Dysfunctional uterine bleeding

August 8th, 2012

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Dysfunctional uterine bleeding   manifest in women as a consequence of certain disorders of the system hypothalamus - pituitary - ovarian - adrenal . This system is responsible for regulating the hormonal ovarian function. The manifestation of dysfunctional uterine bleeding characterized acyclicity: the interval between their manifestations can be from one and a half to six months. Such bleeding   last more than ten days. Usually, uterine bleeding of this nature arise during the period stanovitelnogo reproductive system   female body (so-called juvenile bleeding ), And during the decay of its functions. The women in the reproductive period, such as bleeding may occur as a consequence of the strong stress . infectious diseases . intoxication .

How to identify uterine bleeding?

To distinguish from the normal uterine bleeding of menstruation, there is a special method used by gynecologists. A woman should determine the period of time during which there is a complete blood soaking a tampon or pad.

On uterine bleeding referred to in the event that the hygienic agent is impregnated in blood in one hour, and this occurs for several hours. There should also be a night guard need replacement pads, monthly duration longer than one week, a feeling of fatigue and weakness. If the results of the general analysis of blood indicate anemia And thus we have the described features, a woman should see a doctor suspected of developing uterine bleeding.

Features and causes of dysfunctional uterine bleeding

Dysfunctional uterine bleeding are mostly anovulatory character . Their occurrence is associated with toxic and infectious influence on the structure of hypothalamus That have not yet reached maturity. It is in this context adversely affects the female body tonzillogennaya infection. In addition, among the factors affecting the development of bleeding, marked physical and mental overload, unbalanced diet, provoking hypovitaminoses . The reasons for manifestation of this pathology are also previously transferred abortion , Taking certain drugs. Uterine bleeding well as arise owing to violations in the functioning of
thyroid cancer (patients with hypothyroidism . hyperthyroidism ).

At the youthful age of the manifestation of juvenile bleeding observed most frequently in the first two years after a girl's first period has passed. According to medical statistics, uterine bleeding of this type is approximately 30% of all diseases from the scope of gynecology, which are diagnosed in women 18-45 years of age.

During menstrual pause dysfunctional uterine bleeding - is the most frequently occurring gynecological disease. If a woman in menopause uterine bleeding occurs, the causes of its development mainly determined by the patient's age. This age-related changes in hypothalamic structures provoke the manifestation of such bleeding. After all, during the premenopause women are much more likely to develop adenomatosis . hyperplasia   and other pathologies.

Symptoms

Symptoms of this disease are mainly determined by the severity of anemia and therefore the intensity of blood loss during bleeding. Woman in period of uterine bleeding feels the a strong general weakness and fatigability, at it or her is absent the appetite, the skin and mucous membranes turn pale, manifests itself tachycardia   and headache . Also, there are changes in coagulation and rheological properties of blood.

If the bleeding continues for a long period, there is a development hypovolemia . Dysfunctional uterine bleeding in women in menopause are typically more severe, since these patients develop bleeding compared to other gynecological diseases and disorders - hypertension . obesity . hyperglycemia .

Complications

As dysfunctional uterine bleeding complications in the nature of adolescence may be syndrome of acute blood loss . But if such a complication occurs in physically fit women, then of deaths are not talking. Also, when bleeding often occurs anemic syndrome , The occurrence of which is related to the intensity and duration of bleeding. Cases of fatal bleeding in adolescence, usually associated with the presence of acute multiple organ disorders resulting from severe anemia, as well as with the emergence of irreversible violations of a systemic nature. They develop as a consequence of chronic iron deficiency in girls, who for a long period of suffering intense uterine bleeding.

If there is no proper treatment, violation of ovarian function in the future may lead to infertility   in women (the so-called endocrine infertility ).

Diagnostics

To establish the correct diagnosis in the event of signs of uterine bleeding should be, above all, to completely eliminate the disease and pathological conditions under which a woman can develop uterine bleeding. It is about impaired uterine pregnancy . placental polyp . uterine cancer . polyp endometrial . adenomyosis . ectopic pregnancy . endometrial cancer . Polycystic ovaries   and etc.

Diagnosis of dysfunctional uterine bleeding provides an overall analysis of blood and hormonal research.

In the process of diagnosis and differential diagnosis is carried out separately scraping the uterine body and the mucous membrane of the cervical canal. The nature of the pathology of the endometrium is determined indirectly by referring to the general appearance of scraping. At diagnostics of dysfunctional uterine bleedings at patients of reproductive age is conducted histological study. It allows you to define the development of hyperplastic processes: glandulocystica   and atypical hyperplasia . adenomatosis . If the patient is bleeding recurrent nature, scraping should be done under the supervision of hysteroscopy. Informative method of investigation in the case of bleeding is ultrasound, which can give precise details about the size of fibroids, the presence of pockets of inner Endometriosis   and others. During the ultrasound examination also confirmed or ruled out as a masterbatch, and ectopic pregnancy.

Differential diagnosis involves the exclusion of blood diseases, which are characterized by increased bleeding, a tumor of the ovary, which are accompanied by hormonal activity, arbitrarily terminate a pregnancy. It is important to take into account the presence of blood clotting disorders, which should be discussed in history.

Treatment of dysfunctional uterine bleeding

In the course of drug therapy for dysfunctional uterine bleeding envisaged two stages. Initially, doctors decide how to stop uterine bleeding (this process is called hemostasis). Further, should take all measures to ensure quality prevention of rebleeding.

Method stop uterine bleeding depends on whether, in what condition abides a sick. If the patient has signs of severe anemia and hypovolemia (evidenced by blanching of the skin and mucous membranes, low hemoglobin in the blood - less than 80 g / l), while continuing active uterine bleeding, treatment of the disease involves a surgical hemostasis. This is done by scraping the endometrium, then it is obligatory to histological study scraping. If you want to avoid breaking the hymen intact, using special tools. Not allowed treatment by conservative hemostasis hormonal agents before the curettage.

This is followed by a treatment that is intended to eliminate the symptoms of anemia and to restore hemodynamics. For this purpose, blood transfusion and plasma infusion reopoliglyukina . It showed also reception of B vitamins   and vitamin C , Formulations that contain iron. In the treatment of of dysfunctional uterine bleeding important to ensure a sick daily high-calorific nutrition, abundant use of liquid.

If the patient's condition is diagnosed moderate or satisfactory condition, and there is no pronounced symptoms of hypovolemia and anemia (level Hemoglobin   in the blood exceeds 80 g / l), the hemostasis hormone drugs held type. In this case estrogen-progestin preparations   or pure Estrogens Followed by mandatory intake of progestogens. Until the bleeding stops estrogen-progestin drugs should be taken daily for 4-5 tablets. As a rule, the end of the first day of profuse hemorrhage stops. Thereafter, the dose was gradually reduced, reducing its every day for one tablet. Further, the treatment continues for over 18 days: the patient takes one pill a day. Important to note that after taking the estrogen-progestin formulations are generally menstruation can be quite abundant . To reduce the loss of blood, is shown receiving calcium gluconate or appointed hemostatic drugs for uterine bleeding.

Conservative hemostasis provides antianemic therapy: the reception of B vitamins and vitamin C preparations that contain iron.

As the prevention of recurrent bleeding is important hormonal drugs that are selected individually, taking into account the data of histological examination of scrapings of the endometrium. A very important point in the treatment of dysfunctional uterine bleeding is a strict control of the use of hormones, as their improper use may adversely affect the status of girls and women.

If the treatment is carried out in stages and is correct, then we can talk about favorable prognosis. But a certain number of women (about 3-4%), which have not passed the time course of adequate therapy, the evolution of endometrial hyperplasia in adenocarcinoma . Also on the background of progesterone deficiency may develop endometriosis . shotty breast , Uterine fibroids. Greatly increased risk of symptoms Endometriosis   after a woman was held again scraping the lining of the uterus.

In some cases, treatment involves the removal of the uterus. Indications for this step is the development of dysfunctional uterine bleeding, which is combined with atypical adenomatous hyperplasia or recurrent endometrial and uterine cancer with submucosal, nodular form of endometriosis uterus.

In some cases, also apply the general non-specific treatment to eliminate negative emotions, to get rid of the consequences overstrain . Sometimes, patients are advised to attend psychotherapy, undergo treatment sleeping pills, tranquilizers, vitamin complexes.

Prevention

Effective preventive measures of dysfunctional uterine bleeding is considered oral contraceptives, which in addition to protection against unintended pregnancy and, hence, the prevention of abortion and contribute to the suppression of proliferative processes in the endometrium.

Important timely readjustment of foci of infection which spreads ( tonsillitis . sore throat . caries et al.), permanent measures aimed at tempering the overall physical activity. Particular attention should be paid, and to provide adequate nutrition, drinking a sufficient amount of vitamin-containing products in the spring and fall. Women who have had juvenile bleeding, are under medical observation gynecologist.