One resorted to my teenage doctor, "Oxana, see our girl. 16 years, 72 hemoglobin. " Wow! At the level of hemoglobin 70-90g / L, we are talking about moderate anemia. Less than 70 g / l - severe anemia, it is necessary to solve the issue of blood transfusion.
The level of hemoglobin found by chance a girl on the eve of donated blood to get help at the school after SARS. Account time in such a situation is on the clock, day and already lost. The situation is alarming.
- Lena, all tell the doctor! What have you done? Abortion? Tablets saw? I do not hide anything.
Lena - beautiful tall girl, long hair, brown eyes. Few spoils greenish yellow complexion.
- Yes, nothing that I did not do ...
Lena is sexually active for a year. Well lives ... The two partners, two of sexual contact. Last 5 months ago. Both contacts are protected by a condom. Relationship failed. Sometimes.
- Lena, what's bothering you?
- I'm very plentiful monthly .
- Always plentiful?
- Always. From the very beginning.
From history
The first menstruation came at age 13. Menses are 5-6 days after 28 of them for 3-4 days very much.
80-120 ml of blood and per menstrual bleeding - a profuse blood loss leading to iron deficiency anemia. Blood loss over 120 ml per cycle - life-threatening.
The problem of objectification of blood loss volume is quite complicated. And the patient and the doctor is difficult to estimate the amount of lost blood. Today, there are special plates, believes based, but in Russia this counting method is not widely used.
Doctors define special test questions that help identify heavy blood loss.
- At night the proceeds? We have to change the gasket at night?
- It happens that a pad is not enough for one hour?
- It happens that you take with you extra clothes?
Lena is the way it is.
- Good. Come on a chair, let's see how it looks.
While the girl undresses, I estimate the thickness of the corner of my eye pads and the number of bleeding. Well, very well for 10 am.
- Oh, and I still have a tampon ...
- Another swab ?! It is through the pad so many passed ?!
Security question "Do you use tampons and pads at the same time? Whether there are thus leak? "Too, but it is usually necessary to ask very adult aunt.
From history
Uterus corresponds to the age, firm, mobile, painless. In the appendages nothing special found.
It's really common Lenochkina menstruation.
This girl, we was hospitalized. She certainly help - examine, restore blood loss. Then we will find a long-term treatment, and of menstrual bleeding will be gone.
PALM (Eng. - palm)
P olyp - endometrial polyp
A denomyosis - adenomyosis
L eiomyoma - leiomyoma, uterine fibroids
M alignancy and hyperplasia - ozlokachestvlnie (cancer) and hyperplasia
COEIN (in consonance with English. Coin - coin)
C oagulopathy - coagulopathy, violation of blood coagulation
O vulatory dysfunction - ovulation disorders
E ndometrial - disease of the endometrium
I atrogenic - iatrogenic injury (medicinal use hormones, intrauterine devices, and others.)
N ot yet classified - not yet classified
According to the classification PALM-COEIN, the diagnosis of chronic abnormal uterine bleeding set, if unpredictable, overly long, abnormal volume and / or frequency of menstruation continues 3 months.
The doctor should be a clear sequence of actions: detailed inquires about the nature of menstruation, said co-morbidities, take medication, and lifestyle factors potentially contributing to the emergence of abnormal uterine bleeding .
Further assessment depends on the patient's reproductive plans, but be sure to include a detailed study of the structure of the uterus, the level of hemoglobin and hematocrit, search endocrine causes of ovulatory disorders, markers of blood coagulation disorders.
Highly effective treatment uterine bleeding well developed. In our arsenal there are lots of resources, the use of which depends on the age, sex and reproductive history and plans for the patient. For some, the ideal hormonal contraceptives, significantly reduces the amount of blood loss. Someone salvation seem gormonvydelyayuschaya Navy. After elimination of structural anomalies and diseases of the endometrium, requiring surgery, the method of choice for treatment of uterine bleeding associated with ovulatory dysfunction (including juvenile bleeding), according to medical therapy.
Instruction for parents
Dear Parents, look at their younger daughters. Palish not it?
Begin need to worry if:
- Menstrual bleeding lasting more than 10 days.
- From the 1st day of menstruation before the 1st day of menstruation takes place at least another 21 days.
- 1 hour child is using more than one pad.
Dear girls, if each of your menstruation becomes a "glorious sea - sacred Baikal", tell parents about it. Or the doctor.
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