Opsomenorey – lengthening of a menstrual cycle at which its duration makes over 35 days. Violation has cyclic character, periods repeat at least, than in 3 months. Monthly can proceed both in the form of a gipooligomenorea, and in the form of a gipermenorea. The probability of approach of pregnancy at patients from opsomenorey is reduced. Inspection at this violation includes standard gynecologic survey, ultrasonography of bodies of a small pelvis, hormonal blood tests, a kolpotsitologiya, according to indications – RDV. The strategy of treatment of an opsomenorea is defined with causes of infringement of a menstrual cycle; the leading role in it is played by hormonal therapy.
Opsomenorey () – increase in an interval between periods from 36 days to 3 months (at norm of 21-35 days). Along with oligomenorey, gipomenorey and spaniomenorey, treats options of a hypomenstrual syndrome. Primary (congenital) or secondary (acquired) character can have Opsomenorey. In practical gynecology speak about primary option of a bradimenorea in case rare monthly are noted from the very beginning of menstrual function. The secondary option is characterized by an urezheniye of periods after the period when the woman had a normal menstrual rhythm. As well as other violations of a menstrual cycle, negatively affects reproductive function that, first of all, is connected with change of staging of a cycle, inferiority or lack of an ovulation.
Primary it is formed as a result of malformations of genitals, a delay of sexual development, the general and genital infantility, an adynamy in the period of a puberty. In this case menarche usually comes late, and further the rhythm of periods becomes rare. Lead various acquired pathological states which are negatively affecting menstrual function to development of a secondary opsomenorea. It can be alimentary dystrophy, a psychoemotional trauma, hard physical work, severe intoxications. Change of a rhythm of periods as an opsomenorea can be associated with surgeries - abortions, RDV, an ovary resection, an ooforektomiya, adneksektomiy.
Sometimes develops against the background of endocrine violations (often – a polikistoza of ovaries, a hypothyroidism, Shikhan's syndrome), autoimmune, parasitic diseases, tumors of a brain, slow infectious processes, including urinogenital system. Except a pathological opsomenorea the physiological urezheniye of periods – for example, during puberty and formation of a cycle, in the premenopauzalny period in connection with gradual fading of function of ovaries meets.
Clinically proceeds in the form of rare monthly. The intermenstrual interval makes over 35 days, but no more than 3 months. Intensity of menstrual bleeding usually insignificant (dabs or drops of blood), duration short. Change of staging of a menstrual cycle causes inferiority of an ovulation or an anovulyation therefore many patients from opsomenorey have infertility. In certain cases passes into a secondary amenoreyu. Along with rare monthly, there are symptoms of the main disease.
2 various types of a current can have Opsomenorey: with existence of the prolonged two-phase or monophase menstrual cycle. At the extended two-phase cycle the delay of monthly is caused by the dragged-out process of maturing of a follicle. The follicle or does not develop in the first phase of a cycle at all, or undergoes an atresia at one of development stages. Secretion of estrogen in this case low, basal temperature – single-phase, a kolpotsitologiya indicates low extent of proliferation of an epithelium. In the further ambassador of a growth inhibition the follicle nevertheless ripens, but the ovulation can occur for 20-30 day of a menstrual cycle. Duration of a phase of a yellow body is shortened or not changed. Level of sex hormones does not differ from that at a normal menstrual cycle, basal temperature in the second phase becomes above 37 °C, the cytology of vaginal dabs reflects sekretorny changes of endometrium.
Opsomenorey against the background of a monophase cycle occurs less often – in 22-24% of cases, usually at patients with a hypoplasia of genitals. The condition of endometrium at the same time remains without dynamics and corresponds to the beginning of a proliferative phase. As one more reason of an opsomenorea at a monophase cycle the follicle persistention can serve. In this case the phase of a yellow body does not come, and the persistiruyushchy follicle creates conditions for an endometrium giperplaziya. The return development of a follicle is followed by sharp falling of level of estrogen and rejection of a functional layer of a uterus of endometrium that is clinically expressed by a menorragiya.
Diagnostics of an opsomenorea
Establishment of the reasons of an ospsomenorea demands carrying out a wide range of diagnostic actions. At primary visit to the gynecologist complaints, character of a menstrual cycle, the gynecologic and all-somatic anamnesis are specified. Survey on a chair allows to reveal anomalies of development of bodies of a reproduction, to take dab for a kolpotsitologichesky research ("a hormonal mirror"). By means of ultrasonography of bodies of a small pelvis anatomic deviations, inflammatory processes which served development of an opsomenorea are defined.
For inspection of the infectious status the analysis of gynecologic dabs is carried out: microscopy, PTsR, on flora. For the purpose of identification of hormonal violations the FSG, LG level, Prolactinum, an estradiol, progesterone is investigated. Definition of hormones of adrenal glands, a thyroid gland is in some cases shown. At suspicion of ekstragenitalny pathology as the opsomenorea reason, the patient goes for consultation to the endocrinologist, the neurosurgeon.
Treatment of an opsomenorea
The directions and volume of medical actions are defined by the main pathology, age and reproductive plans of the woman. Congenital anatomic defects, severe forms of sexual infantility badly give in to correction. In these cases tactics of treatment of an opsomenorea is developed together with geneticists and endocrinologists. Some types of pathology (a tumor of a brain, SPKYa) can demand surgery.
The leading role in regulation of a menstrual cycle is played by hormonal therapy. It allows to restore a normal rhythm of periods. If it appears insufficiently for pregnancy approach, resort to stimulation of an ovulation. If inflammatory gynecologic diseases were the reason of an opsomenorea, carry out antibiotic treatment, vitamin therapy, immunostimulation. Use treatment by natural factors (a balneoterapiya, mud cure), an electrophoresis of a vorotnikovy zone, gynecologic massage, acupuncture. At deficiency of weight the individual diet with a full-fledged diet is developed. The patient with opsomenorey is recommended to avoid physical activities and psychoemotional shocks.