Dysfunctional bleeding in the uterus includes a fairly large group of bleeding during the anovulatory cycle. They occur without ovulation, the corpus luteum is absent. Their onset provokes the persistence of the follicle. They also arise as a result of prolonged estrogenic action.
The persistence of the follicle is characterized by the achievement of one or more follicles of a certain maturation. However, ovulation and formation of the corpus luteum do not occur. The duration of the follicle in this case is several months and is accompanied by the production of a significant amount of estrogen hormones.
Achieving this condition can last from seven to eight days. After this, changes of a regressive nature and a decrease in estrogen levels in the body are detected. Hormonal decline provokes destructive disorders of the endometrium and bleeding, similar to menstrual bleeding. The prolonged persistence of the follicle is combined with a delay in menstruation (in some cases up to several weeks) and heavy bleeding over a long period. In addition, the condition is accompanied by glandular cystic hyperplasia in the endometrium. Bleeding of this type is most often detected in premenopausal and juvenile age.
Juvenile bleeding accounts for five to ten percent of all cases. They occur during incomplete puberty during a menstrual cycle. For girls from twelve to fourteen years old, the cycle is characterized as anovulatory in 60% of cases, from fifteen to seventeen years old in 43% of cases and from 18 to 20 years old in 27%.
Follicular atresia is accompanied by prolonged estrogen production. However, their number is relatively small. Constant estrogen content, not characterized by peaks, provokes endometrial hyperplasia. In this case, a change in vascular tone is detected, which causes a violation in the blood circulation of the endometrium, the occurrence of bleeding and foci of necrosis. As a rule, cycle delays in this condition are longer than those that accompany the persistence of the follicle.
In both states, anovulatory bleeding is detected, which usually occurs after a menstrual delay, which can last for several days, or up to six to eight weeks or several months. With persistence, more heavy bleeding is observed, but they are less prolonged.
Diagnosis of anovulatory bleeding is carried out taking into account the clinical basis and data of endocrinological studies. Persistence is characterized by the presence of a basal temperature below 37º, a high content (50-100 mcg / day) of estrogen. In this case, a low content of pregnanediol is detected.
Atresia is accompanied by a low constant basal temperature. At the same time, moderate excretion of estrogens and reduced excretion of pregnanediol are observed.
Differentiation of the diagnosis is made with uterine diseases of an organic nature (uterine fibroids, cervical cancer and others), with common diseases (liver, blood, hemorrhagic diathesis and others). Patients who are diagnosed with follicle persistence are prescribed treatment aimed at stopping bleeding (the first stage of therapy) and restoring normal menstruation (second stage of therapy). The task of the first stage is to provoke secretory transformation in hyperplastic endometrium. The second stage of therapy performs the task of preventing repeated bleeding and consists in restoring cycles and stimulating ovulation.