes: proteinuria:
NOS ( R80)
Bence Jones ( R80)
caused by pregnancy ( O12.1)
isolated NOS ( R80)
orthostatic NOS ( N39.2)
persistent NOS ( N39.1)

N07 Hereditary nephropathy, not elsewhere classified

Excluded: Alport syndrome ( Q87.8)
hereditary amyloid nephropathy ( E85.0)
syndrome (absence) (underdevelopment) of the nails-supra-epilepticus ( Q87.2)
hereditary familial amyloidosis without neuropathy ( E85.0)

N08 * Glomerular lesions in diseases classified elsewhere

Includes: nephropathy in diseases classified elsewhere
Excludes: renal tubulointerstitial lesions in diseases classified elsewhere ( N16. -*)

Includes: pyelonephritis
Excludes: cystic pyeloureteritis ( N28.8)

N10 Acute tubulointerstitial nephritis

Spicy:

pyelitis
pyelonephritis
B95-B97).

N11 Chronic tubulointerstitial nephritis

Included: chronic:
infectious interstitial nephritis
pyelitis
pyelonephritis
B95-B97).

N11.0 Non-obstructive chronic pyelonephritis associated with reflux
Pyelonephritis (chronic) associated with (vesicoureteral) reflux
Excludes: vesicoureteral reflux NOS ( N13.7)
N11.1 Chronic obstructive pyelonephritis
Pyelonephritis (chronic) associated with:
anomaly) (pelvic-ureteric
inflection) (connections
obstruction) (pelvic ureteral segment
structure) (ureter
Excluded: calculous pyelonephritis ( N20.9)
obstructive uropathy ( N13. -)
N11.8 Other chronic tubulointerstitial nephritis
Non-obstructive chronic pyelonephritis NOS
N11.9 Chronic tubulo-interstitial nephritis, unspecified
Chronic:
interstitial nephritis NOS
pyelitis NOS
pyelonephritis NOS

N12 Tubulo-interstitial nephritis, not specified as acute or chronic

Interstitial nephritis NOS
Pyelitis NOS
Pyelonephritis NOS
Excludes: calculous pyelonephritis ( N20.9)

N13 Obstructive uropathy and reflux uropathy

Excludes: kidney and ureteral stones without hydronephrosis ( N20. -)
congenital obstructive changes in the renal pelvis and ureter ( Q62.0-Q62.3)
obstructive pyelonephritis ( N11.1)

N13.0 Hydronephrosis with obstruction of the ureteropelvic junction
Excluded: with infection ( N13.6)
N13.1 Hydronephrosis with ureteral stricture, not elsewhere classified
Excluded: with infection ( N13.6)
N13.2 Hydronephrosis with obstruction of the kidney and ureter with calculus
Excluded: with infection ( N13.6)
N13.3 Other and unspecified hydronephrosis
Excluded: with infection ( N13.6)
N13.4 Hydroureter
Excluded: with infection ( N13.6)
N13.5 Kink and stricture of the ureter without hydronephrosis
Excluded: with infection ( N13.6)
N13.6 Pyonephrosis
Conditions listed under headings N13.0-N13.5, with an infection. Obstructive uropathy with infection
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N13.7 Vesicoureteral reflux uropathy
Vesicoureteral reflux:
NOS
with scarring
Excludes: pyelonephritis associated with vesicoureteral reflux ( N11.0)
N13.8 Other obstructive uropathy and reflux uropathy
N13.9 Obstructive uropathy and reflux uropathy, unspecified. Urinary tract obstruction NOS

N14 Tubulointerstitial and tubular lesions due to drugs and heavy metals

If it is necessary to identify a toxic substance, an additional external cause code (class XX) is used.

N14.0 Analgesic nephropathy
N14.1 Nephropathy due to other drugs, medications or biologically active substances
N14.2 Unspecified drug, medication and biologically active substance nephropathy
N14.3 Heavy metal nephropathy
N14.4 Toxic nephropathy, not elsewhere classified

N15 Other tubulointerstitial renal diseases

N15.0 Balkan nephropathy. Balkan endemic nephropathy
N15.1 Abscess of the kidney and perirenal tissue
N15.8 Other specified renal tubulointerstitial lesions
N15.9 Unspecified tubulointerstitial renal disease. Kidney infection NOS
Excludes: urinary tract infection NOS ( N39.0)

N16 * Tubulo-interstitial renal disease in diseases classified elsewhere

leukemia ( C91-C95+)
lymphoma ( C81-C85+, C96. -+)
multiple myeloma ( C90.0+)
N16.2* Tubulointerstitial kidney damage in blood diseases and disorders involving the immune mechanism
Tubulointerstitial kidney damage in:
mixed cryoglobulinemia ( D89.1+)
sarcoidosis ( D86. -+)
N16.3* Tubulointerstitial kidney damage in metabolic disorders
Tubulointerstitial kidney damage in:
cystinosis ( E72.0+)
glycogen storage diseases ( E74.0+)
Wilson's disease ( E83.0+)
N16.4* Tubulo-interstitial kidney damage in systemic connective tissue diseases
Tubulointerstitial kidney damage in:
dryness syndrome [Sjogren] ( M35.0+)
systemic lupus erythematosus ( M32.1+)
N16.5* Tubulointerstitial kidney damage in transplant rejection ( T86. -+)
N16.8* Tubulointerstitial renal disease in other diseases classified elsewhere

RENAL FAILURE (N17-N19)

If it is necessary to identify the external agent, an additional external reason code (class XX) is used.

Excluded: congenital renal failure ( P96.0)
tubulointerstitial and tubular lesions caused by drugs and heavy metals ( N14. -)
extrarenal uremia ( R39.2)
hemolytic uremic syndrome ( D59.3)
hepatorenal syndrome ( K76.7)
postpartum ( O90.4)
prerenal uremia ( R39.2)
renal failure:
complicating abortion, ectopic or molar pregnancy ( O00-O07, O08.4)
after childbirth and delivery ( O90.4)
after medical procedures ( N99.0)

N17 Acute renal failure

N17.0 Acute renal failure with tubular necrosis
Tubular necrosis:
NOS
spicy
N17.1 Acute renal failure with acute cortical necrosis
Cortical necrosis:
NOS
spicy
renal
N17.2 Acute renal failure with medullary necrosis
Medullary (papillary) necrosis:
NOS
spicy
renal
N17.8 Other acute renal failure
N17.9 Acute renal failure, unspecified

N18 Chronic renal failure

Includes: chronic uremia, diffuse sclerosing glomerulonephritis
Excludes: chronic renal failure with hypertension ( I12.0)

N18.0 End stage renal disease
N18.8 Other manifestations of chronic renal failure
Uremic neuropathy + ( G63.8*)
Uremic pericarditis + ( I32.8*)
N18.9 Chronic renal failure, unspecified

N19 Renal failure, unspecified

Uremia NOS
Excluded: renal failure with hypertension ( I12.0)
uremia of the newborn ( P96.0)

URINE STEALTH DISEASE (N20-N23)

N20 Kidney and ureter stones

Excluded: with hydronephrosis ( N13.2)

N20.0 Kidney stones. Nephrolithiasis NOS. Calculi or kidney stones. Coral calculi. Kidney stone
N20.1 Ureteral stones. Ureteral calculus
N20.2 Kidney stones with ureteral stones
N20.9 Unspecified urinary stones. Calculous pyelonephritis

N21 Lower urinary tract stones

Includes: with cystitis and urethritis

N21.0 Bladder stones. Concretions in the diverticulum of the bladder. Bladder stone
Excludes: coral calculi ( N20.0)
N21.1 Urethral stones
N21.8 Other stones in the lower urinary tract
N21.9 Lower urinary tract stones, unspecified

N22 * Urinary tract stones in diseases classified elsewhere

N22.0* Urinary stones with schistosomiasis [bilharziasis] ( B65. -+)
N22.8* Urinary tract stones in other diseases classified elsewhere

N23 Renal colic, unspecified

OTHER DISEASES OF THE KIDNEY AND URETER (N25-N29)

Excluded: with urolithiasis ( N20-N23)

N25 Disorders resulting from renal tubular dysfunction

Excludes: metabolic disorders classified in rubrics E70-E90

N25.0 Renal osteodystrophy. Azotemic osteodystrophy. Tubular Disorders Associated with Phosphate Loss
Renal (s):
rickets
dwarfism
N25.1 Nephrogenic diabetes insipidus
N25.8 Other disorders due to renal tubular dysfunction
Lightwood-Albright Syndrome. Renal tubular acidosis NOS. Secondary hyperparathyroidism of renal origin
N25.9 Renal tubular dysfunction, specified

N26 Shrinked kidney, unspecified

Kidney atrophy (terminal). Renal sclerosis NOS
Excludes: shriveled kidney with hypertension ( I12. -)
diffuse sclerosing glomerulonephritis ( N18. -)
hypertensive nephrosclerosis (arteriolar) (arteriosclerotic) ( I12. -)
small kidney for some unknown reason ( N27. -)

N27 Small kidney of unknown origin

N27.0 Small kidney, unilateral
N27.1 Small kidney, bilateral
N27.9 Small kidney, unspecified

N28 Other diseases of kidney and ureter, not elsewhere classified

Excluded: hydroureter ( N13.4)
kidney disease:
acute NOS ( N00.9)
chronic NOS ( N03.9)
kink and stricture of the ureter:
with hydronephrosis ( N13.1)
without hydronephrosis ( N13.5)

N28.0 Ischemia or infarction of the kidney
Renal artery:
embolism
obstruction
occlusion
thrombosis
Kidney infarction
Excluded: Goldblatt's kidney ( I70.1)
renal artery (extrarenal part):
atherosclerosis ( I70.1)
congenital stenosis ( Q27.1)
N28.1 Kidney cyst, acquired. Cyst (multiple) (single) kidney, acquired
Excludes: cystic kidney disease (congenital) ( Q61. -)
N28.8 Other specified diseases of the kidney and ureter. Kidney hypertrophy. Megaloureter. Nephroptosis
Pyelitis)
Pyeloureteritis) cystic
Ureterite)
Ureterocele
N28.9 Diseases of the kidney and ureter, unspecified. Nephropathy NOS. Renal disease NOS
Excluded: nephropathy NOS and renal disorders NOS with morphological lesions, specified in the headings. 0-8 ( N05. -)

N29 * Other disorders of the kidney and ureter in diseases classified elsewhere

OTHER DISEASES OF THE URINARY SYSTEM (N30-N39)

Excludes: urinary tract infection (complicating):
O00 -O07 , O08.8 )
O23 . — , O75.3 , O86.2 )
with urolithiasis ( N20-N23)

N30 Cystitis

If necessary, identify the infectious agent ( B95-B97) or the corresponding external factor (class XX) use an additional code.
Excludes: prostatocystitis ( N41.3)

N30.0 Acute cystitis
Excludes: radiation cystitis ( N30.4)
trigonite ( N30.3)
N30.1 Interstitial cystitis (chronic)
N30.2 Other chronic cystitis
N30.3 Trigonitis. Urethrotrigonitis
N30.4 Radiation cystitis
N30.8 Other cystitis. Bladder abscess
N30.9 Cystitis, unspecified

N31 Bladder neuromuscular dysfunction, not elsewhere classified

Excludes: spinal bladder NOS ( G95.8)
due to spinal cord injury ( G95.8)
neurogenic bladder associated with cauda equina syndrome ( G83.4)
urinary incontinence:
NOS ( R32)
refined ( N39.3-N39.4)

N31.0 Uninhibited bladder, not elsewhere classified
N31.1 Reflex bladder, not elsewhere classified
N31.2 Neurogenic bladder weakness, not elsewhere classified
Neurogenic bladder:
atonic (motor impairment) (sensory impairment)
autonomous
non-reflexive
N31.8 Other neuromuscular dysfunctions of the bladder
N31.9 Unspecified neuromuscular dysfunction of the bladder

N32 Other disorders of the bladder

Excludes: bladder stone ( N21.0)
cystocele ( N81.1)
hernia or prolapse of the bladder in women ( N81.1)

N32.0 Bladder neck obturation. Bladder neck stenosis (acquired)
N32.1 Vesico-intestinal fistula. Vesico-colonic fistula
N32.2 Cystic fistula, not elsewhere classified
Excludes: fistula between the bladder and female genital tract ( N82.0-N82.1)
N32.3 Bladder diverticulum. Bladder diverticulitis
Excludes: stone in bladder diverticulum ( N21.0)
N32.4 Bladder rupture, nontraumatic
N32.8 Other specified lesions of the bladder
Bladder:
calcified
wrinkled
N32.9 Unspecified involvement of bladder

N33 * Disorders of the bladder in diseases classified elsewhere

N33.0* Tuberculous cystitis ( A18.1+)
N33.8* Lesions of the bladder in other diseases classified elsewhere
Lesions of the bladder with schistosomiasis [bilharziasis] ( B65. -+)

N34 Urethritis and urethral syndrome

If necessary, identify the infectious agent
use additional code ( B95-B97).
Excluded: Reiter's disease ( M02.3)
urethritis in diseases primarily sexually transmitted ( A50-A64)
urethrotrigonitis ( N30.3)

N34.0 Urethral abscess
Abscess:
Cooper's glands
glands of Littre
periurethral
urethral (glands)
Excludes: urethral caruncle ( N36.2)
N34.1 Nonspecific urethritis
Urethritis:
non-gonococcal
non-venereal
N34.2 Other urethritis. Urethral meatitis. Ulcer of the urethra (external opening)
Urethritis:
NOS
postmenopausal
N34.3 Urethral syndrome, unspecified

N35 Urethral stricture

Excludes: urethral stricture after medical procedures ( N99.1)

N35.0 Post-traumatic urethral stricture
Urethral stricture:
postpartum
traumatic
N35.1 Postinfectious urethral stricture, not elsewhere classified
N35.8 Other urethral stricture
N35.9 Urethral stricture, unspecified. Outer hole of NOS

N36 Other diseases of the urethra

N36.0 Urethral fistula. False urethral fistula
Fistula:
urethroperineal
urethrorectal
urinary NOS
Excluded: fistula:
urethroscrotal ( N50.8)
urethrovaginal ( N82.1)
N36.1 Urethral diverticulum
N36.2 Urethral caruncle
N36.3 Prolapse of the mucous membrane of the urethra. Prolapsed urethra. Urertocele in men
Excludes: urethrocele in women ( N81.0)
N36.8 Other specified diseases of the urethra
N36.9 Disease of urethra, unspecified

N37 * Disorders of the urethra in diseases classified elsewhere

N37.0* Urethritis in diseases classified elsewhere. Candidal urethritis ( B37.4+)
N37.8* Other lesions of the urethra in diseases classified elsewhere

N39 Other diseases of the urinary system

Excluded: hematuria:
NOS ( R31)
recurrent and persistent ( N02. -)
N02. -)
proteinuria NOS ( R80)

N39.0 Urinary tract infection without localization
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N39.1 Persistent proteinuria, unspecified
Excluded: complicating pregnancy, childbirth and the postpartum period ( O11-O15)
with refined morphological changes ( N06. -)
N39.2 Orthostatic proteinuria, unspecified
Excludes: with specified morphological changes ( N06. -)
N39.3 Involuntary urination
N39.4 Other specified types of urinary incontinence
Overflow)
Reflex) urinary incontinence
On awakening)
Excludes: enuresis NOS ( R32)
urinary incontinence:
NOS ( R32)
inorganic origin ( F98.0)
N39.8 Other specified diseases of the urinary system
N39.9 Unspecified urinary tract disorder

DISEASES OF THE MALE GENITAL ORGANS (N40-N51)

N40 Prostatic hyperplasia

Adenofibromatous hypertrophy)
Adenoma (benign))
Enlargement (benign)) of the prostate
Fibroadenoma) glands
Fibroma)
Hypertrophy (benign))
Myoma
Median lobe (prostate) adenoma
Blockage of prostate duct NOS
Excludes: benign tumors other than adenoma, fibroma
and prostate fibroids ( D29.1)

N41 Inflammatory diseases of the prostate gland

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N41.0 Acute prostatitis
N41.1 Chronic prostatitis
N41.2 Prostate abscess
N41.3 Prostate cystitis
N41.8 Other inflammatory diseases of the prostate
N41.9 Unspecified inflammatory disease of the prostate. Prostatitis NOS

N42 Other diseases of the prostate

N42.0 Prostate stones. Prostatic stone
N42.1 Congestion and hemorrhage in the prostate gland
N42.2 Prostate atrophy
N42.8 Other specified diseases of the prostate
N42.9 Unspecified prostate disease

N43 Hydrocele and spermatocele

Includes: dropsy of the spermatic cord, testis, or testicular sheath
Excludes: congenital hydrocele ( P83.5)

N43.0 Hydrocele encapsulated
N43.1 Infected hydrocele
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N43.2 Other forms of hydrocele
N43.3 Hydrocele, unspecified
N43.4 Spermatocele

N44 Testicular torsion

Twisting:
epididymis
spermatic cord
testicles

N45 Orchitis and epididymitis

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N45.0 Orchitis, epididymitis and epididymo-orchitis with abscess. Abscess of the epididymis or testicle
N45.9 Orchitis, epididymitis and epididymo-orchitis without mention of an abscess. Epididymitis NOS. Orchitis NOS

N46 Male infertility

Azoospermia NOS. Oligospermia NOS

N47 Excessive foreskin, phimosis and paraphimosis

Tight-fitting foreskin. Tight foreskin

N48 Other diseases of the penis

N48.0 Penile leukoplakia. Kraurosis of the penis
Excludes: carcinoma in situ of the penis ( D07.4)
N48.1 Balanoposthitis. Balanitis
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N48.2 Other inflammatory diseases of the penis
Abscess)
Furuncle)
Carbuncle) of the cavernous body and penis
Cellulite)
Penile cavernitis
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N48.3 Priapism. Painful erection
N48.4 Organic impotence
If necessary, an additional code is used to identify the cause.
Excludes: psychogenic impotence ( F52.2)
N48.5 Penile ulcer
N48.6 Balanitis. Plastic induration of the penis
N48.8 Other specific diseases of the penis
Atrophy)
Hypertrophy) of the cavernous body and penis
Thrombosis)
N48.9 Disease of the penis, unspecified

N49 Inflammatory diseases of male genital organs, not elsewhere classified

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
Excludes: inflammation of the penis ( N48.1-N48.2)
orchitis and epididymitis ( N45. -)

N49.0 Inflammatory diseases of the seminal vesicle. Vesiculitis NOS
N49.1 Inflammatory diseases of the spermatic cord, vaginal membrane and vas deferens. Vazit
N49.2 Inflammatory diseases of the scrotum
N49.8 Inflammatory diseases of other specified male genital organs
N49.9 Inflammatory diseases of the unspecified male genital organ
Abscess)
Furuncle) unspecified male
Carbuncle) of the genital organ
Cellulite)

N50 Other diseases of male genital organs

Excludes: testicular torsion ( N44)

N50.0 Testicular atrophy
N50.1 Vascular disorders of the male genital organs
Hematocele)
Hemorrhage) of male genital organs
Thrombosis)
N50.8 Other specific diseases of the male genital organs
Atrophy)
Hypertrophy) of the seminal vesicle, spermatic cord,
Edema) of the testicle [except for atrophy], of the vaginal ulcer and of the vas deferens
Chilocele of the vaginal membrane (non-filarial) NOS
Urethroscrotal fistula
Structure:
spermatic cord
vaginal membrane
vas deferens
N50.9 Disease of male genital organs, unspecified

N51 * Disorders of male genital organs in diseases classified elsewhere

N51.0* Disorders of the prostate gland in diseases classified elsewhere
Prostatitis:
gonococcal ( A54.2+)
caused by Trichomonas ( A59.0+)
tuberculous ( A18.1+)
N51.1* Lesions of the testicle and its appendages in diseases classified elsewhere
Chlamydial:
epididymitis ( A56.1+)
orchitis ( A56.1+)
Gonococcal:
epididymitis ( A54.2+)
orzit ( A54.2+)
Mumps orchitis ( B26.0+)
Tuberculosis:

• epididymis ( A18.1+)

• testicles ( A18.1+)

N51.2* Balanitis in diseases classified elsewhere
Balanitis:
amoebic ( A06.8+)
candidal ( B37.4+)
N51.8* Other lesions of the male genital organs in diseases classified elsewhere
Filarial chilocele of the vaginal membrane ( B74. -+)
Herpes infection of the male genital organs ( A60.0+)
Seminal tuberculosis ( A18.1+)

DISEASES OF THE BREAST (N60-N64)

Excludes: diseases of the breast associated with childbirth ( O91-O92)

N60 Benign Breast Dysplasia
Includes: fibrocystic breast disease
N60.0 Solitary cyst of the mammary gland. Breast cyst
N60.1 Diffuse cystic mastopathy. Cystic mammary gland
Excludes: with epithelial proliferation ( N60.3)
N60.2 Fibroadenosis of the breast
Excludes: breast fibroadenoma ( D24)
N60.3 Fibrosclerosis of the breast. Cystic mastopathy with epithelial proliferation
N60.4 Ectasia of the mammary gland ducts
N60.8 Other benign breast dysplasias
N60.9 Benign breast dysplasia, unspecified

N61 Inflammatory diseases of the breast

Abscess (acute) (chronic) (not postpartum):
areola
breast
Carbuncle of the mammary gland
Mastitis (acute) (subacute) (not postpartum):
NOS
infectious
Excludes: infectious mastitis of the newborn ( P39.0)

N62 Breast hypertrophy

Gynecomastia
Breast hypertrophy:
NOS
massive pubertal

N63 Unspecified mass of mammary gland

Breast nodule (s) NOS

N64 Other diseases of the breast

N64.0 Nipple fissure and fistula
N64.1 Fatty necrosis of the mammary gland. Fat necrosis (segmental) of the breast
N64.2 Breast atrophy
N64.3 Galactorrhea not related to childbirth
N64.4 Mammalgia
N64.5 Other signs and symptoms of the breast. Breast induration. Discharge from the nipple
Inverted nipple
N64.8 Other specified diseases of the breast. Galactocele. Subinvolution of the mammary gland (post-lactation)
N64.9 Unspecified breast disease

INFLAMMATORY DISEASES OF FEMALE PELVIC ORGANS (N70-N77)

Excluded: complicating:
abortion, ectopic or molar pregnancy ( O00 -O07 , O08.0 )
pregnancy, childbirth and the puerperium ( O23. — ,O75.3 , O85 , O86 . -)

N70 Salpingitis and oophoritis

Included: abscess:
fallopian tube
ovary
tubo-ovarian
pyosalpinx
salpingo-oophoritis
tubo-ovarian inflammatory disease
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N70.0 Acute salpingitis and oophoritis
N70.1 Chronic salpingitis and oophoritis. Hydrosalpinx
N70.9 Salpingitis and oophoritis, unspecified

N71 Inflammatory diseases of the uterus, other than the cervix

Includes: endo (myo) metritis
metritis
myometritis
pyometra
uterine abscess
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N71.0 Acute inflammatory disease of the uterus
N71.1 Chronic inflammatory disease of the uterus
N71.9 Inflammatory disease of uterus, unspecified

N72 Inflammatory disease of the cervix

Cervicitis)
Endocervicitis) with or without erosion or ectropion
Exocervicitis)
If necessary, identify the infectious agent
use additional code ( B95-B97).
Excluded: erosion and ectropion of the cervix without cervicitis ( N86)

N73 Other female pelvic inflammatory diseases

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N73.0 Acute parametritis and pelvic cellulite
Abscess:
broad ligament) specified as
parametria) acute
Pelvic phlegmon in women)
N73.1 Chronic parametritis and pelvic cellulite
N73.0, specified as chronic
N73.2 Parametritis and pelvic phlegmon, unspecified
Any condition in the subheading N73.0 not specified as acute or chronic
N73.3 Acute pelvic peritonitis in women
N73.4 Chronic pelvic peritonitis in women
N73.5 Pelvic peritonitis in women, unspecified
N73.6 Pelvic peritoneal adhesions in women
Excluded: postoperative pelvic peritoneal adhesions in women ( N99.4)
N73.8 Other specified female pelvic inflammatory diseases
N73.9 Unspecified female pelvic inflammatory disease
Infectious or inflammatory diseases of the female pelvic organs NOS

N74 * Female pelvic inflammatory disease in diseases classified elsewhere

N74.0* Tuberculous infection of the cervix ( A18.1+)
N74.1* Inflammatory diseases of the female pelvic organs of tuberculous etiology ( A18.1+)
Tuberculous endometritis
N74.2* Inflammatory diseases of the female pelvic organs caused by syphilis ( A51.4+, A52.7+)
N74.3* Gonococcal inflammatory diseases of the female pelvic organs ( A54.2+)
N74.4* Inflammatory diseases of the female pelvic organs caused by chlamydia ( A56.1+)
N74.8* Female pelvic inflammatory disease in other diseases classified elsewhere

N75 Diseases of the bartholin gland

N75.0 Bartholin gland cyst
N75.1 Bartholin gland abscess
N75.8 Other diseases of the Bartholin gland. Bartholinitis
N75.9 Bartholin gland disease, unspecified

N76 Other inflammatory diseases of vagina and vulva

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
Excludes: senile (atrophic) vaginitis ( N95.2)

N76.0 Acute vaginitis. Vaginitis NOS
Vulvovaginitis:
NOS
spicy
N76.1 Subacute and chronic vaginitis

Vulvovaginitis:
chronic
subacute
N76.2 Acute vulvitis. Vulvitis NOS
N76.3 Subacute and chronic vulvitis
N76.4 Vulvar abscess. Boil of the vulva
N76.5 Ulceration of the vagina
N76.6 Ulceration of the vulva
T76.8 Other specified inflammatory diseases of the vagina and vulva

N77 * Ulceration and inflammation of the vulva and vagina in diseases classified elsewhere

NON-INFLAMMATORY DISEASES OF FEMALE GENITAL ORGANS (N80-N98)

N80 Endometriosis

N80.0 Endometriosis of the uterus. Adenomyosis
N80.1 Ovarian endometriosis
N80.2 Endometriosis of the fallopian tubes
N80.3 Endometriosis of the pelvic peritoneum
N80.4 Endometriosis of the rectovaginal septum and vagina
N80.5 Intestinal endometriosis
N80.6 Endometriosis of the cutaneous scar
N80.8 Other endometriosis
N80.9 Endometriosis, unspecified

N81 Female genital prolapse

Excludes: prolapse of the genitals complicating pregnancy, childbirth or delivery ( O34.5)
prolapse and hernia of the ovary and fallopian tube ( N83.4)
prolapse of the stump (vault) of the vagina after hysterectomy ( N99.3)

N81.0 Urethrocele in women

Excluded: urethrocele with:
cystocele ( N81.1)
prolapse of the uterus ( N81.2-N81.4)
N81.1 Cystocele. Cystocele with urethrocele. Prolapsed vaginal wall (anterior) NOS
Excludes: cystothele with uterine prolapse ( N81.2-N81.4)
N81.2 Incomplete prolapse of the uterus and vagina. Prolapse of the cervix NOS
Vaginal prolapse:
first degree
second degree
N81.3 Complete prolapse of the uterus and vagina. Residence (uterus) NOS. Uterine prolapse of the third degree
N81.4 Uterine and vaginal prolapse, unspecified. Uterine prolapse NOS
N81.5 Enterocele of the vagina
Excludes: enterocele with prolapse of the uterus ( N81.2-N81.4)
N81.6 Rectocele. Prolapse of the back of the vagina
Excluded: rectal prolapse ( K62.3)
rectocele with prolapse of the uterus ( N81.2-N81.4)
N81.8 Other forms of female genital prolapse. Lack of pelvic floor muscles
Old tears of the pelvic floor muscles
N81.9 Unspecified female genital prolapse

N82 Fistula involving female genital organs

Excludes: vesico-intestinal fistula ( N32.1)

N82.0 Vesicovaginal fistula
N82.1 Other fistulas of the female urinary tract
Fistulas:
cervico-urinary
ureterovaginal
urethrovaginal
utero-ureteric
utero-urinary
N82.2 Vaginal-small intestinal fistula
N82.3 Colonic vaginal fistula. Rectovaginal fistula
N82.4 Other intestinal-genital fistulas in women. Intestinal fistula
N82.5 Genital-cutaneous fistulas in women

Fistula:
utero-abdominal
vaginal-perineal
N82.8 Other female genital fistulas
N82.9 Fistula of female genital organs, unspecified

N83 Noninflammatory lesions of ovary, fallopian tube and broad ligament of uterus

Excluded: hydrosalpinx ( N70.1)

N83.0 Follicular ovarian cyst. Graafian follicle cyst. Hemorrhagic follicular cyst (ovary)
N83.1 Corpus luteum cyst. Hemorrhagic cyst of the corpus luteum
N83.2 Other and unspecified ovarian cysts
Retention cyst)
Simple cyst) of the ovary
Excludes: ovarian cyst:
associated with a developmental anomaly ( Q50.1)
neoplastic ( D27)
polycystic ovary syndrome ( E28.2)
N83.3 Acquired atrophy of the ovary and fallopian tube
N83.4 Prolapse and hernia of the ovary and fallopian tube
N83.5 Torsion of the ovary, pedicle, and fallopian tube
Twisting:
additional pipe
Morgagni cysts
N83.6 Hematosalpinx
Excluded: hematosalpinx with:
hematocolposome ( N89.7)
hematometer ( N85.7)
N83.7 Broad ligament hematoma
N83.8 Other non-inflammatory diseases of the ovary, fallopian tube and broad ligament of the uterus
Broad ligament rupture syndrome [Masters-Allen]
N83.9 Unspecified noninflammatory disease of the ovary, fallopian tube, and broad ligament of the uterus

N84 Polyp of female genital organs

Excludes: adenomatous polyp ( D28. -)
placental polyp ( O90.8)

N84.0 Polyp of the body of the uterus
Polyp:
endometrium
uterus NOS
Excludes: polypoid endometrial hyperplasia ( N85.0)
N84.1 Polyp of the cervix. Polyp of the mucous membrane of the cervix
N84.2 Vaginal polyp
N84.3 Polyp of the vulva. Labia polyp
N84.8 Polyp of other parts of the female genital organs
N84.9 Female genital polyp, unspecified

N85 Other non-inflammatory diseases of the uterus, excluding cervix

Excludes: endometriosis ( N80. -)
inflammatory diseases of the uterus ( N71. -)

non-inflammatory diseases of the cervix uteri ( N86-N88)
polyp of the body of the uterus ( N84.0)
prolapse of the uterus ( N81. -)

N85.0 Endometrial glandular hyperplasia
Endometrial hyperplasia:
NOS
cystic
glandular cystic
polypoid
N85.1 Adenomatous endometrial hyperplasia. Endometrial hyperplasia atypical (adenomatous)
N85.2 Hypertrophy of the uterus. Large or enlarged uterus
Excludes: postpartum uterine hypertrophy ( O90.8)
N85.3 Subinvolution of the uterus
Excludes: postpartum subinvolution of the uterus ( O90.8)
N85.4 Incorrect position of the uterus
Anteversion)
Retroflection) of the uterus
Retroversion)
Excludes: as a complication of pregnancy, childbirth or after childbirth ( O34.5, O65.5)
N85.5 Inversion of the uterus
O71.2)
postpartum uterine prolapse ( N71.2)
N85.6 Intrauterine synechiae
N85.7 Hematometer. Hematosalpinx with hematometer
Excludes: hematometer with hematocolpos ( N89.7)
N85.8 Other specified inflammatory diseases of the uterus. Acquired uterine atrophy. Fibrosis of the uterus NOS
N85.9 Non-inflammatory disease of the uterus, unspecified. Uterine lesions NOS

N86 Erosion and ectropion of cervix

Decubital (trophic) ulcer)
Inversion) of the cervix
Excluded: with cervicitis ( N72)

N87 Cervical dysplasia

Excludes: carcinoma in situ of the cervix ( D06. -)

N87.0 Mild cervical dysplasia. Grade I cervical intraepithelial neoplasia
N87.1 Moderate dysplasia of the cervix. Grade II cervical intraepithelial neoplasia
N87.2 Severe cervical dysplasia, not elsewhere classified
Severe dysplasia NOS
Excludes: cervical intraepithelial neoplasia grade III with or without mention
D06. -)
N87.9 Dysplasia of cervix uteri, unspecified

N88 Other non-inflammatory diseases of the cervix

Excludes: inflammatory diseases of the cervix ( N72)
polyp of the cervix ( N84.1)

N88.0 Leukoplakia of the cervix
N88.1 Old lacerations of the cervix. Adhesions of the cervix
O71.3)
N88.2 Cervical stricture and stenosis
Excluded: as a complication of childbirth ( O65.5)
N88.3 Insufficiency of the cervix
Examination and care for (suspected) ischemic-cervical insufficiency outside of pregnancy
Excluded: complicating the condition of the fetus and newborn ( P01.0)
complicating pregnancy ( O34.3)
N88.4 Hypertrophic lengthening of the cervix
N88.8 Other specified non-inflammatory diseases of the cervix
Excludes: current obstetric trauma ( O71.3)
N88.9 Noninflammatory disease of cervix uteri, unspecified

Excludes: carcinoma in situ of the vagina ( D07.2), vaginal inflammation ( N76... -), senile (atrophic) vaginitis ( N95.2)
leucorrhoea with trichomoniasis ( A59.0)
N89.0 Mild vaginal dysplasia. Intraepithelial neoplasia of the vagina, grade I
N89.1 Moderate vaginal dysplasia. Grade II vaginal intraepithelial neoplasia
N89.2 Severe vaginal dysplasia, not elsewhere classified
Severe vaginal dysplasia NOS
Excludes: grade III vaginal intraepithelial neoplasia with or without mention
about pronounced dysplasia ( D07.2)
N89.3 Vaginal dysplasia, unspecified
N89.4 Vaginal leukoplakia
N89.5 Vaginal stricture and atresia
Vaginal:
adhesions
stenosis
Excludes: postoperative vaginal adhesions ( N99.2)
N89.6 Dense hymen. Rigid hymen. Dense virgin ring
Excludes: hymen overgrown ( Q52.3)
N89.7 Hematokolpos. Hematokolpos with hematometer or with hematosalpinx
N89.8 Other non-inflammatory diseases of the vagina. Beli NOS. Old vaginal tear. Vaginal ulcer
Excluded: current obstetric trauma ( O70. — , O71.4,O71.7-O71.8)
old rupture with involvement of the pelvic floor muscles ( N81.8)
N89.9 Non-inflammatory vaginal disease, unspecified

N90 Other non-inflammatory diseases of the vulva and perineum

Excludes: carcinoma in situ of the vulva ( D07.1)
current obstetric trauma ( O70. — , O71.7-O71.8)
inflammation of the vulva ( N76. -)

N90.0 Mild vulvar dysplasia. Intraepithelial neoplasia of the vulva, grade I
N90.1 Moderate dysplasia of the vulva. Intraepithelial neoplasia of the vulva II degree
N90.2 Severe vulvar dysplasia, not elsewhere classified
Severe vulvar dysplasia NOS
Excludes: grade III intraepithelial neoplasia of the vulva with or without mention
about pronounced dysplasia ( D07.1)
N90.3 Vulvar dysplasia, unspecified
N90.4 Leukoplakia of the vulva
Dystrophy)
Krauroz) vulva
N90.5 Vulvar atrophy. Vulvar stenosis
N90.6 Vulvar hypertrophy. Hypertrophy of the labia
N90.7 Vulvar cyst
N90.8 Other specified non-inflammatory diseases of the vulva and perineum. Vulvar adhesions. Clitoris hypertrophy
N90.9 Non-inflammatory disease of vulva and perineum, unspecified

N91 Lack of menses, scanty and infrequent menses

Excludes: ovarian dysfunction ( E28. -)

N91.0 Primary amenorrhea. Violation of menstruation in puberty
N91.1 Secondary amenorrhea. Lack of menstruation in women who have had them before
N91.2 Amenorrhea, unspecified. Lack of menses NOS
N91.3 Primary oligomenorrhea. Scanty or infrequent periods from the onset
N91.4 Secondary oligomenorrhea. Lean or infrequent menses in women with previously normal periods
N91.5 Oligomenorrhea, unspecified. Hypomenorrhea NOS

N92 Heavy, frequent and irregular menses

Excludes: bleeding after menopause ( N95.0)

N92.0 Heavy and frequent menstruation with a regular cycle
Periodically profuse menses NOS. Menorrhagia NOS. Polymenorrhea
N92.1 Heavy and frequent menstruation with an irregular cycle
Irregular bleeding during the intermenstrual period
Irregular, shortened intervals between menstrual bleeding. Menometrorrhagia. Metrorrhagia
N92.2 Heavy menstruation during puberty
Profuse bleeding at the beginning of the menstrual period. Puberty menorrhagia. Puberty bleeding
N92.3 Ovulatory bleeding. Regular menstrual bleeding
N92.4 Heavy bleeding in the premenopausal period
Menorrhagia or metrorrhagia:
climacteric
in menopause
premenopausal
premenopausal
N92.5 Other specified forms of irregular menses
N92.6 Irregular menses, unspecified
Irregular:
bleeding NOS
menstrual cycles NOS
Excludes: irregular menstruation in the background:
lengthened intervals or scanty bleeding ( N91.3-N91.5)
shortened intervals or profuse bleeding ( N92.1)

N93 Other abnormal uterine and vaginal bleeding

Excludes: neonatal vaginal bleeding ( P54.6)
false menstruation ( P54.6)

N93.0 Postcoital or contact bleeding
N93.8 Other specified abnormal uterine and vaginal bleeding
Dysfunctional or functional uterine or moisture bleeding NOS
N93.9 Abnormal uterine and vaginal bleeding, unspecified

N94 Pain and other conditions associated with female genital organs and menstrual cycle

N94.0 Pain in the middle of the menstrual cycle
N94.1 Dyspareunia
Excludes: psychogenic dyspareunia ( F52.6)
N94.2 Vaginismus
Excludes: psychogenic vaginismus ( F52.5)
N94.3 Premenstrual tension syndrome
N94.4 Primary dysmenorrhea
N94.5 Secondary dysmenorrhea
N94.6 Dysmenorrhea, unspecified
N94.8 Other specified conditions associated with female genital organs and menstrual cycle
N94.9 Conditions associated with female genital organs and menstrual cycle, unspecified

N95 Disorders of menopause and other disorders of the peri-menopausal period

Excluded: profuse bleeding in the premenopausal period ( N92.4)
postmenopausal:
osteoporosis ( M81.0)
with a pathological fracture ( M80.0)
urethritis ( N34.2)
premature menopause NOS ( E28.3)

N95.0 Postmenopausal bleeding
N95.3)
N95.1 Menopause and climacteric state in a woman
Menopause-related symptoms such as hot flashes, insomnia, headaches, impaired attention
Excludes: associated with artificial menopause ( N95.3)
N95.2 Postmenopausal atrophic vaginitis. Senile (atrophic) vaginitis
Excludes: associated with artificial menopause ( N95.3)
N95.3 Conditions associated with artificially induced menopause. Post-Artificial Menopause Syndrome
N95.8 Other specified disorders of the menopausal and perimenopausal period
N95.9 Menopausal and perimenopausal disorders, unspecified

N96 Habitual miscarriage

Examination or medical care outside of pregnancy. Relative infertility
Excluded: current pregnancy ( O26.2)
with current abortion ( O03-O06)

N97 Female infertility

Included: inability to get pregnant
female sterility NOS
Excludes: relative infertility ( N96)

N97.0 Female infertility due to lack of ovulation
N97.1 Female infertility of tubal origin. Associated with congenital malformation of the fallopian tubes
Pipe:
obstruction
blockage
stenosis
N97.2 Female infertility of uterine origin. Associated with congenital malformation of the uterus
Egg implantation defect
N97.3 Female infertility of cervical origin
N97.4 Female Infertility Associated with Male Factors
N97.8 Other forms of female infertility
N97.9 Female infertility, unspecified

N98 Complications associated with artificial insemination

N98.0 Infection associated with artificial insemination
N98.1 Ovarian hyperstimulation
Ovarian hyperstimulation:
NOS
associated with induced ovulation
N98.2 Complications associated with attempted implantation of a fertilized egg after extracorporeal
fertilization
N98.3 Complications associated with attempted embryo implantation
N98.8 Other complications associated with artificial insemination
Complications of artificial insemination:
donor sperm
husband's sperm
N98.9 Complications associated with artificial insemination, unspecified

OTHER DISEASES OF THE Urogenital System (N99)

N99 Disorders of the genitourinary system after medical procedures, not elsewhere classified

Excludes: radiation cystitis ( N30.4)
osteoporosis after surgical removal of the ovary ( M81.1)
with a pathological fracture ( M80.1)
conditions associated with artificially induced menopause ( N95.3)

N99.0 Postoperative renal failure
N99.1 Postoperative urethral stricture. Urethral stricture after catheterization
N99.2 Postoperative vaginal adhesions
N99.3 Prolapse of the vaginal fornix after extirpation of the uterus
N99.4 Postoperative adhesions in the small pelvis
N99.5 Dysfunction of the external urinary tract stoma
N99.8 Other disorders of the genitourinary system after medical procedures. Residual ovary syndrome
N99.9 Disorder of the genitourinary system after medical procedures, unspecified

Algodismenorrhea is a pain syndrome that occurs monthly in the first days of the menstrual cycle. The nature of the pain differs depending on the personal characteristics of the woman's body, as well as on the causes of painful menstruation. Algodismenorrhea syndrome can serve as a symptom of a more serious disease, therefore, when a pathological condition appears, you need to consult a gynecological office. An individual clinical picture will allow the doctor to prescribe an adequate treatment for a woman or suggest a standard of care for pain during menstruation.

Classification

Algomenorrhea (code for microbiology 10 - N94.4, N94.5, N94.6, in Latin - algomenorrhea) is one of the most common diseases in gynecology. The disease is classified for reasons of occurrence that provoke a deterioration in well-being during menstruation. The importance of classification is reflected in the tactics of treatment that a gynecologist will undertake to combat painful periods. Types of pathology:

Primary algomenorrhea ... Almost all young gynecological patients know what it is in women. The onset of pain is observed in adolescents during the first one and a half years of menstruation. The syndrome develops as a result of psychogenic, endocrine, constitutional disorders. At the same time, there are no signs of organic pathologies of the pelvic organs. Primary algomenorrhea is not associated with gynecological diseases, but often speaks of other dysfunctions of body systems. This type of disease has a strong relationship with young girls' individual perception of pain.

Secondary algodismenorrhea ... The form of the disease is directly related to the disruption of the internal organs of the reproductive system. In this case, pain during menstruation should be considered as a sign of other pathologies. The diagnosis of algodismenorrhea of ​​the secondary kind is made after examinations and determination of the underlying disease. In addition to pain in this form of the disease, there are symptomatic manifestations of a causal anomaly.

Causes of pathology

The pathogenesis of the disease is influenced by various factors. Primary and secondary algodismenorrhea are caused by different reasons. The first type of pathological pain appears as a result of an increase in the level of prostaglandins in the endometrium. At the same time, the activity of muscle contraction increases, the vessels spasm, and cellular hypoxia begins. Nerve endings are irritated, and pain appears from this. The primary disease is explained by the presence of the following disorders:

1. Mechanical. These include the pathological development of the genitals, the wrong position of the uterine organ. Pain during menstruation can be triggered by the accumulation of blood in the uterine cavity.
2. Hormonal. They are characterized by the predominance of estrogen hormones over progesterones.
3. Constitutional. Insufficient development of muscle tissues and their poor stretching as a result of infantilism, asthenic physique.
4. Psychogenic. Algodismenorrhea is a common disease in women with a weak psyche, autonomic disorders. Women with a low pain threshold are much more sensitive to cramps during menstruation.

If a secondary pain syndrome is diagnosed during menstruation, it is necessary to determine what kind of disease is causing the discomfort. This type of algodismenorrhea often affects older women. The main causes of pain:

• Endometriosis In pathology, endometrial tissue spreads to the uterus, causing intrauterine contractions. Pain occurs a week before menstruation and stops completely in the middle of the cycle.
• Myoma. Uterine nodules lead to unhealthy muscle contractions, and may continue not only during menstruation, but also in other phases of the cycle.
• Adhesion process. Inflammatory fluid (exudate) restricts the internal genital organs in mobility, which is why menstruation is accompanied by pain.

Algodismenorrhea is often detected in female infertility, after abortion, as a result of the setting of the spiral.

Symptoms and signs of the disease

The clinic of the pathological condition is quite typical for all variants of the disease. The main symptom of algodismenorrhea is pain in the lower abdomen, which can radiate to the lower back, hips, can be felt in the ovaries, uterus, or completely cover the abdominal region.

The type of pain is pulling, cramping, pressing, aching, bursting. How intense the pain syndrome is depends on the individual condition of the body.

In some cases, the course of the disease is complicated: the body temperature rises, general weakness, sweating, headaches, dizziness, fainting appear, physical capacity for work is lost. Some women suffer from nausea and vomiting, diarrhea, and bloating. Itching of the genitals, the release of a large amount of blood is possible.

Painful sensations are of very high intensity, which requires an ambulance call with possible hospitalization. Doctors fill out a call card, which indicates personal data and the reason for the poor health.

Diagnostics

Diagnosis of patients with algodismenorrhea begins with a gynecologist's examination and anamnesis. By external signs, the doctor determines the type of physique, anomalies in the development of the skeleton, reveals the presence of vascular networks and varicose veins. If there is a history of vegetative-vascular dystonia, mitral canal prolapse, scoliosis and other disorders, this may be associated with the primary type of the disease. After that, material is taken for analyzes in the form of smears, crops, and hormonal levels are checked.

If there is a suspicion of organic disorders, additional diagnostic procedures are used. Hysteroscopy allows you to assess the condition of the uterine walls, ultrasound makes it possible to determine the structure of internal organs and detect the presence of neoplasms. In rare cases, the examination includes a laparoscopy. According to the indications, other diagnostic measures are also used.

Treatment of algodismenorrhea

How algodismenorrhea responds to treatment depends on the individual case. Different therapies are used for the primary and secondary forms. Treatment of algodismenorrhea of ​​the second type is expressed in getting rid of the underlying disease and symptomatic restoration of working capacity if the stomach hurts too much during menstruation. How to treat the primary form of pathology:

1. Pain relievers and antispasmodics. Analgesics act directly on the muscle tissue of the uterus, thereby reducing pain and significantly alleviating the condition during menstruation.
2. Non-steroidal anti-inflammatory drugs. Provide a change in the amount of prostaglandins after taking them. Their level becomes lower, which relieves pain and improves the general condition. These drugs can be preventive in nature and taken several days before menstruation.
3. Oral contraceptives with progestogens. Eliminate the increased amount of estrogen, which can moderate the pain of algodismenorrhea.
4. Folk remedies. Recipes for infusions with dandelion, yarrow, eucalyptus flowers can significantly alleviate algodismenorrhea.
5. Preparations containing magnesium. They help to cope with functional disorders of muscle tissue and resist its intense contractions.
6. Vitamins. Increases immunity, strengthens the body and improves overall health.

Many women are interested in whether the disease can be cured at home. It is recommended to use pain relievers, antispasmodic or hormonal drugs from the list only after consulting a doctor. Many drugs have undesirable side effects, so the treatment regimen should be selected individually. How long the treatment should last and how to relieve pain, the doctor should determine after the tests.

Prophylaxis

Prevention of dysmenorrhea is a healthy active lifestyle, in which the disease is much easier, the absence of bad habits. Preventive recommendations include exercising at least a few hours a week, eating healthy foods that affect the normal distribution of hormones in the body. With constitutional primary algodismenorrhea, it is important to monitor posture and correct pathological changes in the skeleton in time, treat systemic diseases, control hormonal levels and visit a gynecologist at least once a year.