Bleeding uterine dysfunctional

Bleeding uterine dysfunctions occur as a result of impaired production of ovarian hormones. They are divided into bleeding in juvenile age, in childbearing age and in the climacteric period. In girls, they are usually associated with impaired function of the hypothalamus - pituitary - ovary system. In women of childbearing age, dysfunctional uterine bleeding is more often caused by inflammatory diseases of the genital organs, in the climacteric period - a violation of the regulation of menstrual function.

At the heart of pathogenesis are violations of the process of ovulation (anovulation) as a result of persistence or atresia of follicles. As a result, the yellow body is not formed, the secretory transformation of the endometrium does not occur. Long-term exposure to estrogens (with follicular atresia) or their increased production (with follicle persistence) lead to proliferation of the endometrium. This is expressed in the development of polyposis or glandular cystic hyperplasia. Under the influence of the subsequent decline in the concentration of estrogens in the body, the hyperplastic endometrium is torn away for a long time, which is accompanied by acyclic bleeding. Bleeding continues until all the endometrium is severed (sometimes for many days and even weeks).

Symptoms, course. The disease is characterized by an alternation of menstruation delay (for several weeks) and bleeding. Bleeding can be of varying strength and duration. With prolonged and severe bleeding, posthemorrhagic anemia develops. With a gynecological examination outside the bleeding uterus is ordinary or somewhat larger than usual, the size; Often detect cystic changes in one ovary. Outside the bleeding (the phase of temporary amenorrhea), diagnostic tests of functional diagnostics are of great diagnostic importance (see Amenorrhea) .The anovulatory cycle with follicle persistence is characterized by signs of increased production of estrogens: pupillary symptoms +++, ++++, CPI 70-80%, monophasic basal temperature.

Diagnosis of dysfunctional bleeding due to atresia of the follicles is based on a longer bleeding delay (up to 1-2 months); A monotonous pupil symptom at the level of ++, a relative low CRI (20-30%), a monophasic basal temperature. With histological examination of scraping of the endometrium, in both cases there is no secretory transformation of the mucous membrane, and often there is polyposis or endometrial hyperplasia. In urine, the low content of pregnanediol-lower 1-1.5 mg / day. Differential diagnosis is performed with beginning or incomplete abortion, ectopic pregnancy, inflammation of the uterine appendages, uterine myoma, endometriosis of the uterus, cancer of the body, cervix, hormonal-active ovarian tumors, blood diseases.

Treatment has two main goals: stopping bleeding and preventing repeated bleeding. Cessation of bleeding can be achieved by scraping the uterus and introducing hormonal drugs (estrogens, progesterone, combined estrogen-progestogen drugs, androgens). With menopause, if there has not been a curettage of the uterus, it is necessary to begin with this operation to exclude, in the first place, cancer of the uterus. In adolescence, the uterus is used for curettage only in extreme cases, mainly according to vital indications (severe uterine bleeding, which does not cease under the influence of hormones). In childbearing age, scraping of the uterus is performed depending on the specific situation (duration of the disease, bleeding force, effectiveness of hormonal hemostasis). Estrogens for hemostasis are prescribed in large doses: synestrol 1 ml 0.1% solution w / m every 2-3 hours; Ethinyl estradiol 0.1 mg every 2-3 hours. Usually, hemostasis occurs one day after the start of administration of the drugs. After that, continue to enter estrogens for 10-15 days, but in smaller doses under the control of functional diagnostics tests (CRI, a pupil symptom) followed by the administration of progesterone for 8 days (10 mg daily IM). 2-3 days after the end of the progesterone administration, a menstrual reaction occurs. During the next months of treatment, combined hormone therapy is used according to the generally accepted scheme (the first 15 days are estrogens, then within 6-8 days, progesterone). Progesterone for hemostasis can be prescribed only to patients without anemia, as it relaxes the muscles of the uterus and can increase bleeding. The drug is administered at 10 mg daily in / m for 6-8 days. Combined estrogen-progestin drugs are prescribed for the purpose of hemostasis for 4-6 tablets a day until the bleeding stops. Bleeding usually stops after 24-48 hours. After this, the drug should be continued for 20 days, but 1 tablet a day. 2 days after the end of the medication, a menstrual reaction occurs.

To prevent recurrent bleeding, hormonal regulation of the menstrual cycle is necessary in combination with restorative, anti-inflammatory drugs and other methods of therapy of concomitant diseases. To do this, usually use zestrogens 5000 to 10 000 units daily (folliculin, etc.) for the first 15 days followed by the introduction of progesterone by 10 mg for 6-8 days or such ovulation stimulants as clostilbehyde (see Amenorrhea). Combined esrogrogenestegens are also effective. Their administration begins 5 to 6 days after the diagnostic curettage of the uterus and continues for 21 days (1 tablet a day). After 2-3 days, a menstrual reaction occurs. It is necessary to conduct 5-6 such courses of therapy. In the menopausal period after diagnostic scraping and excluding endometrial cancer, androgens can be prescribed: methyltestosterone 30 mg per day under the tongue for 30 days; Testosterone propionate 1 ml 2.5% solution v / m 2 times a week for 1 month. Treatment with androgens is designed to suppress ovarian function and create persistent amenorrhea.

In addition to hormone therapy, for the treatment of dysfunctional uterine bleeding widely used symptomatic therapy: oxytocin in 0.5-1 ml (2.5-5 units) in / mg; Methylergometrine by 1 ml of 0.2% solution in / m; Pregnanol 1 ml of a 1.2% solution in / m; Extract 20 pints of water pepper 3 times a day, etc. Assign vitamins, blood transfusions of 100 ml of blood, physiotherapy (electrostimulation of the cervix, electroplated Sherbac collar, diathermy of the mammary glands). Radiography is practically not applied.