BLEEDING UTERINE DYSFUNCTIONAL honey.
Dysfunctional uterine bleeding (DMC) is bleeding due to pathology of endocrine regulation, not associated with organic causes, most often arising in connection with anovulatory cycles (90% DMC). Provided that at least 2 years have passed after menarche, DMC refers to regular menstrual cycles with heavy bleeding lasting more than 10 days; a menstrual cycle of less than 21 days and an irregular menstrual cycle. As a rule, DMC is accompanied by anemia.
The frequency is 14-18% of all gynecological diseases. Prevailing age: 50% of cases are over 45 years old (premenopausal and menopausal periods), 20% are adolescence (menarche).
Etiology
Spotting in the middle of the cycle - a consequence of a decrease in estrogen production after ovulationFrequent menstruation is a consequence of the shortening of the follicular phase due to inadequate feedback from the hypothalamic-pituitary system
Shortening of the luteal phase - premenstrual spotting or polymenorrhea due to a premature decrease in progesterone secretion; the result of insufficient functions of the corpus luteum
Prolonged activity of the corpus luteum is a consequence of the constant production of progesterone, which leads to a lengthening of the cycle or prolonged bleeding
Anovulation - excess estrogen production, not associated with the menstrual cycle, not accompanied by cyclic LH production or progesterone secretion by the corpus luteum
Other causes are damage to the uterus, leiomyoma, carcinoma, vaginal infections, foreign bodies, ectopic pregnancy, hydatidiform mole, endocrine disorders (especially thyroid dysfunction), blood dyscrasia. Pathomorphology. Depends on the cause of the DMK. Necessarily pathohistological examination of endometrial preparations.
Clinical picture
Uterine bleeding, irregular, often painless, the volume of blood loss is variable.The absence of:
Manifestations of systemic diseases
Dysfunctions of the urinary system and gastrointestinal tract
Long-term use of aspirin (acetylsalicylic acid) or anticoagulants
The use of hormonal drugs
Diseases of the thyroid gland
Galactorrhea
Pregnancy (especially ectopic)
Signs of malignant neoplasms of the genital organs.
Laboratory research
Necessary in case of suspicion of other endocrine or hematological disorders, as well as in patients in the premenopausal periodThey include an assessment of the functions of the thyroid gland, a general blood test, determination of PT and PTT, chorionic gonadotropin (to exclude pregnancy or cystic drift), diagnosis of hirsutism, determination of the concentration of prolactin (in the case of pituitary dysfunction).
Special studies
Special tests to determine the presence of ovulation and its timingMeasurement of basal temperature to detect anovulation
Determination of the pupil phenomenon
Definition of the fern phenomenon
Symptom of cervical mucus tension
Pap smear
Ultrasound to check for ovarian cysts or uterine tumors
Transvaginal ultrasound - if pregnancy is suspected, genital anomalies, polycystic ovary
Endometrial biopsy
All patients over 35 years old:
With obesity
With diabetes mellitus
With arterial hypertension
Curettage of the uterine cavity - with a high risk of endometrial hyperplasia or carcinoma. If endometritis, atypical hyperplasia, and carcinoma are suspected, curettage of the uterine cavity is preferable to endometrial biopsy.
Differential diagnosis
Liver diseaseHematological diseases (von Willebrand disease, leukemia, thrombocytopenia)
Iatrogenic causes (damage, drift of infection)
Intrauterine spirals
Taking drugs (oral contraceptives, anabolic steroids, glucocorticoids, anticholinergic drugs, digitalis drugs, anticoagulants)
Pregnancy (ectopic), spontaneous abortion
Diseases of the thyroid gland
Trauma
Uterine cancer
Leiomyoma of the uterus.
Treatment:
Mode. Outpatient; hospitalization for severe bleeding and hemodynamic instability.Surgery
Emergencies (profuse bleeding, severe hemodynamic disturbances)Curettage of the uterine cavity with DMC of the reproductive and climacteric periods
Removal of the uterus is indicated only in the presence of concomitant pathology.
Conditions that do not require urgent care - curettage of the uterine cavity is shown with the ineffectiveness of drug treatment.
Drug therapy
Drugs of choiceFor emergencies (severe bleeding; hemodynamic instability)
Conjugated estrogens 25 mg IV every 4 hours, maximum 6 doses are allowed
After stopping bleeding - medroxy-progesterone acetate 10 mg / day for 10-13 days or oral combined contraceptives containing 35 mg of ethinyl estradiol or its equivalent
Correction of anemia - replacement therapy with iron preparations.
For conditions not requiring emergency treatment
Estrogen hemostasis - folliculin 10,000-20,000 U or ethinylestradiol 0.05-0.1 mg, or estrone 1-2 ml 0.1% solution IM every 3-4 hours - 4-5 injections day. Then the dose is gradually reduced over 5-7 days (up to 10,000 IU of folliculin) and continue to be administered for 10-15 days, and then 10 mg of progesterone is injected over 6-8 days
Progesterone hemostasis (contraindicated in moderate and severe anemia) - medroxyprogesterone 10 mg / day for 6-8 days or 20 mg / day for 3 days
Oral contraceptives - on the first day, 1 tablet after 1 hour until the bleeding stops (no more than 6 tablets), then 1 tablet / day is reduced daily. Continue taking 1 tablet / day until 21 days, after which they stop taking it, which provokes a menstrual-like reaction.
Alternative drug
Progesterone instead of medroxy-lrogesterone
100 mg of oil solution of progesterone in / m - for emergency stop bleeding; not used in cyclic therapy
Vaginal suppositories should not be used because dosing drugs in this case is difficult
Danazol - 200-400 mg / day. May cause virilization; mainly used in patients with the forthcoming extirpation of the uterus.
Contraindications
Treatment
carried out only after excluding other causes of uterine bleedingBlind hormone therapy is not recommended.
Precautionary measures
... If bleeding continues after the therapy, additional examination is necessary. Estrogens are not indicated in the perimenopausal period and when endometrial cancer is suspected. With juvenile DMC, curettage is necessary to exclude endometrial cancer, and with DMC of the climacteric period, hormones are not prescribed until the results of histological examination are obtained.Observation of the patient. All women receiving estrogens for DMK should keep a diary to record abnormal bleeding and monitor the effectiveness of therapy.
Complications
Anemia
Adenocarcinoma of the uterus with prolonged unreasonable estrogen therapy. Course and prognosis
Vary depending on the cause of the DMK
In young women, effective drug treatment of DMC with no surgery is possible / Pregnancy. DMC must be differentiated from ectopic pregnancy or cystic mole.
See also, Dysmenorrhea Reduction. DMC - dysfunctional uterine bleeding ICD N93.8 Other specified abnormal bleeding from the uterus and vagina
Disease Handbook. 2012 .
See what "UTERINE DYSFUNCTIONAL BLEEDING" is in other dictionaries:
dysfunctional uterine bleeding- (h. uterina dysfunctionalis) K. m. in menstrual disorders caused by hormonal dysregulation ... Comprehensive Medical Dictionary
Uterine bleeding- The request for Bleeding from female genital organs is forwarded here. Uterine bleeding ICD 10 N92 N93 Uterine bleeding is different in etiology and the nature of the discharge of blood from the uterus. Bleeding can be caused by various ... ... Wikipedia
Female genital bleeding- The request for Bleeding from female genital organs is forwarded here. Uterine bleeding ICD 10 N92 N93 Uterine bleeding is different in etymology and the nature of the discharge of blood from the uterus. Bleeding can be caused by various ... ... Wikipedia
Honey. Hyperplasia is an increase in the number of cells in a tissue (except for a tumor) or organ, resulting in an increase in the volume of a given anatomical formation or organ. There are several types of glandular proliferation with different ... ... Disease Handbook
DCMK- dysfunctional menopausal uterine bleeding ... Dictionary of abbreviations of the Russian language
Honey. The perimenopausal period is the period of a woman's life, characterized by a natural age-related extinction of the functions of the reproductive system. Includes premenopausal, menopause and 2 years postmenopausal. The terms menopause, climacteric ... Disease Handbook - Dysfunctional climacteric uterine bleeding honey. Dictionary: S. Fadeev. Dictionary of abbreviations of the modern Russian language. S. Pb .: Polytechnic, 1997.527 p ... Dictionary of abbreviations and acronyms
Dysfunctional uterine bleeding (DMC, abnormal uterine bleeding) - regulatory bleeding caused by dysfunction of one of the links in the neurohumoral regulation of menstrual function. This is pathological bleeding from the genital tract, not associated with organic lesions of the organs involved in the menstrual cycle. Attention should be paid to the relative nature of this definition, to some of its conventions. Firstly, the idea is quite acceptable that the organic causes of uterine bleeding cannot be identified by existing diagnostic methods, and secondly, the lesions of the endometrium observed in DMK cannot but be recognized as organic.
ICD-10 code
N93 Other abnormal uterine and vaginal bleeding
Causes of dysfunctional uterine bleeding
Dysfunctional uterine bleeding is the most common term for abnormal uterine bleeding.
The main reason is the increased production of estrogen and a decrease in the production of progesterone. Increased production of estrogen can lead to endometrial hyperplasia. In this case, the endometrium is rejected unevenly, which leads to either profuse or prolonged bleeding. Endometrial hyperplasia, especially atypical adenomatous hyperplasia, predisposes to the development of endometrial cancer.
In most women, dysfunctional uterine bleeding is anovulatory. Anovulation is usually secondary, such as in polycystic ovary syndrome, or is of idiopathic origin; sometimes hypothyroidism can be the cause of anovulation. In some women, dysfunctional uterine bleeding may be anovulatory despite normal gonadotropin levels; the causes of such bleeding are idiopathic. About 20% of women with endometriosis have dysfunctional uterine bleeding of unknown origin.
Symptoms of dysfunctional uterine bleeding
Bleeding may occur more frequently than a typical period (less than 21 days later - polymenorrhea). Prolongation of menstruation itself or increased blood loss (> 7 days or> 80 ml) is called menorrhagia or hypermenorrhea, the appearance of frequent, irregular bleeding between periods is called metrorrhagia.
Dysfunctional uterine bleeding, depending on the time of occurrence, is subdivided into juvenile, reproductive and climacteric. Dysfunctional uterine bleeding can be ovulatory and anovulatory.
Ovulatory bleeding is characterized by the preservation of the biphasic cycle, however, with a violation of the rhythmic production of ovarian hormones by the type:
- Shortening of the follicular phase... They occur more often during puberty and menopause. During the reproductive period, they can be caused by inflammatory diseases, secondary endocrine disorders, vegetative neurosis. At the same time, the interval between months is reduced to 2-3 weeks, menstruation is of the type of hyperpolymenorrhea.
When examining TFD of the ovaries, a rise in rectal temperature (RT) above 37 ° C begins from the 8-10th day of the cycle, cytological smears indicate a shortening of the 1st phase, histological examination of the endometrium gives a picture of secretory transformations of its type of failure of the 2nd phase.
Therapy is primarily aimed at eliminating the underlying disease. Symptomatic treatment - hemostatic (vikasol, dicinone, syntocinon, calcium preparations, rutin, ascorbic acid). With heavy bleeding - oral contraceptives (non-ovlone, ovidone) according to the contraceptive (or initially hemostatic - up to 3-5 tablets per day) scheme - 2-3 cycles.
- Shortening of the luteal phase more often characterized by the appearance of usually small spotting before and after menstruation.
According to TFD of the ovaries, a rise in rectal temperature after ovulation is noted only for 2-7 days; cytologically and histologically, the insufficiency of the secretory transformations of the endometrium is revealed.
Treatment consists in prescribing corpus luteum preparations - gestagens (progesterone, 17-OPK, duphaston, uterozhestan, norethisterone, norkolut).
- Lengthening of the luteal phase (persistence of the corpus luteum)... It occurs when the function of the pituitary gland is impaired, and is often associated with hyperprolactinemia. Clinically, it can be expressed in a slight delay in menstruation, followed by hyperpolymenorrhea (meno-, menometrorrhagia).
TFD: lengthening the rise in rectal temperature after ovulation up to 14 days or more; histological examination of scraping from the uterus - insufficient secretory transformation of the endometrium, scraping is often moderate.
Treatment begins with curettage of the uterine lining, which stops bleeding (interruption of the current cycle). Further - pathogenetic therapy with dopamine agonists (parlodel), gestagens or oral contraceptives.
Anovulatory bleeding
Anovulatory dysfunctional uterine bleeding, characterized by the absence of ovulation, is more common. In this case, the cycle is single-phase, without the formation of a functionally active corpus luteum, or there is no cyclicity.
During puberty, lactation and premenopause, frequently occurring anovulatory cycles may not be accompanied by pathological bleeding and do not require pathogenetic therapy.
Depending on the level of estrogen produced by the ovaries, anovulatory cycles are distinguished:
- With insufficient maturation of the follicle, which subsequently undergoes reverse development (atresia). It is characterized by an extended cycle, followed by minor prolonged bleeding; often occurs during juvenile age.
- Long-term persistence of the follicle (Schroeder's hemorrhagic metropathy). A mature follicle does not ovulate, continuing to produce estrogens in an increased amount, the corpus luteum is not formed.
The disease is characterized by often profuse, prolonged bleeding for up to three months, which may be preceded by delays in menstruation up to 2-3 months. It occurs more often in women after 30 years of age with concomitant hyperplastic processes of the target organs of the reproductive system or in early premenopause. It is accompanied by anemia, hypotension, impaired function of the nervous and cardiovascular systems.
Differential diagnosis: RT - single-phase, colpocytology - decreased or increased estrogenic effect, the level of E 2 in the blood serum - multidirectional, progesterone - sharply reduced. Ultrasound - linear or sharply thickened (more than 10 mm) heterogeneous endometrium. Histological examination reveals the compliance of the endometrium with the beginning of the folliculin phase of the cycle or its pronounced proliferation without secretory transformations. The extent of endometrial proliferation ranges from glandular hyperplasia and endometrial polyps to atypical hyperplasia (structural or cellular). Severe cellular atypia is considered preinvasive endometrial cancer (clinical stage 0). All patients with dysfunctional uterine bleeding at reproductive age suffer from infertility.
Diagnosis of dysfunctional uterine bleeding
The diagnosis of dysfunctional uterine bleeding is a diagnosis of exclusion and may be suspected in patients with unexplained genital tract bleeding. Dysfunctional uterine bleeding must be differentiated from disorders that cause similar bleeding: pregnancy or pregnancy-related disorders (eg, ectopic pregnancy, spontaneous abortion), anatomical gynecological disorders (eg, fibroids, cancer, polyps), foreign bodies in the vagina, inflammation (for example, cervicitis) or disorders in the hemostatic system. If patients have ovulatory bleeding, then anatomical changes should be excluded.
The history and general examination focuses on looking for signs of inflammation and swelling. For women of reproductive age, a pregnancy test is required. In the presence of profuse bleeding, hematocrit and hemoglobin are determined. This is how the THG level is examined. In order to identify anatomical changes, transvaginal ultrasonography is performed. In order to determine anovulatory or ovulatory bleeding, it is necessary to determine the level of progesterone in the blood serum; if the level of progesterone is equal to or equal to 3 ng / ml or more (9.75 nmol / l) during the luteal phase, then it is assumed that the bleeding is ovulatory. In order to exclude endometrial hyperplasia or cancer, it is necessary to perform an endometrial biopsy in women over the age of 35, with obesity, with polycystic ovary syndrome, in the presence of ovulatory bleeding, irregular menstruation, which suggest the presence of chronic anovulatory bleeding, with an endometrial thickness of more than 4 mm, with questionable ultrasound data. In women, in the absence of the above situations with an endometrial thickness of less than 4 mm, including patients with an irregular menstrual cycle who have a shortened anovulation period, further examination is not required. In patients with atypical adenomatous hyperplasia, it is necessary to perform hysteroscopy and separate diagnostic curettage.
If patients have contraindications to the appointment of estrogens or if after 3 months of therapy with oral contraceptives normal periods do not resume and pregnancy is not desirable, a progestin is prescribed (for example, medroxyprogesterone 510 mg once a day by mouth for 10-14 days each month). If the patient wants to become pregnant and the bleeding is not profuse, in order to induce ovulation, 50 mg clomiphene is prescribed orally from the 5th to the 9th day of the menstrual cycle.
If dysfunctional uterine bleeding does not respond to hormone therapy, it is necessary performing hysteroscopy with separate diagnostic curettage... Hysterectomy or endometrial ablation may be done.
Removal of the endometrium is an alternative for patients who wish to avoid hysterectomy or who are not candidates for major surgery.
In the presence of atypical adenomatous endometrial hyperplasia, medroxyprogesterone acetate is prescribed at 20-40 mg orally 1 time per day for 36 months. If repeated intrauterine biopsy reveals an improvement in the endometrium with hyperplasia, cyclic medroxyprogesterone acetate is prescribed (5-10 mg orally once a day for 10-14 days of each month). If pregnancy is desired, clomiphene citrate can be given. If the biopsy reveals a lack of effect from the treatment of hyperplasia or progression of atypical hyperplasia is noted, a hysterectomy is necessary. With benign cystic or adenomatous endometrial hyperplasia, it is necessary to prescribe cyclic medroxyprogesterone acetate; the biopsy is repeated after approximately 3 months.
MKB 10
Treatment
Dysfunctional uterine bleeding (UBH)
Contact Us Privacy Policy Wikipedia Description Disclaimer Developers Cookie Agreement Mobile. Therapeutic tactics for uterine bleeding of the reproductive period is determined by the results of the histological result of the scrapings taken.
APPROXIMATE FAILURE TIME
Expectant tactics and conservative hemostasis, especially hormonal hemostasis, are erroneous. Sometimes cryodestruction of the endometrium or surgical removal of the uterus is performed - supravaginal amputation of the uterus, hysterectomy.
BLEEDING IN FETAL AGE.
For any irregularities in the menstrual cycle (heavy menstruation with clots after a delay in menstruation or at the time of the next menstruation, continuing spotting for more than 7 days), you should consult a doctor.
ANOVULATORY UTERINE BLEEDING - occur much more often. They occur in 2 age periods:
general information
There are 2 large groups of uterine bleeding:
Observation of the patient. All women receiving estrogens for DMK should keep a diary to record abnormal bleeding and monitor the effectiveness of therapy.
Mental and physical fatigue
Patients who underwent separate diagnostic curettage and, based on the results of histological examination, were diagnosed with HPE, are prescribed hormonal therapy. The principles of hormone therapy HPE is the central antigonadotropic action of the drug, as a result of which the synthesis and release of gonadotropins and, as a result, ovarian steroids are reduced. When choosing drugs, it is necessary to take into account: the histological structure of the endometrium, the patient's age, contraindications and tolerability of the drug, the presence of concomitant metabolic disorders, estrogenital and gynecological pathology. In patients under 35 years of age, the use of monophasic COCs with a content of 0.03 mg of the estrogenic component in a prolonged mode is recommended for 6 months. After such a rebound therapy, ovulatory menstrual cycles are restored.
The choice of the method of hemostatic therapy is determined by the general condition of the patient and the amount of blood loss. Suppositories estriol - 0.5 mg. This is expressed in the development of polyposis or glandular - cystic hyperplasia. Under the influence of the subsequent decline in the concentration of estrogens in the body, the hyperplastic endometrium is rejected for a long time, which is accompanied by acyclic bleeding.
· Hormone therapy.
Reduction. DMC - dysfunctional uterine bleeding.
Complications... Anemia. Adenocarcinoma of the uterus with prolonged unreasonable estrogen therapy.
Prolonged exposure to estrogens with follicular atresia or their increased production with persistence of the follicle lead to endometrial proliferation. Uterine and vaginal effects of unopposed ultralow-dose transdermal estradiol. The drugs are prescribed in a dose of 4 tablets on the first day, depending on the intensity of bleeding, reducing the dose by 1-2 tablets in three days until the bloody discharge stops, after which they continue to take COCs for 21 days.
Clinic for ovulatory uterine bleeding: there may be no real bleeding leading to anemia, but there will be bleeding before menstruation, spotting after menstruation, there may be spotting in the middle of the cycle. Also, patients will suffer from miscarriage, and some of them - infertility.
The remaining 10% are of childbearing age. With anovulatory bleeding in a woman's body, the following disorders are observed:
· Examination by tests of functional diagnostics.
As a rule, in 70-80% of cases, bleeding begins after a delay. In 20% - menstruation can start on time, but not end on time. The main complaint is bleeding against a background of delay.
Cameron J. et al. // Obstetr. a Gynecol. - 1990. - Vol. 76. - P. 85–88.
To exclude the pathology that caused uterine bleeding, it is better to carry out hysteroscopy twice: After curettage, when examining the uterine cavity, it is possible to identify areas of endometriosis, small submucous uterine myomas. In rare cases, a hormone-active ovarian tumor becomes the cause of uterine bleeding. To identify this pathology allows ultrasound nuclear magnetic or computed tomography.
1. Ovulatory. Depending on the changes in the ovaries, the following 3 types of DMC are distinguished: a. Shortening of the first phase of the cycle; b. Shortening of the second phase of the cycle; in lengthening the second phase of the cycle.
In juvenile age 20-25%
21.09.2017 — 13:49
The treatment is based on hormone therapy. 3 goals are pursued:
Under the influence of the subsequent decline in the concentration of estrogens in the body, the hyperplastic endometrium is rejected for a long time, which is accompanied by acyclic bleeding.
Symptomatic hemostatic therapy - inhibitors of fibrinolysis (tranexamic acid), NSAIDs (diclofenac, naproxen), angioprotective and microcirculation-improving drugs (etamsylate) - does not cause full hemostasis. These drugs only reduce blood loss and are considered adjuncts. As a second stage, prevention of recurrent bleeding in patients who underwent hormonal hemostasis is recommended. The drugs of choice for this in young women are monophasic COCs (Marvelon ©, Janine ©, Yarina ©, etc.). If a woman does not plan pregnancy in the coming years, then after 6–8 months the introduction of Mirena © is recommended - an intrauterine hormonal releasing system that reliably protects the endometrium from proliferative processes for 5 years.
BLEEDING IN CLIMACTERIC AGE.
Pathomorphology. Depends on the cause of the DMK. Necessarily pathohistological examination of endometrial preparations.
The 1st phase of the cycle has been shortened - it needs to be lengthened - we prescribe estrogens.
2. There is no second phase of the cycle (no release of progesterone).
1. Stopping bleeding
Mode. Outpatient; hospitalization for severe bleeding and hemodynamic instability.
Dysfunctional uterine bleeding
Diagnostic, that is, the scraping is sent for histological examination, which allows a differential diagnosis with violations during pregnancy.
When recurrent bleeding occurs, hormonal and non-hormonal hemostasis is performed. In the future, to correct the revealed dysfunction, hormonal treatment is prescribed, which helps to regulate menstrual function, prevent recurrence of uterine bleeding. Non-specific treatment of uterine bleeding includes the normalization of the neuropsychic state, treatment of all background diseases, and removal of intoxication.
At climacteric age 60%
If you are not a healthcare professional:
Robertson S. et al. Endometrium / Glasse S. et al. - London, 2002. - P. 416-430.
Juvenile bleeding: stopping them is carried out, as a rule, with the help of hormonal drugs (hormonal hemostasis). Used by:
Leads to the development of anemia. Severe climacteric syndrome. Bloody discharge usually stops 5-6 days after you stop taking the drugs. Dysfunctional uterine bleeding - anovulatory bleeding caused by dysfunction of the ovaries.
ICD-10. N92.3 Ovulatory bleeding N92.4 Profuse bleeding in the premenopausal period. N93 Other abnormal bleeding from the uterus and vagina. N95.0 Postmenopausal bleeding
3. The process of follicle maturation is disrupted, which can be 2 peaks: follicle atresia and follicle persistence.
If dysfunction and uterine bleeding still develop, then further measures should be aimed at restoring the regularity of the menstrual cycle and preventing recurrence of bleeding. For this purpose, the appointment of oral estrogen-progestational contraceptives is shown according to the scheme: Pure progestational drugs norkolut, duphaston are prescribed for uterine bleeding from the 1st to the 1st day of the menstrual cycle for 4-6 months. The use of hormonal contraceptives not only reduces the frequency of abortions and the occurrence of hormonal imbalance, but also prevents the subsequent development of anovulatory forms of infertility, endometrial adenocarcinoma, and breast cancer.
· You can use biphasic hormonal oral contraceptives (biseurin): on the first day 5 tablets, on the second day - 4 tablets, etc. 1 tablet is given up to 21 days, followed by a menstrual reaction.
DIAGNOSTICS.
With persistence of the follicle, LH does not increase, and rupture of the follicle does not occur, but the follicle continues to exist (persist). This means that there will be pronounced hyperestrogenism in the body.
3.rehabilitation of patients
· Surgical intervention.
Histological examination of the endometrium
SURGERY
· To prevent bleeding, hormone therapy is used. In juvenile age, follicular atresia is more common, therefore, the estrogenic concentration is reduced. In this case, it is better to prescribe hormone replacement therapy - in the first part of the cycle - estrogens, in the second half - progesterone. If the estrogen saturation is sufficient, then you can limit yourself to one progesterone or chorionic gonadotropin.
Lessey B. et al. Molecul. Reprod. Dev. - 2000. - 62. - P. 446–455.
The duration and intensity of uterine bleeding is influenced by the factors of hemostasis, platelet aggregation, fibrinolytic activity and vascular spasticity. which are violated with DMK.
The peculiarities of the diagnosis of menopausal uterine bleeding consist in the need to differentiate them from menstruation, which at this age become irregular and proceed as metrorrhagia.
Psychogenic factors and stress
Dysfunctional uterine bleeding
Example: Diagnosis - shortening of the 2nd phase of the cycle, it needs to be lengthened, we prescribe progesterone progestogens.
Dysfunctional uterine bleeding
Medicine abstracts
The prognosis for health and life is favorable.
Drug therapy. Drugs of choice .. For emergencies (severe bleeding; hemodynamic instability) ... Conjugated estrogens, 25 mg IV every 4 hours, maximum 6 doses are allowed ... After stopping bleeding, medroxyprogesterone 10 mg / day for 10-13 days or oral combined contraceptives containing 35 mg of ethinylestradiol (ethinylestradiol + cyproterone) ... Correction of anemia - replacement therapy with iron preparations .. In conditions that do not require urgent therapy ... Estrogen hemostasis - ethinylestradiol 0.05-0 , 1 mg. Then the dose is gradually reduced over 5-7 days and continues to be administered for 10-15 days, and then 10 mg of progesterone is injected for 6-8 days ... Progesterone hemostasis (contraindicated in moderate and severe anemia) - medroxyprogesterone according to 10 mg / day for 6-8 days or 20 mg / day for 3 days, norethisterone 1 tablet every 1-2 hours ... Oral contraceptives - on the first day, 1 tablet every 1-2 hours until bleeding stops (no more 6 tablets), then reduce daily by 1 tablet per day. Continue taking 1 tablet per day until 21 days, after which they stop taking it, which provokes a menstrual reaction. Alternative drug .. Progesterone instead of medroxyprogesterone ... 100 mg of progesterone IM - for emergency stop bleeding; do not use in cyclic therapy ... Vaginal suppositories should not be used, because dosing drugs in this case is difficult ... Danazol - 200-400 mg / day. May cause virilization; mainly used in patients with the forthcoming extirpation of the uterus. Contraindications .. Treatment is carried out only after excluding other causes of uterine bleeding .. Appointment of hormone therapy blindly is not recommended.
Follicle persistence ... The follicle during the 1st phase of the cycle matures to mature and ready for ovulation. At this time, the amount of LH rises, which determines ovulation.
Dysfunctional uterine bleeding(DMC) - bleeding due to pathology of endocrine regulation, not associated with organic causes, most often arising in connection with anovulatory cycles (90% DMC). DMC refers to irregular menstrual cycles with heavy bleeding after missed periods. As a rule, DMC is accompanied by anemia. DMC in adolescence (juvenile) is most often caused by follicular atresia, i.e. they are hypoestrogenic, much less often they can be hyperestrogenic with persistence of follicles. Bleeding occurs after a delay in menstruation for different periods and is accompanied by anemia. Menopause bleeding in most cases is also anovulatory, but in most cases they are caused by the persistence of a mature follicle, i.e. is hyperestrogenic. In anovulatory cycles, bleeding is preceded by a delay in menstruation of varying duration.
This herbal medicine is prescribed in 30 drops or 1 tablet 2 times a day. Estrogens are not indicated in the perimenopausal period and when endometrial cancer is suspected. Table 4 Schemes of combined monophasic therapy in continuous mode Name of the drug. A day after the end of the progesterone administration, a menstrual reaction occurs.
03.11.2017 — 13:23
Follicle atresia ... The follicle does not reach its final development, but undergoes shrinkage at the stages of a small maturing follicle. Usually in these cases, the ovary develops on one, and two follicles. They are replaced by the next 2 follicles, which are then also atresized. In this case, there is also no ovulation, there will also be estrogenism, but not sharply expressed.
30.10.2017 — 21:13
Therapeutic, that is, all hyperplastic mucosa is removed from the uterus
The final diagnosis is made after curettage of the uterine cavity. Differential diagnosis is carried out with extragenital pathology, especially with systemic blood diseases (Werlhof disease) - in juvenile age. In childbearing age - with a pathology of pregnancy (miscarriage that has begun, ectopic pregnancy). In menopause, there should be oncological alertness!
Dispensary observation, restoration of ovulatory menstrual cycles or regulation of the menstrual cycle by taking COCs, progestogens in phase II of the cycle, the introduction of the intrauterine hormonal levonorgestrelling system Mirena ©.
In the presence of risk factors, thromboembolic complications are possible, especially in the first year of treatment. Antineoplastic hormonal agents and hormone antagonists. Obstetrics - gynecology Clinical and instrumental diagnostics Laboratory diagnostics Surgical treatment Phytotherapy Contraception Syndromes Pathology in children and adolescents Infertility Menstrual disorders Endocrine disorders Urogenital infections Inflammatory diseases Non-inflammatory diseases Hyperplastic diseases Fistulas Gynecological oncology Pathology of the mammary glands Urgency.
The current version of the page has not yet been reviewed by experienced contributors and may differ significantly from the version checked on September 30; verification requires 1 edit. The request for Bleeding from female genital organs is forwarded here. Uterine bleeding ICD N 92 Symptoms alphabetically Gynecological diseases. Stubs on gynecology. Namespaces Article Discussion.
29.09.2017 — 05:19
The most effective prevention of dysfunctional uterine bleeding, recurrence of HPE in women over 35 years old who are not interested in pregnancy is the use of the IUD, the intrauterine hormonal releasing system Mirena ©, which secretes levonorgestrel from a special reservoir with its maximum concentration in the endometrium and minimum in the blood. As a result of the local action of the drug, endometrial atrophy occurs.
· Symptomatic therapy.
· In the absence of anemia - progesterone in shock doses (30 mg for 3 consecutive days). This is the so-called hormonal curettage: after a few days, the mucous membrane begins to be rejected and you need to be prepared for this.
Smetnik V.P. Tumilovich L.G. In the book. Non-operative gynecology. - M. MIA, 2003. - S. 145-152.
ICB dmc code of the climacteric period
Testosterone is used to suppress the cycle. Rehabilitation at this age consists in the fact that in case of precancer it is necessary to raise the question of surgical treatment. The same question should be asked if there is no effect of hormone therapy.
ICB 10 abnormal uterine bleeding
FURTHER INTRODUCTION
Course and forecast. Vary depending on the cause of the DMK. In young women, effective drug treatment of DMC is possible without surgery.
Dysfunctional uterine bleeding - description, causes, symptoms (signs), diagnosis, treatment.
BIBLIOGRAPHY
DIAGNOSTICS:
Symptoms (signs)
Thus, with anovulatory bleeding in the ovaries, there can be changes in the type of follicle atresia, in the type of follicle persistence, as a rule, in both cases, a period of delay in menstruation is characteristic.
Statistical data. 14-18% of all gynecological diseases. In 50% of cases, the patient is over 45 years old (premenopausal and menopausal periods), in 20% - adolescence (menarche).
2. Anovulatory uterine bleeding.
Prescribe vitamin therapy, donor blood transfusions by ml, physiotherapy, electrical stimulation of the cervix, galvanic collar according to Sherbak, diathermy of the mammary glands.
06.10.2017 — 02:13
In the hyperplastic endometrium, vascular proliferation occurs. They become brittle, prone to estrogenic influences. And the level of estrogen is unstable, it increases and decreases. In response to a decrease in blood estrogen in the hyperplastic endometrium, thrombosis and necrosis are formed, which leads to its rejection. But the fact is that such a hyperplastic endometrium can never be rejected completely, and even more so to perceive a fertilized egg.
Mote P. et al. // Human Reprod. - 2000. - Vol. 15. - Suppl. 3. - P. 48–56.
· During histological examination of the myometrium in both cases, there will be patoproliferation.
4. Throughout the entire period of the cycle, only estrogens are released, which causes at the level of receptor organs not proliferative, but hyperplastic processes (glandular hyperplasia of the endometrium and endometrial polyposis)
Surgery. Emergencies (profuse bleeding, pronounced hemodynamic disturbances) .. Scraping of the walls of the uterine cavity with DMC of the reproductive and climacteric periods .. Removal of the uterus is indicated only in the presence of concomitant pathology. Conditions that do not require urgent care - curettage of the uterine cavity is shown with the ineffectiveness of drug treatment.
FORECAST
TREATMENT consists in the fact that the cycle is restored based on the existing violations.
Causes
Laboratory research. Needed in case of suspicion of other endocrine or hematological disorders, as well as in patients in the premenopausal period. Includes assessment of thyroid function, CBC, PT and PTT, hCG (to exclude pregnancy or cystic drift), hirsutism diagnosis, prolactin concentration (in case of pituitary dysfunction), ultrasound, laparoscopy.
18.10.2017 — 09:09
PATIENT INFORMATION
Before puberty, during pregnancy and immediately after childbirth, menstruation is absent during menopause. From Wikipedia, the free encyclopedia.
Differential diagnostics. Liver disease. Hematological diseases (von Willebrand disease, leukemia, thrombocytopenia). Iatrogenic causes (eg, trauma). Intrauterine devices. Taking drugs (oral contraceptives, anabolic steroids, HA, anticholinergic drugs, digitalis drugs, anticoagulants). Ectopic pregnancy .. Spontaneous abortion. Diseases of the thyroid gland. Uterine cancer. Uterine leiomyoma, endometriosis. Bubble drift. Ovarian tumors.
Cameron J. et al. Clinical Disorders of the “Endometrium and Menstr. Cycle ". - Oxford Univers. Press, 1998.
If these disorders are not treated, then adenocarcinoma develops in the endometrium after 7-14 years.
Short description
I must say that ovulatory bleeding is rare and, as a rule, accompanies inflammatory adhesions in the small pelvis.
Patients with dysfunctional uterine bleeding should be registered with a gynecologist. Mechanism of development of DMC Dysfunctional uterine bleeding develops as a result of a violation of hormonal regulation of the function of the ovaries by the hypothalamic-pituitary system. Dysfunctional uterine bleeding - treatment in Moscow. Transabdominal ultrasound of the pelvic organs. Transvaginal ultrasound of the pelvic organs. Sowing for flora with an antibioticogram in women. Histology of a biopsy of the female genital organs. Treatment plan based on examination results. Breaking News Exercise Promotes Healthy Cells Scientists Synthesize Antibody To Fight Zika Virus Inflammation of the intestines in childhood increases the risk of cancer Found a way to stop the growth of brain tumors PTSD and stress increase the risk of lupus Cancer patients do not receive adequate treatment for myocardial infarction.
Tests of functional diagnostics (monophasic basal temperature both with follicle atresia and with its persistence; pupil symptom with persistence ++++, with atresia +, ++; hormonal colpocytology will in either case indicate an estrogenic effect, karyopycnotic index with atresia the follicle will be low, and with persistence - high.
Manukhin I.B. Tumilovich L.G. Gevorkyan M.A. Clinical lectures on gynecological endocrinology. - M.: GeotarMedia, 2006. - S. 113-141.
Complaints and anamnesis of the patient
Hillard P. Novak's Gynecology. - 2002. - ed. 13. - Ch. 13. - P. 372.
LECTURE No. 3 ON GYNECOLOGY: DYSFUNCTIONAL UTERINE BLEEDING (UBH).
Rehabilitation - it is necessary to reduce the load, to give the opportunity for more rest.
Mechanism of development of DMK
De Cherry A. Polan M. // Obstetrics and Gynecol. - 1983. - Vol. 6. - P. 392–397.
1. Lack of ovulation.
Women of late reproductive age (after 35 years) with recurrent dysfunctional uterine bleeding, contraindications to the use of estrogen-containing COCs are recommended to use antigonadotropic drugs: gestrinone 2.5 mg 2 times a week for 6 months, danazol 400 mg per day for 6 months. The most effective of them are buserelin, goserelin, triptorelin, which are prescribed parenterally once every 28 days, 6 injections. Women should be warned that during therapy, climacteric symptoms appear: hot flashes, sweating, palpitations and others, which stop after the drug is discontinued.
7-14 days depending on the severity of post-hemorrhagic anemia.
Inflammatory processes of the small pelvis
Burlev V.A. // Problems of Reproduction. - 2004. - No. 6. -S. 51-57.
· If there is anemia, it is necessary to stop the bleeding in such a way that the menstrual reaction is delayed, and the given time is devoted to the treatment of the anemia. In this case, they begin with the introduction of estrogens, which causes the regeneration of the mucous membrane. Microfollin on the 1st day 5 tablets or folliculin on the first day 2 ml. After 14 days, we introduce progesterone in order to induce a menstrual reaction.
First of all, there must be oncological alertness. Hemostasis is carried out by separate curettage of the uterine cavity and cervical canal, which pursues therapeutic and diagnostic purposes. If we receive changes of the type of atypical hyperplasia (precancer), then we must immediately raise the question of surgical treatment (amputation of the uterus).
Stopping bleeding at this age is carried out by scraping the uterine cavity, which has 2 goals:
2.prophylaxis of bleeding (regulation of the menstrual cycle)
Causes of DMC:
Hysterectomy as a method of treating dysfunctional uterine bleeding at reproductive age is used extremely rarely, as a rule, when dysfunctional uterine bleeding is combined with myoma or internal endometriosis, with contraindications for hormone therapy.
Therapy of dysfunctional uterine bleeding in menopause is aimed at suppressing hormonal and dyufastone in the treatment of menopause functions. Stopping bleeding with uterine bleeding during the climacteric period is performed exclusively by the surgical method - by means of diagnostic and curettage and hysteroscopy.
Prevention of dysfunctional uterine bleeding should be started at the stage of intrauterine development of the fetus. In childhood and adolescence, it is important to pay attention to general strengthening and general health measures, prevention or timely treatment of diseases, especially of the reproductive system, and prevention of abortion.
Methods for diagnosing uterine bleeding are common for different types and are determined by the doctor individually.
Inpatient surgical treatment is recommended for all patients over 30 years old, regardless of the intensity of bleeding. Under the control of hysteroscopy, separate scraping of the walls of the uterine cavity is performed. Hysteroscopy allows not only to completely remove the hyperplastic endometrium (bleeding substrate), but also to reveal concomitant pathology (polyps, submucous myoma, internal endometriosis).
As a result, the corpus luteum is not formed, the secretory transformation of the endometrium does not occur. There are dysfunctional uterine bleeding in juvenile years. reproductive years and climacteric years of age periods.
If only the hyperplastic process is determined during the histological examination, then hormone therapy is prescribed. Here you can go in two ways: either preservation and regulation of the cycle, or its suppression.
TREATMENT should be taking into account the etiology, pathogenesis and the principle according to which the menstrual function is a function of the whole organism. On the other hand, treatment should be strictly individual. Consists:
12.10.2017 — 16:27
The information published on the site is for informational purposes only and does not replace qualified medical care. Be sure to consult your doctor! When using materials from the site, the active reference is obligatory.
24.10.2017 — 00:11
Nicas G. et al. // Human Reprod. -Vol. 14, Suppl. 2 - P. 99-106.
In adolescence, curettage of the uterus is resorted to only in extreme cases, mainly for health reasons, severe uterine bleeding. Inpatient surgical treatment is recommended for all patients over 30 years old, regardless of the intensity of bleeding. A provoking role in the development of uterine bleeding in the juvenile period is also played by childhood infections, chickenpox, measles, mumps, whooping cough, and rubella. ARI, chronic tonsillitis, complicated pregnancy and childbirth in the mother, etc. Preference for this drug over other traditional means should be given with severe asthenia, the presence of sexual dysfunction in postmenopausal women, as well as with small MM and a history of endometrial hyperplastic processes.
· Dysfunction of the endocrine glands.
This is facilitated by psychotherapeutic techniques, vitamins, sedatives. For anemia, iron supplements are prescribed. Uterine bleeding of reproductive age with improperly selected hormone therapy or a specific reason may recur. With age, the amount of gonadotropins secreted by the pituitary gland decreases, their release becomes irregular, which causes a violation of the ovarian cycle of folliculogenesis, ovulation, and the development of the corpus luteum. Deficiency of progesterone leads to the development of hyperestrogenism and hyperplastic proliferation of the endometrium.
Special studies. Special tests to determine the presence of ovulation and its timing .. Measurement of basal temperature to detect anovulation .. Definition of the phenomenon of "pupil" .. Definition of the phenomenon of "fern" .. Symptom of cervical mucus tension .. Pap smear. An ultrasound scan to check for an ovarian cyst or uterine tumor. Transvaginal ultrasound - if pregnancy is suspected, genital anomalies, polycystic ovaries. Endometrial biopsy .. In all patients over 35 years old .. With obesity .. With diabetes .. With arterial hypertension. Curettage of the uterine cavity - with a high risk of endometrial hyperplasia or carcinoma. If endometritis, atypical hyperplasia, and carcinoma are suspected, curettage of the uterine cavity is preferable to endometrial biopsy.
21.10.2017 — 08:06
The clinical picture. Uterine bleeding, irregular, often painless, the volume of blood loss is variable. Characterized by the absence of: .. manifestations of systemic diseases .. dysfunctions of the urinary system and gastrointestinal tract .. long-term use of acetylsalicylic acid or anticoagulants .. use of hormonal drugs .. thyroid diseases .. galactorrhea .. pregnancy (especially ectopic) .. signs of genital malignant neoplasms organs.
Diagnostics
This page was last edited on June 20 as Text is available under the Creative Commons Attribution-ShareAlike license; in some cases additional conditions may apply.
Before puberty. during pregnancy and immediately after childbirth, menstruation is absent during menopause. Further prevention of uterine bleeding includes taking low-dose progestational drugs Logest, Silest, Novinet, Dufaston, Norkolut. Their introduction begins one day after the diagnostic curettage of the uterus and continues for 21 days, 1 tablet per day. Dictionary of abbreviations of the modern Russian language.
DMC - bleeding that is not associated with either organic changes in the genitals, or with systemic diseases leading to a violation of the blood coagulation system. Thus, DMC is based on a violation of the rhythm and production of gonadotropic hormones and ovarian hormones. DMC is always accompanied by morphological changes in the uterus. In the general structure of gynecological diseases, DMK is 15-20%. Menstrual function is regulated by the cerebral cortex, supra-hypothalamic structures, hypothalamus, pituitary gland, uterus ovaries. This is a complex system with double feedback; for its normal functioning, well-coordinated work of all links is necessary.
Acute and chronic intoxication and occupational hazards
To preserve the cycle, a long-acting drug 17-hydroxyprogesterone capronate (17-OPK), 12.5% solution is prescribed. It is prescribed cyclically on the 17-19th day of the cycle, 1-2 ml, for 6-12 months. The woman is gradually entering menopause.
Etiology... Spotting in the middle of the cycle is a consequence of a decrease in estrogen production after ovulation. Frequent menstruation is a consequence of the shortening of the follicular phase due to inadequate feedback from the hypothalamic - pituitary system. Shortening of the luteal phase - premenstrual spotting or polymenorrhea due to a premature decrease in progesterone secretion; the result of insufficiency of the functions of the corpus luteum. Prolonged activity of the corpus luteum is a consequence of the constant production of progesterone, which leads to a lengthening of the cycle or prolonged bleeding. Anovulation is an excess production of estrogen, not associated with the menstrual cycle, not accompanied by a cyclic production of LH or the secretion of progesterone by the corpus luteum.
Dahmon M. et al. // Journ. Clinical Endocrin and Metabol. - 1999. - Vol. 89. - P. 1737-1743.
- with an increase in antibody titer 2 or more times in the study of blood serum of aborted animals. Dibiomycin is added to the serum in sick calves in order to enhance the therapeutic efficacy at the rate of 10 thousand units per kg of animal weight. If the farm does not have the opportunity to prepare whey, [...]
- Important. if gonorrhea is suspected, it is extremely dangerous to self-medicate. Only a doctor can correctly diagnose and choose an adequate treatment. The most common complications of gonorrhea are infertility and impotence. In the presence of a mixed infection, gonorrhea-chlamydia. schemes are expanded by adding tablets [...]
- (according to research McConcl DJ 1991; Lorincz A. T. 1992; Bosch E X. et al. 2002; Kozlova V. I. Puchner A. F. 2003; Syrjanen S. 2003; Shakhova N. M. et al. 2006;) ... Children aged 6 years and older for the treatment of influenza and ARVI are prescribed in the first 2 days - 1 tablet 3 times a day, in the next 2 days - 1 each [...]
- Therapeutic measures are aimed at correcting the hormonal background of the patient, represented by the following drugs: If a woman feels tension and chest pains before menstruation, you should not wait for more pronounced symptoms, you should consult a mammologist immediately. Before assigning [...]
- With extreme caution, the drug can be used simultaneously with xanthine oxidase inhibitors. zidovudine. diuretics. as well as reduce liver failure. As part of 1 tablet Groprinosin (Groprinosin) contains: Groprinosin for papillomas or genital warts is used in combination with [...]
- leprosy; Interaction Ingaron: instructions for use 2 drops in each nasal passage after the toilet of the nasal passages 5 times a day for 5 to 7 days. Side effects The average cost of Ingaron in pharmacies in Moscow ranges from 290 to 5160 rubles, depending on the dosage and the number of vials in [...]
- through kissing (touching the face to the skin of the face), How to identify an infection on the body? It should be noted that the so-called herpes simplex is of 2 types - Herpes: treatment, photo prolonged exposure to the sun. Herpes is an infectious disease caused by a virus. among women […]
- 2 tbsp. l. Pour crushed dry leaves with 2 cups of boiling water and leave for 10 hours in a warm place. Drink 100 g 4 times a day. The woman was diagnosed with uterine fibroids and was already preparing for surgery, when she was advised a folk remedy for the treatment of fibroids. She made the right mixture and was treated for three weeks, then [...]
- An important criterion for the effectiveness of the treatment is the resolution of the clinical manifestations of the disease. Table of Contents The latest press news indicates that taking Azithromycin for chlamydia is associated with an increased risk of sudden death. Azithromycin is a widely used antibiotic. Doctors [...]
- Symptoms of herpes can be broken down into 5 stages: sepsis of thyroid disease In 99 percent of cases, a rash on the lips is caused by the herpes simplex virus type 1. It is present in one state or another in the body of 2/3 of the inhabitants of the planet, but only a part of people goes into the active phase, [...]
Dysfunctional uterine bleeding(DMK) - bleeding due to pathology of endocrine regulation, not associated with organic causes, most often arising in connection with anovulatory cycles (90% DMC). DMC refers to irregular menstrual cycles with heavy bleeding after missed periods. As a rule, DMC is accompanied by anemia. DMC in adolescence (juvenile) are most often caused by follicle atresia, that is, they are hypoestrogenic, much less often they can be hyperestrogenic with persistence of follicles. Bleeding occurs after a delay in menstruation for different periods and is accompanied by anemia. Menopause bleeding in most cases is also anovulatory, but in most cases they are caused by the persistence of a mature follicle, that is, it is hyperestrogenic. In anovulatory cycles, bleeding is preceded by a delay in menstruation of varying duration.
Code for the international classification of diseases ICD-10:
- N92. 3 - Ovulatory bleeding
- N92. 4 - Heavy bleeding in the premenopausal period
- N93 - Other abnormal bleeding from the uterus and vagina
- N95. 0 - Postmenopausal bleeding
Statistical data
14-18% of all gynecological diseases. In 50% of cases, the patient is over 45 years old (premenopausal and menopausal periods), in 20% - adolescence (menarche).Dysfunctional uterine bleeding: Causes
Etiology
Spotting in the middle of the cycle is a consequence of a decrease in estrogen production after ovulation. Frequent menstruation is a consequence of the shortening of the follicular phase due to inadequate feedback from the hypothalamic - pituitary system. Shortening of the luteal phase - premenstrual spotting or polymenorrhea due to a premature decrease in progesterone secretion; the result of insufficiency of the functions of the corpus luteum. Prolonged activity of the corpus luteum is a consequence of the constant production of progesterone, which leads to a lengthening of the cycle or prolonged bleeding. Anovulation is an excess production of estrogen, not associated with the menstrual cycle, not accompanied by a cyclic production of LH or the secretion of progesterone by the corpus luteum.Pathomorphology
Depends on the cause of the DMK. Necessarily pathohistological examination of endometrial preparations.Dysfunctional uterine bleeding: Signs, Symptoms
Clinical picture
Uterine bleeding, irregular, often painless, the volume of blood loss is variable. The absence of:. manifestations of systemic diseases. dysfunctions of the urinary system and gastrointestinal tract. long-term use of acetylsalicylic acid or anticoagulants. the use of hormonal drugs. diseases of the thyroid gland. galactorrhea. pregnancy (especially ectopic). signs of malignant neoplasms of the genital organs.Dysfunctional uterine bleeding: Diagnosis
Laboratory research
Needed in case of suspicion of other endocrine or hematological disorders, as well as in patients in the premenopausal period. Includes assessment of thyroid function, CBC, PT and PTT, hCG (to exclude pregnancy or cystic drift), hirsutism diagnosis, prolactin concentration (in case of pituitary dysfunction), ultrasound, laparoscopy.Special studies
Special tests to determine the presence of ovulation and its timing. Measurement of basal temperature to detect anovulation. Definition of the "pupil" phenomenon. Definition of the "fern" phenomenon. Symptom of tension in cervical mucus. Pap smear. Ultrasound to check for ovarian cysts or uterine tumors. Transvaginal ultrasound - if pregnancy is suspected, genital anomalies, polycystic ovaries. Endometrial biopsy. All patients are over 35 years old. With obesity. With SD. With arterial hypertension. Curettage of the uterine cavity - with a high risk of endometrial hyperplasia or carcinoma. If endometritis, atypical hyperplasia, and carcinoma are suspected, curettage of the uterine cavity is preferable to endometrial biopsy.Differential diagnosis
Liver disease. Hematological diseases (von Willebrand disease, leukemia, thrombocytopenia). Iatrogenic causes (eg, trauma). Intrauterine devices. Taking drugs (oral contraceptives, anabolic steroids, HA, anticholinergic drugs, digitalis drugs, anticoagulants). Ectopic pregnancy. Spontaneous abortion. Diseases of the thyroid gland. Uterine cancer. Uterine leiomyoma, endometriosis. Bubble drift. Ovarian tumors.Dysfunctional uterine bleeding: Treatment methods
Treatment
Mode
Outpatient; hospitalization for severe bleeding and hemodynamic instability.Drug therapy
Drugs of choice. In case of emergency conditions ( bleeding severe degree; instability of hemodynamics). Conjugated estrogens, 25 mg IV every 4 hours, maximum administration of 6 doses is allowed. After stopping bleeding - medroxyprogesterone 10 mg / day for 10-13 days or oral combined contraceptives containing 35 mg of ethinyl estradiol (ethinyl estradiol + cyproterone). Correction of anemia - iron replacement therapy. For conditions that do not require urgent therapy. Estrogenic hemostasis - ethinylestradiol 0.05-0.1 mg. Then the dose is gradually reduced over 5-7 days and continues to be administered for 10-15 days, and then 10 mg of progesterone is administered over 6-8 days. Progesterone hemostasis (contraindicated in moderate and severe anemia) - medroxyprogesterone 10 mg / day for 6-8 days or 20 mg / day for 3 days, norethisterone for 1 tablet every 1-2 hours. Oral contraceptives - on the first day, 1 tablet after 1 - 2 hours until the bleeding stops (no more than 6 tablets), then 1 tablet per day is reduced daily. Continue taking 1 tablet per day until 21 days, after which they stop taking it, which provokes a menstrual reaction. Alternative drug. Progesterone instead of medroxyprogesterone. 100 mg of progesterone / m - for emergency stop bleeding; not used in cyclic therapy. Vaginal suppositories should not be used, since it is difficult to dose drugs in this case. Danazol - 200-400 mg / day. May cause virilization; mainly used in patients with the forthcoming extirpation of the uterus. Contraindications Treatment is carried out only after excluding other causes of uterine bleeding. Blind hormone therapy is not recommended.Surgery
Emergencies (profuse bleeding, severe hemodynamic disturbances). Scraping of the walls of the uterine cavity with DMC of the reproductive and climacteric periods. Removal of the uterus is indicated only in the presence of concomitant pathology. Conditions that do not require urgent care - curettage of the uterine cavity is shown with the ineffectiveness of drug treatment.Observation of the patient. All women receiving estrogens for DMK should keep a diary to record abnormal bleeding and monitor the effectiveness of therapy.
Complications
Anemia. Adenocarcinoma of the uterus with prolonged unreasonable estrogen therapy.Course and prognosis
Vary depending on the cause of the DMK. In young women, effective drug treatment of DMC is possible without surgery.Reduction
DMC - dysfunctional uterine bleeding.ICD-10. N92. 3 Ovulatory bleeding. N92. 4 Profuse bleeding in the premenopausal period. N93 Other abnormal bleeding from the uterus and vagina. N95. 0 Postmenopausal bleeding.
Tags:
Did this article help you? Yes - 0 Not - 0 If the article contains an error Click here 230 Rating:
Click here to add a comment to: Dysfunctional uterine bleeding(Diseases, description, symptoms, folk recipes and treatment)
Dysfunctional uterine bleeding (the accepted abbreviation is DMC) is the main manifestation of ovarian dysfunction syndrome. Dysfunctional uterine bleeding is characterized by acyclicity, prolonged delays in menstruation (1.5-6 months) and prolonged blood loss (more than 7 days). There are dysfunctional uterine bleeding of juvenile (12-18 years old), reproductive (18-45 years old) and menopausal (45-55 years old) age periods. Uterine bleeding is one of the most common hormonal pathologies of the female genital area.
Juvenile dysfunctional uterine bleeding is usually caused by the unformed cyclic function of the hypothalamus-pituitary-ovary-uterus. In childbearing age, frequent causes of ovarian dysfunction and uterine bleeding are inflammatory processes of the reproductive system, diseases of the endocrine glands, surgical termination of pregnancy, stress, etc., in menopause - dysregulation of the menstrual cycle due to the extinction of hormonal function.
On the basis of the presence or absence of ovulation, ovulatory and anovulatory uterine bleeding are distinguished, the latter accounting for about 80%. The clinical picture of uterine bleeding at any age is characterized by prolonged spotting that appears after a significant delay in menstruation and is accompanied by signs of anemia: pallor, dizziness, weakness, headaches, fatigue, and a decrease in blood pressure.
Juvenile DMK.
Causes.
In the juvenile (pubertal) period, uterine bleeding occurs more often than other gynecological pathologies - in almost 20% of cases. Disruption of the formation of hormonal regulation at this age is facilitated by physical and mental trauma, unfavorable living conditions, overwork, hypovitaminosis, dysfunction of the adrenal cortex and / or thyroid gland. Children's infections (chickenpox, measles, mumps, whooping cough, rubella), acute respiratory infections, chronic tonsillitis, complicated pregnancy and childbirth in the mother also play a provoking role in the development of juvenile uterine bleeding.history data (date of menarche, last menstruation and onset of bleeding).
development of secondary sexual characteristics, physical development, bone age.
hemoglobin level and blood clotting factors (complete blood count, platelets, coagulogram, prothrombin index, clotting time and bleeding time).
indicators of the level of hormones (prolactin, LH, FSH, estrogen, progesterone, cortisol, testosterone, T3, TSH, T4) in the blood serum.
expert opinion: consultation of a gynecologist, endocrinologist, neurologist, ophthalmologist.
indicators of basal temperature in the period between periods (a single-phase menstrual cycle is characterized by a monotonous basal temperature).
the state of the endometrium and ovaries based on ultrasound of the pelvic organs (using a rectal sensor in virgins or a vaginal one in girls who are sexually active). An echogram of the ovaries with juvenile uterine bleeding shows an increase in the volume of the ovaries in the intermenstrual period.
the state of the regulatory hypothalamic-pituitary system according to the X-ray of the skull with the projection of the sella turcica, echoencephalography, EEG, CT or MRI of the brain (in order to exclude tumor lesions of the pituitary gland).
Ultrasound of the thyroid and adrenal glands with dopplerometry.
Ultrasound control of ovulation (to visualize atresia or persistence of the follicle, mature follicle, ovulation, formation of the corpus luteum).
DMC of the reproductive period.
Causes.
In the reproductive period, dysfunctional uterine bleeding accounts for 4-5% of all gynecological diseases. The factors causing ovarian dysfunction and uterine bleeding are neuropsychic reactions (stress, overwork), climate change, occupational hazards, infections and intoxication, abortions, some medicinal substances that cause primary disorders at the level of the hypothalamus-pituitary gland. Infectious and inflammatory processes lead to disorders in the ovaries, which contribute to the thickening of the ovarian capsule and a decrease in the sensitivity of the ovarian tissue to gonadotropins.Non-specific treatment of uterine bleeding includes the normalization of the neuropsychic state, treatment of all background diseases, and removal of intoxication. This is facilitated by psychotherapeutic techniques, vitamins, sedatives. For anemia, iron supplements are prescribed. Uterine bleeding of reproductive age with improperly selected hormone therapy or a specific reason may recur.
DMC of the climacteric period.
Causes.
Premenopausal uterine bleeding occurs in 15% of cases of the number of gynecological pathology in women in the climacteric period. With age, the amount of gonadotropins secreted by the pituitary gland decreases, their release becomes irregular, which causes a violation of the ovarian cycle (folliculogenesis, ovulation, development of the corpus luteum). Deficiency of progesterone leads to the development of hyperestrogenism and hyperplastic proliferation of the endometrium. Climacteric uterine bleeding in 30% develops against the background of climacteric syndrome.After scraping, when examining the uterine cavity, it is possible to identify areas of endometriosis, small submucous fibroids, and uterine polyps. In rare cases, a hormone-active ovarian tumor becomes the cause of uterine bleeding. This pathology can be identified by ultrasound, nuclear magnetic or computed tomography. Methods for diagnosing uterine bleeding are common for different types and are determined by the doctor individually.
Loading ...