Discharge from the uterus that is not associated with systemic disorders, diseases of an organic nature or pregnancy is called dysfunctional uterine bleeding. They are abbreviated as DMK, the frequency of such a pathology occurs in 15–20 percent of all gynecological patients, regardless of the age of the woman. From the usual discharge during menstruation, they are distinguished by the duration and volume of blood loss. A provocative factor in heavy discharge is often a violation of the normal functioning of the ovaries.
Reasons for DMK
Provoking factors in reproductive age are:
- Postoperative period preceded by diagnostic curettage, removal of polyps or abortions.
- Ovarian dysfunction, manifested by insufficient synthesis of hormones, polycystic disease.
- Pathologies of the main female organ - malignant tumors, polyps,fibroids.
- Thyroid disease. The appearance of bleeding contributes to the increased production of thyroid-stimulating hormonal substances.
- Using certain hormonal medications, including contraceptives, and non-steroidal anti-inflammatory drugs.
- Failure of the adrenal glands.
- Impaired production of hormonal substances that affect the menstrual cycle.
Dysfunctional uterine bleeding during premenopause is caused by:
- blood clotting disorder;
- changes in the hypothalamus;
- neoplasms in the uterus of a malignant nature;
- lack of estrogen and progesterone;
- polyps of glandular nature;
- endometrial hyperplasia.
Classification of DMK
Uterine bleeding is divided according to the pathogenetic mechanism into:
- Anovulatory. In this case, the follicle does not mature, there is no ovulation, and the cycle is characterized as single-phase. After a short delay in menstruation, heavy bleeding occurs.
- Ovulatory. The cause of bleeding is increased or, conversely, low production of sex hormones by the ovaries.
Classification of dysfunctional uterine bleeding by volume of blood loss and depending on the menstrual cycle is as follows:
- Menorrhagia. In another way, it is called breakthrough bleeding. Gynecological pathology provokes their occurrence.
- Metrorrhagia, or bleedingacyclic nature. This species is characterized by bleeding after or before menstruation.
- Hypermenorrhea is profuse monthly discharge accompanied by large blood loss.
- Polymenorrhea. Menstruation lasts longer than usual. The volume of blood secretions increases.
The following classification of dysfunctional uterine bleeding is based on age:
- juvenile;
- reproductive;
- climacteric.
Diagnosis
The set of diagnostic measures includes:
- Collecting anamnesis.
- Examination of the cervix - detection of visible changes.
- Cytological analysis of a scraping from the cervical canal.
- Ultrasound - to detect ovarian pathology, endometriosis or fibroids.
- Blood test for hormonal substances, general, biochemistry.
- Diagnostic curettage - detection of atypical cells, hyperplasia.
- MRI - detection of disorders in the pituitary and hypothalamus.
If indicated, additional examination methods and consultations with specialist doctors are recommended.
Pathogenetic mechanism
Dysfunctional uterine bleeding (ICD-10 code: N92) is a consequence of a hormonal failure and a disorder in the regulation of ovarian functions, the activity of which is controlled by the hypothalamic-pituitary system. Failure of the pituitary gland leads to disruption of the maturation of the follicle and menstrual function. As a result, in the female bodyestrogen levels increase. Due to the lack of synthesis of the corpus luteum in the ovaries, progesterone is not produced. In the uterus, there is an overgrowth of the endometrium, which is subsequently rejected and blood loss occurs. The intensity and duration of bleeding depends on fibrinolytic activity, platelet aggregation and vascular tone. Allocations may stop on their own, but there is a risk of their recurrence. The main signs of pathological bleeding:
- dizziness;
- pain in the lower abdomen;
- weakness;
- lower pressure;
- blackout eyes;
- discomfort in the lumbar region;
- poor appetite;
- thirst;
- quite a large amount of allocations;
- irregular periods;
- lengthening menstruation.
Therapy. Consequences
According to clinical guidelines, dysfunctional uterine bleeding is a reason for hospitalization, and urgent. The principles of treatment are as follows:
- stop bleeding;
- relapse prevention;
- scraping;
- hormonal hemostasis;
- eliminate the consequences of hemorrhage;
- use of plasma-substituting drugs for large blood loss.
Bleeding is treated both conservatively and surgically. In the first case, it happens:
- Hormonal, that is, hormonal medications are prescribed to help restore the menstrual cycle. The course of treatment is long, up to eight months. The preparations "Jess", "Rigevidon", "Yarina" have proven themselves well. The treatment regimen is selected by the attending doctor.
- Non-hormonal - aimed at strengthening the elasticity and strength of blood vessels.
For these purposes, Ascorutin, Detralex, Phlebodia and other means are used. In case of low blood clotting, the doctor recommends medications that improve platelet aggregation.
Taking drugs that normalize prolactin production
The surgical method for dysfunctional uterine bleeding in gynecology is used in pathological conditions requiring urgent surgical intervention, for example, when detecting fibroids or polyps.
When choosing a method of therapy, the doctor takes into account the age, duration and intensity of discharge, the cause of the failure of the menstrual cycle, as well as the prescription of the pathology.
With timely treatment, the prognosis is favorable. Inopportunely started therapy leads to persistent anemia and further to infertility. If the provoking factor for bleeding is ovarian dysfunction and hormonal disruptions, then there is a high risk of endometrial degeneration into a malignant neoplasm. The most severe consequence is death caused by prolonged heavy discharge.
Factors that provoke uterine bleeding in reproductive age
Causes of dysfunctional uterine bleeding of the reproductive period are associated with:
- impaired blood circulation as a result of thrombosis and vasodilation;
- failure in the systemhypothalamus-pituitary gland-ovaries-adrenal glands; as a result, anovulatory bleeding appears;
- disruption of hormonal homeostasis after abortion;
- infectious, endocrine pathologies;
- stressful situations;
- intoxication of the body;
- taking hormonal and non-steroidal anti-inflammatory drugs.
Therapy and prevention
Treatment of dysfunctional uterine bleeding in women of childbearing age involves surgery and further prevention of bleeding. Perform surgical hemostasis. To prevent relapses, hormone therapy is indicated. They are selected individually depending on the results of histology. The prognosis is favorable with proper treatment. In order to prevent uterine bleeding, women of childbearing age are recommended:
- good nutrition;
- physical education;
- alternation of work and rest;
- hardening;
- timely treatment of infection;
- taking oral contraceptives as agreed with the doctor.
Uterine bleeding in menopausal women
Dysfunctional uterine bleeding (ICD code of the tenth revision during premenopause - N92.4) is a common gynecological pathology that occurs in women 45–55 years old. The reason is associated with metabolic disorders and the normal functioning of the endocrine system. At this time, bleeding is quite difficult compared to other age periods. Contributing factorsbleeding:
- age-related changes in the structure of the hypothalamus, which regulates ovarian function;
- ovarian tumors of a hormonal nature.
Characteristic for pubertal or reproductive age violations of blood clotting in the period of premenopause, does not occur. Simultaneously with the treatment, the doctor reveals an organic pathology:
- does scraping of the mucous membrane of the body and cervical canal;
- performs an ultrasound of the ovaries.
In the future, the tactics of treating dysfunctional uterine bleeding in the premenopausal period will depend on the presence of concomitant gynecological diseases and other pathologies. During treatment, manipulations are necessarily carried out that help eliminate existing metabolic and endocrine disorders. In most cases, the prognosis with proper treatment is favorable. There is evidence that women using oral contraceptives rarely experience premenopausal bleeding. Therefore, doctors consider taking these medications as part of the prevention of uterine bleeding.
Dysfunctional uterine bleeding in the juvenile period
Juvenile or pubertal uterine bleeding is a discharge during puberty from the first menstrual flow to 18 years of age. This pathological condition is considered a severe form of reproductive system disorders during puberty in children and adolescents. True pubertal uterine bleeding includes bleeding that occursdue to a failure of the hormonal balance and the absence of the root cause, i.e., organic diseases of the genital area. Blood discharge in girls is mostly anovulatory in nature. There are juvenile dysfunctional uterine bleeding after the formation of menstrual function after two or three years. Contribute to the development of this phenomenon:
- intoxication of the body;
- changes in hormonal levels due to puberty, taking hormonal medications;
- infectious diseases of a chronic or acute nature;
- stress situations;
- hypovitaminosis caused by malnutrition;
- pathology of the endocrine system;
- underdevelopment of the uterus.
Main signs of juvenile uterine bleeding:
- discharge from the genital tract for more than eight days;
- bleed interval less than 21 days;
- blood loss exceeding 120 ml per day;
- tachycardia;
- weakness;
- thirst;
- headache;
- fatigue;
- pressure reduction;
- dermis and mucous membranes of pale coloration.
Excessive and prolonged bleeding leads to anemia, which is accompanied by a deterioration in general well-being. A dangerous consequence is a change in the mucous membrane of the main female organ, and as a result, there is a risk of developing a malignant tumor of the uterus. In some cases, it can be difficult to distinguish between normal menstruation and bleeding. For these purposes, a whole range ofactivities, including instrumental and laboratory diagnostics. By the end of puberty, the likelihood of juvenile dysfunctional uterine bleeding (ICD-10 - N92.2) decreases. In the future, menstrual dysfunctions are possible, but the reasons will be different, for example, uncontrolled sexual relations leading to abortion. Termination of pregnancy during the formation of the hormonal background leads to serious violations and provokes bleeding. In addition, the resulting inflammatory process poses a threat to the ovaries, which leads to hormonal dysfunction.
Features of treatment of juvenile uterine bleeding
Therapy depends on the clinical manifestations and the cause of their occurrence. In some cases, it is enough to eliminate the external factor, namely emotional stress or physical activity. If the discharge is not accompanied by severe anemia, then the treatment is carried out on an outpatient basis. However, in most cases, hospitalization is required, as the clinic is severe. Stopping pubertal uterine bleeding is carried out simultaneously with the search for the cause that provoked this condition. They use medicines that have a hemostatic, sedative, increase the tone of the uterus, as well as drugs that strengthen blood vessels. When establishing the cause of the discharge, treatment is directed to its elimination. To stop bleeding, hormonal medications "Dufaston", "Utrozhestan" or combined agents containing estrogens and progestogens are used. Further, the restoration of hormonal function is carried out with the help of the following drugs:
- Marvelon.
- Logest.
- Mersilon.
- "Dufaston".
- "Clomiphene" - indicated for relapses for girls over 16 years old.
The doctor selects the dosage, treatment regimen and duration of therapy individually.
As an emergency therapy for dysfunctional uterine bleeding (in the ICD of the tenth revision, this pathology has the code N92), hormonal drugs will be used along with hemostatic agents. Treatment of juvenile uterine bleeding should be comprehensive and include physiotherapy, consultation with a psychologist, neurologist, endocrinologist.
In addition to conservative therapy, adolescents also use surgical hemostasis, i.e. curettage of the uterine mucosa. This method is used in life-threatening conditions. When carrying out this manipulation, there is a minimal traumatic effect on the uterus. The hymen is preserved. A full menstrual cycle is restored within a year after treatment. To prevent relapse, the girls are under the supervision of a doctor.
Prevention
Preventive measures for all ages include:
- treatment of pathologies of the genital area;
- timely detection of hormonal disruptions;
- good nutrition;
- visiting a doctor at the first sign of abnormal bleeding;
- exclusion of bad habits;
- exercise;
- infectious disease prevention;
- taking hormonal drugs in consultation withdoctor.
It is important to remember that uterine bleeding is successfully treated when treated early. Timely therapy significantly reduces the risk of complications.
