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Dysfunctional uterine bleedings
Dysfunctional uterine bleedings are shown at women as an effect of certain disturbances of work of system a hypothalamus — a hypophysis — ovaries — adrenal glands. This system is responsible for regulation of hormonal function of ovaries. Display of dysfunctional uterine bleedings is characterized by acyclicity: the interval between their manifestations can make from one and a half to six months. Such bleedings last more than ten days. As a rule, uterine bleedings of such nature arise during the stanovitelny period of reproductive system of a female organism (so-called juvenile bleedings), and also during withering of its functions. At women during the reproductive period similar bleedings can be shown as an effect of a severe stress, infectious diseases, organism intoxications.
How to define uterine bleeding?
To distinguish uterine bleeding from usual periods, there is a special method used by gynecologists. The woman has to define that span for which there is a full treatment by blood of a tampon or laying.
It is about uterine bleeding if hygienic means becomes impregnated with blood in one hour, and it happens over several hours in a row. Also need of night replacement of laying, duration of monthly more than one weeks, feeling of fatigue and weakness has to guard. If results of the general blood test indicate anemia, and at the same time the described signs take place, the woman has to see a doctor with suspicion on development of uterine bleeding.
Features and reasons of dysfunctional uterine bleedings
Dysfunctional uterine bleedings have mainly anovulatory character. Their emergence is connected with toxic and infectious influence on structures of a hypothalamus which did not reach a maturity yet. Extremely adversely in this regard the tonzillogenny infection influences a female organism. Besides, among the factors influencing development of bleedings the physical and mental overwork, the inadequate diet of food provoking gipovitaminoza are noted. Earlier postponed abortions, reception of some medicamentous means become the reasons of display of such pathology also. Uterine bleedings also arise owing to disturbances in functioning
thyroid gland (at patients with a hypothyroidism, a hyperthyroidism).
At youthful age display of juvenile bleedings is noted most often in the first two years after at the girl there passed the first periods. According to medical statistics, uterine bleedings of this type make about 30% of all diseases of the sphere of gynecology which are diagnosed for women in 18 — 45 years.
During a menstrual pause dysfunctional uterine bleeding is the most often arising gynecologic disease. If the woman at climacteric age has a uterine bleeding, the reasons of its development mainly are defined by age of the patient. Changes of age character in hypothalamic structures provoke display of such bleedings. In the period of a premenopause at women adenomatosis, a hyperplasia and other pathologies develop much more often.
Symptoms of this disease are defined generally by weight of anemia and, respectively, intensity of blood loss in the period of bleeding. The woman in the period of uterine bleeding feels strong general weakness and fatigue, she has no appetite, skin and mucous membranes turn pale, tachycardia and a headache is shown. Also there are changes in coagulative and rheological properties of blood.
If bleeding proceeds the long period, there is a development of a hypovolemia. Dysfunctional uterine bleedings at women in a climacteric proceed more hard as at such patients of bleeding develop against other gynecologic illnesses and disturbances – hypertensions, obesity, a hyperglycemia.
As complications of uterine bleedings of dysfunctional character during the youthful period there can be a syndrome of acute blood loss. But if such complication arises at physically healthy girls, then about a lethal outcome the speech does not go. Besides, at bleeding the anemic syndrome which emergence is connected with intensity and duration of bleedings often develops. Cases of a lethal outcome at bleedings during the pubertal period are, as a rule, connected with existence of the acute multiorgan disorders arising owing to heavy anemia and also with emergence of irreversible disturbances of system character. They develop as an effect of chronic deficit of iron at girls who throughout the long period have intensive uterine bleedings.
If there is no correct treatment, then disturbance of functions of ovaries can lead further to infertility at the woman (so-called endocrine infertility).
To establish the correct diagnosis in case of existence of symptoms of uterine bleeding, it is necessary to exclude, first of all, completely diseases and morbid conditions at which at the woman uterine bleeding can develop. It is about the broken uterine pregnancy, a placental polyp, a hysteromyoma, an endometria polyp, an adenomyosis, an extrauterine pregnancy, endometria cancer, polycystic ovaries, etc.
Diagnosis of dysfunctional uterine bleedings provides carrying out the general blood test, and also hormonal research.
In the course of establishment of the diagnosis and differential diagnosis the separate scraping of a body of the womb and a mucous membrane of the channel of a neck of uterus is made. Character of pathology in an endometria is defined indirectly by the form to a habit view of scraping. At diagnosis of dysfunctional uterine bleedings at patients of reproductive age histologic research is conducted. It allows to define development of hyperplastic processes: ferruterous and cystous and atipichesky hyperplasia, adenomatosis. If the patient has a bleeding of recurrent character, the scraping should be made under control of hysteroscopy. An informative method of research in case of bleeding is ultrasonography which can give accurate data on the sizes of myomatous nodes, existence of the centers of internal endometriosis, etc. In the course of ultrasonic research both the uterine, and extrauterine pregnancy is also confirmed or excluded.
Carrying out differential diagnosis assumes an exception of diseases of blood of which the raised bleeding, ovary tumors which are followed by hormonal activity is characteristic, any the interrupted pregnancy. It is important to consider existence of disturbances of a blood coagulation about which has to there be a speech in the anamnesis.
Treatment of dysfunctional uterine bleedings
In the course of medicamentous therapy at dysfunctional uterine bleedings two stages are provided. Initially doctors make the decision on how to stop uterine bleeding (this process it is accepted to call a hemostasis). Further it is necessary to take all measures to provide high-quality prevention of repeated bleeding.
The method of a stop of uterine bleeding depends on in what state the patient stays. If the patient has symptoms of the expressed anemia and a hypovolemia (blanching of integuments and mucous membranes, low level of hemoglobin in blood testifies to it — it is lower than 80 g/l), and at the same time active uterine bleeding proceeds, treatment of an illness assumes carrying out a surgical hemostasis. The endometria scraping then histologic research of scraping without fail follows is for this purpose made. If it is necessary to avoid disturbance of an integrity of a hymen, special tools are used. Treatment by a conservative hemostasis by hormonal means before carrying out a scraping is not allowed.
After that treatment which is urged to eliminate displays of anemia follows and to recover a hemodynamics. Hemotransfusion and plasmas, injection of a reopoliglyukin is for this purpose used. Also reception of vitamins of group B and vitamin C, drugs which contain iron is shown. At treatment of dysfunctional uterine bleedings it is important to provide to the patient daily high-calorific food, the plentiful use of liquid.
If the moderately severe state, or a satisfactory condition is diagnosed for the patient, and at the same time there are no sharply expressed symptoms of a hypovolemia and anemia (hemoglobin level in blood exceeds 80 g/l), then the hemostasis is carried out by drugs of hormonal type. In this case estrogen-gestagennye drugs or pure estrogen then reception of gestagen is obligatory. To a bleeding stop drugs it is necessary to accept estrogen-gestagennye in days on 4 — 5 tablets. As a rule, by the end of the first days plentiful blood loss stops. After that the dose is gradually reduced, every day reducing it by one tablet. Further treatment continues on an extent of 18 days: the patient accepts on one tablet a day. It is important to consider that after reception estrogen-gestagennykh of drugs, as a rule, periods happen quite plentiful. To reduce a loss of blood, reception of a gluconate of calcium is shown or styptic drugs at uterine bleedings are appointed.
The conservative hemostasis provides antianemic therapy: reception of vitamins of group B and vitamin C, drugs which contain iron.
As prevention of repeated bleedings reception of hormonal medicines which are selected individually, taking into account data of histologic research of scraping of an endometria is important. Very important point in treatment of dysfunctional uterine bleedings is strict control of use of hormonal drugs as their wrong use can negatively affect a condition of girls and women.
If treatment is carried out step by step and correctly, then it is possible to speak about the favorable forecast. But a certain number of women (about 3 — 4%) who did not complete a course of adequate therapy in time has an evolution of hyperplastic processes of an endometria in an adenocarcinoma. Also against deficit of progesterone endometriosis, a fibrous and cystous mastopathy, a hysteromyoma can develop. Strongly the risk of display of endometriosis increases after to the woman the repeated scraping of a mucous membrane of a uterus was carried out.
In certain cases treatment provides removal of a uterus. Indications to such step development of dysfunctional uterine bleeding which is combined with an atipichesky or recurrent adenomatous hyperplasia of an endometria, and also with a submucosal hysteromyoma, a knotty form of endometriosis of a uterus is considered.
In certain cases also the general nonspecific treatment with the purpose to eliminate negative emotions, to get rid of overfatigue effects is applied. Sometimes advise patients to visit psychotherapy sessions, to receive medical treatment for somnolent drugs, tranquilizers, vitamin complexes.
Reception of oral contraceptives which except protection against unplanned pregnancy, and, so and prevention of abortions, promote suppression of proliferative processes in an endometria is considered effective measures of prevention of dysfunctional uterine bleedings.
Timely sanitation of the centers from which the infection (tonsillitis, quinsy, caries , etc.), the constant measures directed to the general hardening, physical activity extends is important. Special attention should be paid also on providing good nutrition, the use of enough vitamin-containing drugs in the spring and in the fall. Girls who had juvenile bleedings stay under dispensary observation of the gynecologist.