Menorragiya (Plentiful periods) – the blood loss during periods exceeding physiological norm (~ 150 ml). Can serve as manifestation of inflammatory processes of a female genital, myoma of a uterus, dysfunction of ovaries, psychological overfatigue. Involves development of anemia, violation of working capacity and quality of life of the woman. Other complications depend on the reason of the main disease. The menorragiya according to the anamnesis, gynecologic survey, ultrasonography of bodies of a small pelvis is diagnosed. If necessary the biopsy and a cytologic research is conducted. Treatment of a menorragiya can be therapeutic and surgical.
Menorragiya is one of options of a hyper menstrual syndrome (plentiful monthly) at which regular menstrual bleeding lasts over 7 days, and blood loss at the same time makes more than 100-150 ml. Plentiful and long periods disturb about 30% of women, however, not everyone handles a menorragiya problem to the gynecologist. Distinguish primary menorragiya arising along with the first periods, and secondary – developing after the period of a normal menstruirovaniye.
The main manifestation of a menorragiya are long and plentiful menstrual allocations with blood clots. The long and expressed blood loss can lead to the anemia which is shown in deterioration in health, weakness, dizziness, development of unconscious states. Quite often at menorragiya there are bleedings from gums and a nose, bruises, bruises on a body. At a periods menorragiya so plentiful that the woman is forced to replace a hygienic tampon or laying each hour, and sometimes and more often.
Main reasons for a menorragiya
The following violations can serve as the reasons leading to development of a menorragiya:
- Hormonal instability. It is especially expressed at patients of preclimacteric and awkward age. Instability of a hormonal background during these physiological periods increases risk of development of a menorragiya.
- Diseases of reproductive system: myoma, polyps, uterus, dysfunction of ovaries. Develop owing to a hormonal imbalance in an organism and serve as the menorragiya reason at 80% of women.
- Use of intrauterine contraceptives. Menorragiya in this case is undesirable side effect which can demand removal of Naval Forces (an intrauterine spiral).
- The diseases connected with violation of the curtailing system of blood (for example, deficiency of vitamin K, thrombocytopenia), and also reception of some medicines influencing coagulability (anticoagulants). The raised bleeding accompanying violations of the curtailing system of blood can be shown by plentiful periods – menorragiya.
- Hereditary menorragiya. Quite often the menorragiya is the family disease transmitted in the female line of inheritance.
- Diseases of pelvic bodies, thyroid gland, kidneys, liver, heart. At a menorragiya the patient should consult with the endocrinologist and the therapist for an exception of the endocrine and all-somatic reasons of plentiful periods.
- Excessive power loadings, overfatigue, stressful situations, change of climatic conditions All factors forcing an organism to adapt to new conditions and loadings can provoke development of a menorragiya.
Diagnostics of a menorragiya
The diagnosis "menorragiya" is made on the basis of complaints and signs of excessive blood loss. At any uterine bleeding pregnancy, in particular, extra-uterine is excluded. The test for pregnancy - definition in blood of a horionichesky gonadotrophin allows to exclude pregnancy and the related pathology.
For diagnosis of a menorragiya data of the anamnesis matter (reception of medicines, complications of the previous pregnancy and childbirth etc.). For clarification of the reasons of a menorragiya inspection of a vagina and neck of a uterus regarding existence of foreign matters, traumatic damages, polyps, tumors, inflammatory or atrophic changes is performed.
At suspicions of pathology of a uterus and ovaries carry out diagnostic procedures: Ultrasonography of bodies of a small pelvis, hysteroscopy, uterus neck biopsy, scraping and analysis of fabric of endometrium. By methods of laboratory diagnostics at a menorragiya investigate hemoglobin, carry out biochemical blood test and a koagulogramma, define a hormonal background, onkomarker of CA 19-9, SA-125. For identification of precancer or cancer cells in a neck of a uterus carry out the cytologic analysis of dab across Papanikolau.
Maintaining a menstrual calendar in which the periods duration, a profuseness and the nature of allocations is noted is recommended to the women suffering from a menorragiya. The profuseness of blood loss is determined by the frequency of change of laying or a tampon.
Therapeutic treatment of a menorragiya
The way of treatment of a menorragiya is chosen depending on the reason, a profuseness and duration of menstrual bleedings. Self-treatment of a menorragiya can aggravate a disease only.
As medicamentous therapy of a menoragiya for regulation of hormonal balance long reception of hormonal contraception is appointed. The progesterone and estrogen which are a part of oral contraceptives interfere with excess growth of endometrium and reduce the number of allocations during periods more than by 40%. Selection of oral contraceptives is carried out on consultation of the gynecologist in an individual order.
Reception of additives of iron in order to avoid iron deficiency anemia is recommended to women with a menorragiya. Reception a routine and ascorbic acid will help to lower blood loss. The anti-inflammatory medicines (ibuprofen) influencing duration and the number of bloody allocations are applied to treatment of a menorragiya. At severe bleedings appoint styptic medicines – etamsylate, chloride or a gluconate of calcium, aminocaproic acid. At violation of hormonal balance effectively homeopathic treatment.
For treatment of a menorragiya use intrauterine systems with levonogestrely. Possessing contraceptive action, they interfere with endometrium proliferation, reduce its thickness and blood supply. However, if the menorragiya is caused by application of an intrauterine contraceptive, then it it is necessary to remove and use other methods and means of protection. Normalization of the mode, good rest and food is recommended to women with menorragiya. After the termination of menstrual bleeding conduct a course of physiotherapeutic procedures (10-15 sessions of ozokerite and a diathermy). Some cases of a menorragiya demand surgical intervention.
Surgical treatment of a menorragiya
The surgical gynecology carries out treatment of a menorragiya according to the following indications:
- recidivous current of a menorragiya;
- physiological violations or injuries of genitals;
- inefficiency of the carried-out drug treatment of a menorragiya;
- the expressed iron deficiency anemia.
With the diagnostic and medical purpose at menorragiya carry out the hysteroscopy allowing to diagnose any pathology of a uterus (for example, endometrium polyps) and to eliminate it. The scraping of a cavity of a uterus allows to reduce bleeding then the menorragiya renews again by several menstrual cycles.
At long and plentiful menstrual bleedings or in the presence of a fibromyoma and polyps resort to a hysterectomy - expeditious removal of a uterus. In some cases performing its nadvlagalishchny amputation is possible. Expeditious treatment of a menorragiya is applied at women 40 years, at younger age – only in especially hard cases are more senior. Diseases and tumors of a thyroid gland causing a menorragiya are treated or is medicamentous, or surgically.
Menorragiya at teenagers
As instability of a hormonal background is characteristic of teenagers, quite often the menorragiya occurs at girls of 13-16 years. The main reason for a teenage menorragiya – violation of balance between levels of progesterone and estrogen, influencing maturing and rejection of endometrium of a uterus. The burdened current of periods can develop in cases of increase in a thyroid gland, bad coagulability of blood, infections of a genital tract. Hereditary forms of a koagulopatiya (violations of a hemostasis) are the frequent reason of teenage menorragiya.
Are transferred by teenagers of a menorragiya especially hard and demand immediate medical consultation with the purpose of determination of the causes and correction of violations. In the absence of treatment of menorragiya at teenagers further at 30% develops ovaries.
Together with the girl her mother should come to primary consultation and to inform the doctor on the family anamnesis, the course of pregnancy and diseases transferred the child. The doctor estimates anthropometrical these patients (growth, weight), extent of development of secondary sexual characteristics for an exception of the pathological processes influencing development of the girl. Time of the beginning of periods, feature of course and the characteristic of a menstrual cycle (cycle duration, duration, a profuseness and morbidity of menstrual bleeding etc.) become clear. The attention is paid to questions of influence of periods on the general health and efficiency of the girl (whether she skips studies because of a menorragiya whether she is engaged in sports sections, etc.). This information is an important indicator as the general, and gynecologic health of the teenager.
At a menorragiya at teenagers the research of content of hemoglobin of blood for detection of anemia is obligatory. In the presence of iron deficiency anemia at patients with menorragiya purpose of medicines of iron is carried out. The low-dosed hormonal contraceptives containing no more than 35 mkg estrogen component in 1 tablet of medicine are applied to regulation of a menstrual cycle at teenage menorragiya. Schooling of the girl to maintaining a menstrual calendar with fixing of characteristics of a menstrual cycle will be useful.
Efficiency of result of treatment of a menorragiya is estimated approximately in 6 months, and as its indicator serves restoration of normal volume of menstrual bleeding. Further observation at the gynecologist standard – 2 times a year.
Prevention of a menorragiya
Menorragiya, even if she does not serve as display of a serious and dangerous disease, gives to the woman a lot of inconvenience and considerably worsens quality of her life. As preventive measures of development of a menorragiya women are recommended to abstain from excessive physical activities, occupations strength sports, to avoid reexhaustions, stresses, sharp change of climatic conditions. At inefficiency of these measures and deterioration in health the address to the doctor has to be immediate.
Reception of the polyvitaminic complexes including group B vitamins, vitamin C, folic acid and iron is useful to prevention of a menorragiya. Regular filling of a menstrual calendar will help to define the moment of emergence of a menorragiya that will allow to hold diagnostic and medical events in due time.
Bleeding always is medical emergency. Therefore, tightening on a visit to the doctor at development of a menorragiya, the woman independently aggravates indicators of expressiveness of anemia, increases danger of development of an endometritis, worsens a condition of the curtailing system of blood.