Anovulyatorny uterine bleeding
Anovulyatorny uterine bleeding – uterine bleeding at a single-phase (anovulyatorny) menstrual cycle. As a rule, appears after a periods delay, differs from usual menstrual bleeding in the bigger duration and size of blood loss. Can provoke anemia. Anovulyatorny uterine bleedings arise against the background of infantility, malformations, chronic intoxications, infections, endocrine violations, stresses and bad food. Are diagnosed on the basis of complaints, the anamnesis, gynecologic survey and results of special researches. Treatment – pharmacotherapy, elimination of the main pathology.
Anovulyatorny uterine bleeding
Anovulyatorny uterine bleeding – the dysfunctional bleeding arising against the background of an anovulyatorny cycle. It is provoked by harmful effects, observed against the background of some diseases and congenital anomalies. Arises owing to the atresia of an unripe follicle or a persistention of a follicle involving violation of cyclic development of a blanket of endometrium and growth of this layer with its subsequent rejection. Anovulyatorny uterine bleedings come to light at pubertatny or preklimakterichesky age more often. Differ from usual periods in an irregularity, bigger duration and size of blood loss. Are combined with the infertility caused by lack of an ovulation. Can provoke secondary iron deficiency anemia. Treatment of anovulyatorny uterine bleedings is performed by experts in the field of gynecology.
What is an anovulyatorny menstrual cycle
The normal menstrual cycle consists of two phases. The first phase begins from the first day of periods. The old inside layer of endometrium is torn away, then proliferation – formation of a new inside layer ready to accept the impregnated ovum begins. At the same time in an ovary under the influence of follikulostimuliruyushchy hormone there is a maturing of an ovum. After maturing of an ovum the forward share of a hypophysis throws out in blood peak amount of lyuteineziruyushchy hormone which initiates an ovulation – a rupture of a mature follicle and an exit of an ovum in a fallopiyeva a pipe. After that the second phase of a menstrual cycle begins.
On the place of a follicle the yellow body producing progesterone is formed. Activity of proliferation of endometrium decreases, height of a blanket increases, optimum conditions for implantation of an ovum are created. Some days before the beginning of periods growth of endometrium stops. The yellow body regresses, the level of progesterone decreases. Blood circulation in a blanket of endometrium is broken, cages nekrotizirutsya. The angiospasm is replaced by their paralytic expansion, and the become lifeless cages leave together with menstrual blood.
At an anovulyatorny cycle the second phase is absent. The ovulation does not come, fertilization is impossible. The return development of a follicle (atresia) or continuation of growth of a follicle with formation of kistovidny education can be observed (persistention). The yellow body is not formed, the level of progesterone does not increase, cells of endometrium continue to proliferirovat. Because of lag of growth of vessels food of a blanket worsens, in it there are dystrophic changes. Rejection of a nekrotizirovanny epithelium is followed by opening of vessels and plentiful bleeding.
Single-phase cycles which can result from violation of activity of a hypophysis and reduction of amount of follikulostimuliruyushchy or lyuteineziruyushchy hormone, and also disorders of hormonal balance (change of a ratio of estrogen, androgens, lyuteineziruyushchy and follikulostimuliruyushchy hormone) are an immediate cause of anovulyatorny bleeding. The single-phase cycles which are followed by anovulyatorny uterine bleedings are provoked by infantility, malformations, metabolic disorders, avitaminosis, chronic intoxications, infectious diseases and heavy stresses.
Single-phase cycles are not always the certificate of pathology, and menorragiya at such cycles are not always regarded as anovulyatorny uterine bleedings. Normal such cycles arise within 1-2 years after menarche, in a premenopauza and during feeding by a breast. Besides, at some women anovulyatorny cycles alternate with ovulyatorny. The diagnosis is exposed only when single-phase cycles are followed by plentiful bleedings with violation of the general state and working capacity.
Allocate three options of anovulyatorny uterine bleeding:
- at an atresia of a set of follicles
- at a short-term rhythmic persistention of follicles
- at a long persistention of follicles
The atresia of a set of follicles is diagnosed at teenage age. Anovulyatorny uterine bleeding begins after a periods delay for a period of a half moon before half a year, can be moderate, but long (more than 10-15 days) or very plentiful, quickly leading to development of anemia. In hard cases the secondary violations of coagulability which are even more aggravating anovulyatorny uterine bleeding are possible.
The short-term rhythmic persistention of follicles can be observed at any age, but to a thicket comes to light in the reproductive period. Is followed by the menstrualnopodobny anovulyatorny uterine bleeding which is usually arising after a periods delay for a period of several days up to several weeks. The long persistention of follicles usually comes to light in a premenopauza, but can occur also at women of other age. Bleedings are long, plentiful, repeat through 1,5-2 and more than a month. At a long persistention more often than at other forms, anemia is observed. Accession of secondary iron deficiency anemia at all forms of anovulyatorny uterine bleeding is followed by weakness, drowsiness, bystry fatigue, dizzinesses, faints, tachycardia, perspiration, pallor of skin and mucous.
The diagnosis is established on the basis of complaints of the patient, collecting the anamnesis, data of the general and gynecologic survey and special researches. In favor of this pathology unusually plentiful or long bleedings developing after a periods delay testify. During gynecologic survey of patients with anovulyatorny uterine bleedings the positive symptom of a pupil which is not weakening and not disappearing in the second half of a cycle is found. At a slime research from the tservikalny channel the positive phenomenon of a fern comes to light. Rectal temperature remains stable throughout all cycle.
The separate diagnostic scraping at anovulyatorny uterine bleedings is carried out at reproductive and premenopauzalny age. At patients of teenage age material for a histologic research is received by aspiration. At a histologic research of the material taken from women with a rhythmic persistention of follicles excess proliferation of endometrium or a ferruterous and cystous giperplaziya of endometrium comes to light; patients with a long persistention of follicles have a ferruterous and cystous, adenomatozny, polipozny or atipichesky giperplaziya of endometrium.
For definition of the reasons of development of anovulyatorny uterine bleedings and an exception of other diseases which are followed by similar symptomatology appoint comprehensive inspection. Anovulyatorny bleedings differentiate with blood diseases, thrombocytopenia, dysfunction of a liver, diseases of endocrine system, organic and inflammatory diseases of reproductive system. Depending on complaints and results of survey the patient with anovulyatorny uterine bleeding can be directed to consultation to the endocrinologist, the therapist or the infectiologist. The program of inspection includes the general blood test, the general analysis of urine, biochemical blood test, blood test on hormones, ultrasonography of bodies of a small pelvis and other researches.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment of this pathology can be performed on an outpatient basis or in the conditions of gynecologic office and includes three stages: stop of anovulyatorny uterine bleeding, normalization and regulation of a menstrual cycle. A priority of the gynecologist is reduction of blood loss and a stop of bleeding. At primary address this problem is solved at a stage of a separate diagnostic scraping. At the repeated address concerning anovulyatorny uterine bleeding carry out conservative therapy.
Indispensable condition of conservative therapy is lack of signs of a giperplaziya of endometrium by results of ultrasonography and the histologic decision about a condition of endometrium received not earlier than within three months prior to treatment. At anovulyatorny uterine bleedings apply means to strengthening of a vascular wall and increase in coagulability of blood, carry out a hormonal hemostasis. At an atresia of a set of follicles usually use estrogen, at a regular persistention – synthetic progestins, at a long persistention – gestagena. Medicines select individually taking into account age, existence or absence of anemia and other factors.
The main method of surgical treatment of anovulyatorny uterine bleeding is the scraping which is carried out along with the medical and diagnostic purpose. The procedure is obligatory at all bleedings at patients in a premenopauza and at the majority of anovulyatorny uterine bleedings at patients of reproductive age. To teenagers the scraping is carried out only according to vital indications. In exceptional cases carry out nadvlagalishchny amputation of a uterus or a hysterectomy. At patients of premenopauzalny age with the indication to operation anovulyatorny uterine bleedings in a combination precancer diseases of a neck of a uterus and an atipichesky giperplaziya of endometrium are. In other cases removal of a uterus is carried out only at very heavy bleedings, life-endangering patients.
Apply iron medicines to correction of the secondary iron deficiency anemia which arose owing to anovulyatorny uterine bleedings. Carry out treatment of infectious, somatic and endocrine diseases. Eliminate chronic intoxications, appoint the balanced diet. The gynecologist-endocrinologist is engaged in treatment of an anovulyatorny menstrual cycle. Sick appoint gonadotrophins for a period of 3-6 months in an interval between the 11 and 14 day of a cycle. In 6-8 days prior to the beginning of periods to patients with anovulyatorny uterine bleedings intramuscularly enter progesterone.
Apply an endonasal electrophoresis (impact on gipotalamo-hypophysial area), electrostimulation of a neck of a uterus and other physiotherapeutic procedures to stimulation of an ovulation. Hormonal therapy and physical therapy of anovulyatorny uterine bleedings is carried out against the background of the all-strengthening treatment. Sometimes in the first phase of a menstrual cycle appoint the vagotropny medicines stimulating maturing of a follicle. In the second phase apply the simpatikotropny medicines increasing activity of a yellow body. The forecast depends on the reason of development of systematic single-phase menstrual cycles and the subsequent anovulyatorny uterine bleedings.