Violation of blood loss during the menstrual cycle intensity .Dysfunctional uterine bleeding
Endocrinology / / August 12, 2017
intensity of menstrual blood loss can be enhanced, then it is called hypermenorrhea, or menorrhagia, or reduced, that is called gipooligomenoree.
hypermenorrhoea can appear on the basis of a number of gynecological diseases (uterine fibroids, inflammatory diseases of the uterus, and so on. D.) In the normal two-phase menstrual cycle.In these cases hypermenorrhoea has no endocrine genesis, and is due to violation of the contractility of the uterus, deceleration exclusion and epithelialization of the wound bed of the mother.However hypermenorrhoea may have endocrine genesis (most often in patients with uterine hypoplasia) during anovulatory cycles.This is not even a very high production of estrogen without progesterone stimulation leads to varying degrees of endometrial proliferation.Most gipomenoreya associated with severe ovarian failure on the basis of hypoplasia of the genitals.The weak development of the follicle is a low excretion of estrogen, which in turn causes a slight degree of endometrial pro
Dysfunctional uterine bleeding
only those violations should be classified as dysfunctional uterine bleeding that is not associated with the presence of pathological changes in the uterus and appendages, and are at the heart of the endocrine genesis.
Dysfunctional uterine bleeding can be subdivided on the bleeding observed in girls in the period of the menstrual cycle (juvenile bleeding), bleeding in the reproductive period of a woman's life and menopausal bleeding.This division caused by different approaches to the treatment of patients, and possibly not the same genesis of these diseases.
Etiological and pathogenetic factors that cause dysfunctional uterine bleeding are common chronic and acute infectious diseases, functional and organic diseases of the nervous system, psychological trauma, extragenital diseases systems and organs, the sexual and the general infantilism, excessive physical activity, inflammation of internal genital organs, etc.., violation of regulatory processes in the period of menopause.
The cause of dysfunctional uterine bleeding, it was believed the presence of persistent follicle in the ovary (the theory of persistent follicle).
According to this theory, persistent follicle, or a group of maturing follicles undergoing atresia at different stages of maturation, induces a state of constant proliferation of the endometrium due to continuous production of estrogen.Due to the absence of the corpus luteum in the ovaries and the production of progesterone does not happen endometrial secretory transformation.Bleeding may occur as a result of falling at any level (high or low) of estrogen.
With regard to the mechanism of the disease in patients with menopausal bleeding, this hypothesis in most cases is not confirmed as histopathological examination Spaying shows a sharp decrease in the number of follicles, the presence of theca and tech-granulezokletochkovoy hyperplasia of the stroma of the ovary, as well as tech-granulezokletochkovyh.
With regard to patients with bleeding and juvenile patients with dysfunctional uterine bleeding chadorodnogo period, there is no conclusive data that would confirm or deny the theory of persistent follicle.Indirect data in favor of this hypothesis can be attributed the success of the treatment of patients with juvenile bleeding gonadotropins.
The basis of dysfunctional uterine bleeding is probably a violation of the regulation of ovarian activity on the part of the hypothalamic centers.In this release of gonadotropins in most patients as a chadorodnogo age, and in juvenile and menopausal bleeding is normal or even below normal.There is speculation that with dysfunctional uterine bleeding is observed lack of production and release of LH, and most importantly it is not cyclic selection.
As estrogen excretion juvenile bleeding different from chadorodnogo age bleeding significantly lower level of emissions.Isolation of estrogen in juvenile bleeding averages 10-12 micrograms / 24 hours, which is significantly lower than in healthy girls as in anovulatory and ovulatory cycles at.At the same time the majority of patients the monotonous nature of their excretion.This low estrogen excretion with juvenile hemorrhages, probably due to lack of maturity of the ovaries is not capable of responding sufficiently high estrogen production.At the same time the sensitivity of peripheral tissues (endometrium) to estrogens is high, as in the continuous operation of even small amounts of estrogen developing endometrial hyperplasia.Cytology smears of vaginal bleeding to show a high degree of vaginal epithelium proliferation (high eosinophilic cariopyknotic and indexes) in the absence of lutein transformations.However, this is not an indication of high estrogen production, but rather due to the lack of progesterone stimulation.
with dysfunctional uterine bleeding and menopause chadorodnogo allocation of estrogen may vary.In some individuals the allocation of estrogen is also stored at relatively low levels - 10-20 mg / 24 hours, but in some people it is much higher, reaching the values characteristic of the mid-follicular phase of the normal cycle (30-70 mg / 24 hours).Only occasionally there are cases when the allocation of estrogen on the absolute values exceeds the maximum level of the normal menstrual cycle, ie. E. Rises above 100 mg / 24 h. However, if the level of allocation of estrogen dysfunctional uterine bleeding a little different from the norm, then the nature of their excretion hasa significant difference.
During amenorrhea prior to onset of bleeding, the allocation of long-term estrogen can be maintained at the level of 30-70 micrograms.24 h, while such values are normally only observed for a few days during the cycle.Bleeding may occur with the constant, relatively high and low level, or at the time of all the ongoing increase in estrogen release.In this case, bleeding occurs by intermittent bleeding ( «break through» phenomenon).Sometimes during the preceding bleeding observed rise in allocation of estrogen, which is kept fairly long time, and before the onset of bleeding a reduction in their allocation, so that the bleeding starts at the background of low estrogen excretion.In such cases, the bleeding is a consequence of the fall of hormone levels ( «withdrawal bleeding»).Isolation
pregnanediol amenorrhea in period prior to bleeding, and during the actual bleeding is low.
characteristic feature of the endometrium in this disease is the varying degree of hyperplasia of the endometrium glands (in 50-70% of cases) in the absence of secretory changes.
first histological study of the endometrium in this disease belong to Schroder and Meyer.
Hyperplasia endometrial glands at the same time can be as simple as just noted an increase in the number of glandular tubes.Secretion absent.The amount of connective tissue between the glands is small, excessive growth in the glands may adhere to each other.
Along with simple endometrial hyperplasia, can be observed and mixed picture: glandular or glandular cystic endometrial hyperplasia, combined in some areas with simple endometrial hyperplasia.
ratio of stroma and glands in the hyperplastic endometrium may also vary.Sometimes the number of glands dominates the stroma, and sometimes significant stromal overgrowth leads to polypoid growths.
In more rare cases, the histological picture of endometrial hyperplasia does not show the typical it.It is possible that endometrial atrophy is detected during prolonged bleeding when it was complete rejection hyperplastic endometrium.
- ovarian hormones.Estrogens
- ovarian anatomy
- ovarian hormones.Androgens
- menstrual cycle Hormonal
- menstrual irregularities
- tests of functional diagnostics of ovarian activity
- Violation monthly rate.Amenorrhea
- Violation of the menstrual cycle with monthly rhythm disorder.Opsomenoreya
- Violation of the menstrual cycle with monthly rhythm disorder.Polimenoreya
- principles of hormone therapy violations
- menstrual Principles of hormonal treatment of dysfunctional uterine bleeding
- Prevention of recurrence of dysfunctional uterine bleeding
- polycystic degeneration of the ovaries (Stein syndrome - Leventhal)
Clinic dysfunctional uterinebleeding.Dysfunctional uterine bleeding can start on time next month, which does not end in a long and continuing krovootdelenie.In 25% of cases before bleeding may be a period of "monthly confused" and, in particular, their acceleration (cyclic anovulatory polimenorei).In such cases, the gaps between the bleeding is reduced to 15-20 days and krovootdeleniya duration increases.Such frequent and prolonged krovootdeleniya can alternate with longer latency periods, after which again can come protracted krovootdelenie.But most dysfunctional uterine bleeding observed after a delay monthly from several days to several weeks or even months.
Bleeding can be very abundant at once - profuse when rapid blood loss leading to a sharp anemizatsii sick and calls for urgent action, stopping the bleeding, life-threatening patient.Sometimes the bleeding intensity is so small that it does not affect either the general condition of the patient, any disability, although continues for weeks or months.The severity of the disease determines the intensity of the blood loss, leading to anemizatsii as bleeding itself is not accompanied by any pain or other unpleasant symptoms.If there is no anemia, patients feel quite well.Severe anemia often are when juvenile bleeding.
When vaginal study mucous vulva and vagina juicy, "loose."The uterus is often slightly increased.
most valuable data for diagnosis brings histological examination of the uterine lining.Scraping is usually abundant.A valuable diagnostic indicator is also cytological picture of vaginal mucosa.In periods of amenorrhea before bleeding detected a significant proliferation of the vaginal mucosa, but no specific changes lutein.At the beginning of bleeding vaginal smears may show a mild degree of atrophy.
menopausal bleeding prone to frequent relapses.Relapses can occur for 5-10 years or more.Before applying hormone therapy relapses were observed from 40 to 75% of cases.The period of application of hormonal preparations for the treatment of dysfunctional uterine bleeding relapse rates dropped significantly, to an average of 25%.