Uterine secretions that are not associated with systemic disorders, organic diseases, or pregnancy are called dysfunctional uterine bleeding. They are called DMK for short, the frequency of such a pathology is found in 15–20 percent of all patients with a gynecological profile, regardless of the age of the woman. From the normal discharge during menstruation, they are distinguished by the duration and volume of blood loss. A provocative factor in copious discharge is often a violation of the normal functioning of the ovaries.
Causes of DMK
Provoking factors in reproductive age are:
- Postoperative period preceded by diagnostic curettage, removal of polyps or abortion.
- Dysfunction of the ovaries, manifested by insufficient synthesis of hormones, polycystic.
- 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.
- Taking some hormonal medications, including contraceptives, as well as non-steroidal anti-inflammatory drugs.
- Adrenal gland failure.
- Disruption in the production of hormonal substances that affect the menstrual cycle.
Dysfunctional uterine bleeding during premenopause is caused by:
- blood clotting disorder;
- changes in the hypothalamus;
- malignant neoplasms in the uterus;
- lack of estrogen and progesterone;
- polyps of glandular nature;
- endometrial hyperplasia.
Classification of DMK
Uterine bleeding is divided by 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.
The classification of dysfunctional uterine bleeding by the 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 bleeding of an acyclic nature. This species is characterized by blood discharge after or before menstruation.
- Hypermenorrhea is an abundant monthly discharge, accompanied by a large loss of blood.
- Polymenorrhea. Menstruation lasts longer than usual. The volume of blood discharge increases.
The following classification of dysfunctional uterine bleeding is based on the age period:
- juvenile;
- reproductive;
- menopause.
Diagnostics
The complex of diagnostic measures includes:
- History taking.
- Examination of the cervix - detecting visible changes.
- Cytological analysis of scraping from the cervical canal.
- Ultrasound - to detect pathology of the ovaries, endometriosis or fibroids.
- Blood test for hormonal substances, general, biochemistry.
- Diagnostic curettage - identification of atypical cells, hyperplasia.
- MRI - detection of abnormalities in the pituitary and hypothalamus.
If there are indications, additional examination methods and consultations with specialist doctors are recommended.
Pathogenetic mechanism
Dysfunctional uterine bleeding (ICD-10 code: N92) is a consequence of hormonal malfunction and dysregulation of ovarian functions, which are monitored by the hypothalamic-pituitary system. Failure of the pituitary gland leads to impaired follicular maturation and menstrual function. As a result, estrogen levels increase in the female body. Due to the lack of corpus luteum synthesis in the ovaries, progesterone is not produced. In the uterus, the growth of the endometrium is observed, 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 recurrence. The main signs of pathological bleeding:
- dizziness;
- pain in the lower abdomen;
- weakness;
- pressure reduction;
- darkening in the eyes;
- discomfort in the lumbar region;
- poor appetite;
- thirst;
- quite a large amount of discharge;
- irregular periods;
- prolonged menstruation.
Therapy. Effects
According to clinical recommendations, dysfunctional uterine bleeding is the reason for hospitalization, and urgent. The principles of treatment are as follows:
- stopping bleeding;
- relapse prevention;
- scraping;
- hormonal hemostasis;
- elimination of the consequences of hemorrhage;
- the use of plasma-replacing drugs with large blood loss.
With bleeding, both conservative and surgical treatment is used. In the first case, it happens:
- Hormonal, i.e., hormonal medications are prescribed that help restore the menstrual cycle. The course of treatment is long, up to eight months. Well proven drugs are "Jess", "Rigevidon", "Yarina." The treatment regimen is selected by the attending doctor.
- Non-hormonal - aimed at strengthening the elasticity and strength of blood vessels.
For these purposes, use Ascorutin, Detralex, Flebodia and other means. In case of low blood coagulation, 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 for pathological conditions requiring urgent surgical intervention, for example, in the detection of fibroids or polyps.
When choosing a method of therapy, the doctor takes into account the age, duration and intensity of the discharge, the reason for the failure of the menstrual cycle, as well as the duration of the pathology.
With timely treatment, the prognosis is favorable. Untimely started therapy leads to persistent anemia and further to infertility. If the provoking factor of bleeding is ovarian dysfunction and hormonal disruptions, then the risk of endometrial degeneration into a malignant neoplasm is high. The most serious consequence is a fatal outcome caused by prolonged profuse discharge.
Factors provoking uterine bleeding in reproductive age
The causes of dysfunctional uterine bleeding of the reproductive period are associated with:
- circulatory disorders due to thrombosis and vasodilation;
- failure in the hypothalamus-pituitary-ovarian-adrenal system; as a result, anovulatory bleeding appears;
- disruption of hormonal homeostasis after an abortion;
- infectious, endocrine pathologies;
- stressful situations;
- intoxication of the body;
- taking hormonal and non-steroidal anti-inflammatory drugs.
Therapy and Prevention
The treatment of dysfunctional uterine bleeding in women of childbearing age implies surgical intervention and further prophylaxis of blood secretions. Surgical hemostasis is performed. To prevent relapse, hormonal agents are 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 training;
- alternation of work and rest;
- hardening;
- timely treatment of infection;
- taking oral contraceptives in consultation with the doctor.
Uterine bleeding in women in menopause
Dysfunctional uterine bleeding (ICD code of the tenth revision during the premenopausal period - 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. Factors contributing to blood secretions:
- age-related changes in the structure of the hypothalamus, which regulates ovarian function;
- tumors of the ovaries of a hormonal nature.
Blood clotting disorders characteristic of puberty or reproductive age do not occur during premenopause. Simultaneously with the treatment, the doctor identifies organic pathology:
- makes curettage of the mucous membrane of the body and cervical canal;
- conducts an ultrasound of the ovaries.
In the future, the tactics of treatment of dysfunctional uterine bleeding in the premenopausal period will depend on the presence of concomitant gynecological diseases and other pathologies. During treatment, manipulations are surely carried out that help eliminate the existing metabolic and endocrine disorders. In most cases, the prognosis with proper treatment is favorable. There is evidence that women using oral contraceptives rarely have bleeding during premenopause. Therefore, doctors consider taking these medications as an element in the prevention of uterine bleeding.
Juvenile dysfunctional uterine bleeding
Juvenile or pubertal uterine bleeding is a discharge during puberty from the first menstrual flow to 18 years. This pathological condition is considered a severe form of reproductive system disorders during puberty in children and adolescents. True puberty uterine bleeding includes bleeding that occurs due to a malfunction in the hormonal balance and the absence of the root cause, i.e., organic diseases of the genital area. Blood discharge in girls is mainly anovulatory in nature. Juvenile dysfunctional uterine bleeding occurs after the establishment of menstrual function after two or three years. Contribute to the development of this phenomenon:
- intoxication of the body;
- change in hormonal levels due to puberty, hormonal medication;
- infectious diseases of a chronic or acute nature;
- stressful situations;
- hypovitaminosis caused by malnutrition;
- pathology of the endocrine system;
- underdevelopment of the uterus.
The main signs of juvenile uterine bleeding:
- discharge from the genital tract for more than eight days;
- the interval between bleeding is less than 21 days;
- blood loss exceeding 120 ml per day;
- tachycardia;
- weakness;
- thirst;
- headache;
- fast fatiguability;
- pressure reduction;
- dermis and mucous membranes of pale staining.
Heavy and prolonged bleeding leads to anemia, which is accompanied by a deterioration in overall health. 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 of activities is carried out, including instrumental and laboratory diagnostics. By the end of the puberty, the likelihood of juvenile dysfunctional uterine bleeding (ICD-10 - N92.2) is reduced. 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 disorders and provokes bleeding. In addition, the resulting inflammatory process poses a threat to the ovaries, which leads to hormonal dysfunction.
Features of the treatment of juvenile uterine bleeding
Therapy depends on the clinical manifestations and the reasons for their appearance. In some cases, it is enough to eliminate an external factor, namely emotional stress or physical activity. If the discharge is not accompanied by severe anemia, then treatment is carried out on an outpatient basis. However, in most cases hospitalization is required, as the clinic is difficult. The stop of pubertal uterine bleeding is carried out simultaneously with the search for the cause that provoked this condition. Apply medicines that have hemostatic, sedative, increasing the tone of the uterus effect, as well as drugs that strengthen blood vessels. When establishing the cause of discharge, treatment is directed to its elimination. To stop bleeding, use the hormonal medicines Dufaston, Utrozhestan or combined products containing estrogens and gestagens. Further, hormonal function is restored using the following drugs:
- Marvelon
- Logest.
- Mercilon.
- 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 code N92), hormonal drugs will be used together with hemostatic agents. Treatment of juvenile uterine bleeding should be comprehensive and include physiotherapy, consultation of a psychologist, neurologist, endocrinologist.
In addition to conservative therapy, surgical hemostasis is also used in adolescents, 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. For the prevention of relapse, 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;
- going to the doctor at the first sign of pathological bleeding;
- exclusion of bad habits;
- physical education classes;
- prevention of infectious diseases;
- taking hormonal drugs in consultation with the doctor.
It is important to remember that uterine bleeding is successfully treated when treated early. Timely initiated therapy significantly reduces the risk of complications.