Dysfunctional uterine bleeding (abbreviated DMK) is the most striking manifestation of the syndrome caused by ovarian dysfunction. There are dysfunctional uterine bleeding of the juvenile period (occurs at the age of 12-19 years), bleeding of the reproductive period (manifests itself at the age of 19 to 45 years) and menopausal bleeding (can be detected in the period of 45-57 years). All dysfunctional types of bleeding are characterized by copious bleeding during and after calendar menstruation (the menstrual cycle is disrupted). Such a disease is dangerous for the occurrence and development of anemia, uterine fibroids, endometriosis, fibrocystic mastopathy and even breast cancer. Treatment of various types of bleeding involves hormonal and non-hormonal hemostasis, as well as therapeutic and diagnostic curettage.
The content of the article:
What is dysfunctional uterine bleeding?
The mechanism of development of dysfunctional uterine bleeding
Juvenile dysfunctional uterine bleeding
Dysfunctional uterine bleeding of the reproductive period
Dysfunctional uterine bleeding of the premenopausal (menopausal) period
Prevention of dysfunctional uterine bleeding
Dysfunctional uterine bleeding
What is dysfunctional uterine bleeding?
Dysfunctional uterine bleeding is a pathological type of bleeding that is associated with a malfunction of the endocrine glands during the production of sex hormones. Such bleeding can be of several types: juvenile (during puberty) and menopausal (during the withering of ovarian functionality) types, as well as bleeding of the reproductive period.
Dysfunctional types of bleeding are expressed by a sharp increase in blood loss during menstruation (menstruation begins abruptly) or when the menstruation period increases markedly. Dysfunctional bleeding can replace the period of amenorrhea (the period when bleeding lasts from 5-6 weeks) with a period of cessation of bleeding for a certain time. The latter can lead to anemia.
If we talk about the clinical picture, then regardless of which uterine type of bleeding is inherent in the patient, it is characterized by abundant bloody discharge after a long delay in menstruation. Dysfunctional bleeding is accompanied by dizziness, general weakness, pallor of the skin, prolonged headache, low blood pressure, and so on.
The mechanism of development of dysfunctional uterine bleeding
Any uterine type of dysfunctional bleeding and its development is based on a violation of the hypothalamic-pituitary system, namely, a violation of the function of the ovaries. Violation of the secretion of gonadotropins in the pituitary gland, which affect the maturation of the follicle and the ovulation process, leads to menstruation failure, which means that the menstrual cycle completely changes. At the same time, the ovary is not able to provide a proper environment for the full maturation of the follicle. The development of the follicle either does not pass at all, or passes partially (without ovulation). The formation and development of the yellow body is simply impossible. The uterus begins to experience the increased influence of estrogens, because in the absence of the corpus luteum, progesterone cannot be produced. A woman’s body, like her uterus, is in a state called hyperestrogenism. The uterine cycle is disrupted. Such a violation leads to the spread of the endometrium, after which rejection occurs, the main sign of which will be profuse bleeding, lasting for a considerable period. Usually, how long the uterine type of bleeding will last is influenced by various factors of hemostasis, namely: platelet aggregation, vascular spastic ability and fibrinolytic activity. Their violation characterizes dysfunctional uterine bleeding.
Of course, any uterine type of bleeding can stop on its own after a certain time. However, if the bleeding recurs again and again, you should immediately consult a doctor.
If we talk about the causes of the development of a particular type of DMK, then the juvenile uterine type of bleeding may be caused by an incomplete function of one of the departments: uterus-ovary-pituitary-hypothalamus. Bleeding of the reproductive period can be caused by various inflammatory processes of the reproductive system, as well as surgical intervention (for example, abortions) or one of the diseases of the endocrine glands. The uterine climacteric type of bleeding is affected by a violation of the regulation of menstruation (the menstrual cycle changes) for the reason that the ovary begins to fade, and the hormonal type of function fades.
Juvenile dysfunctional uterine bleeding
Reasons
Uterine bleeding of the juvenile period occurs in 20% of cases among all pathologies in the field of gynecology. The causes of such a deviation can be anything: mental or physical injuries, fatigue, stress, poor living conditions, the problem of dysfunction of the adrenal cortex (or thyroid gland), hypovitaminosis and more. Childhood infections (measles, chickenpox, whooping cough, rubella) can also cause bleeding to occur soon. Moreover, chronic tonsillitis or transferred acute respiratory infections are the causative agents of juvenile bleeding.
Diagnostics
Diagnosis of juvenile uterine bleeding presupposes the presence of anamnesis data (the date of menarche, the date of the last menstruation and the date when the bleeding began). During the examination, the hemoglobin level, blood clotting factor, blood test, coagulogram, platelets, prothrombin index and the duration of bleeding are taken into account. Doctors also recommend testing for the level of hormones such as LH, prolactin, FSH, TSH, T3, T4, progesterone, estrogen, testosterone, cortisol.
The menstrual cycle, or rather, deviations in it, can be measured by an indicator of the basal temperature in the period between menstruation. It is known that the menstrual cycle of one phase has a monotonous basal temperature.
Juvenile uterine bleeding is diagnosed on the basis of ultrasound results, while the pelvic organs are examined. For the examination of virgins, a rectal sensor is used, and for the examination of girls who live a sexual life, a vaginal sensor is used. The ovary and its condition are well shown by an echogram, which detects a possible increase in volume during the intermenstrual cycle.
In addition to ultrasound of the pelvic organs, ultrasound of the adrenal glands and thyroid gland is also necessary. In order to detect the persistence of the follicle, monitor the condition and deviation in ovulation, as well as the presence of the corpus luteum, a special type of ultrasound is used to control ovulation.
Patients also need to be diagnosed with the help of X-ray of the skull, examining the hypothalamic-pituitary system. Brain EEG, echoencephalography, MRI and CT will only be a plus. By the way, MRI and CT scans can detect or exclude a tumor in the pituitary gland.
Juvenile bleeding and its diagnosis are not limited only to the consultation of a gynecologist, but also require the conclusion of a neurologist and endocrinologist.
Treatment
Treatment of any type of dysfunctional uterine bleeding requires urgent hemostatic measures. Prevention will be the next step in order to prevent possible uterine bleeding in the future, as well as to normalize the menstrual cycle as quickly as possible.
Dysfunctional uterine bleeding can be stopped both by traditional methods and by surgical ones. The choice of method will be determined based on the patient’s condition, as well as the amount of blood lost. Usually, a symptomatic hemostatic drug (dicinone, ascorutin, vikasol and aminocaproic acid) is used for moderate anemia. Thanks to them, the uterus will shrink, and blood loss will decrease.
If treatment with non-hormonal drugs turns out to be ineffective, a hormonal drug comes into play, which will answer the question: how to stop uterine bleeding with hormonal pills? Usually doctors prescribe medications such as marvelon, non-ovlon, rigevidone, mercilon or any other similar drug. Finally, the bleeding stops 5-7 days after the end of taking the drug.
If the uterine bleeding period continues, leading to a deterioration of the patient’s condition (may be expressed in constant weakness, dizziness, fainting, and so on), it will be necessary to conduct a hysteroscopy procedure with scraping and scraping for further examination. The curettage procedure is prohibited for those who have problems with blood clotting.
Treatment of DMK also involves antianemic therapy. The latter means the use of preparations containing iron (for example, venofer or fenyuls), preparations containing vitamin B12, B6, vitamin C and vitamin P. Treatment also includes transfusion of erythrocyte fluid and frozen plasma.
Prevention of uterine bleeding involves taking such progestogenic drugs as logest, novinet, norcolut, silest and others. Prevention also includes general hardening of the body, proper nutrition and prevention of chronic infectious diseases.
Dysfunctional uterine bleeding of the reproductive period
Reasons
Factors that cause dysfunctional uterine bleeding, as well as the process of ovarian dysfunction itself, can be physical and mental fatigue, stress, harmful work, climatic changes, various infections, taking medications, abortions. The ovary malfunctions during inflammatory or infectious processes. Malfunctions of the ovary entail a thickening of its capsule, a decrease in the sensitivity of the ovarian tissue.
Diagnostics
Diagnosis of this type of bleeding involves the exclusion of any organic pathology of the genitals (abortion at home, possible tumors and traumatic injuries), as well as diseases of the liver, heart and endocrine glands.
The diagnosis of such uterine bleeding is not limited to general clinical methods. The use of separate diagnostic curettage with further histological examination of the endometrium, as well as the hysteroscopy procedure is another possible diagnostic option.
Treatment
Treatment for uterine bleeding during the reproductive period is prescribed after determining the histological result of previously taken scrapings. If the bleeding is repeated, the patient is prescribed hormonal hemostasis. The hormonal type of treatment is able to regulate the function of menstruation, restoring the normal menstrual cycle.
Treatment implies not only a hormonal method, but also such non-specific treatment as normalization of mental state, withdrawal of intoxication. The latter is designed to implement various psychotherapeutic techniques, as well as any sedative. In case of anemia, a drug containing iron will be prescribed.
Dysfunctional uterine bleeding of the premenopausal (menopausal) period
Reasons
In the premenopausal period, uterine bleeding occurs in 16% of cases. It is known that with age, a woman decreases the amount of gonadotropins that are secreted by the pituitary gland. The release of these substances from year to year becomes irregular. The latter causes a violation of the ovarian cycle, which implies a violation of ovulation, the development of the corpus luteum and folliculogenesis. Progesterone deficiency usually leads to hyperplastic overgrowth of the endometrium or to the development of hyperestrogenism. In most cases, menopausal uterine bleeding occurs in parallel with menopausal syndrome.
Diagnostics
Diagnosis of menopausal uterine bleeding is the need to distinguish bleeding from menstruation, which at this age becomes irregular. In order to exclude the pathology that caused uterine bleeding, experts advise to perform hysteroscopy at least twice — in the period before diagnostic curettage and in the period after it.
After the curettage procedure in the uterine cavity, it will be easy to detect endometriosis or fibroids. The cause may also be polyps that fill the uterus. Not so often the cause of bleeding is a problematic ovary, namely an ovarian tumor. To determine such a pathology, you can use ultrasound or computed tomography. In general, uterine bleeding and its diagnosis is common to all its types.
Treatment
Treatment of dysfunctional uterine bleeding in the menopausal period is aimed at the final suppression of menstrual function, at artificially causing menopause. It is possible to stop bleeding during the menopausal period only surgically, by medical curettage, as well as with the help of hysteroscopy. Traditional hemostasis is erroneous here. With rare exceptions, specialists perform cryodestruction of the endometrium, and in extreme cases, remove the uterus.
Prevention of dysfunctional uterine bleeding
Prevention of DMK should be started during pregnancy. At an early age and in adolescence, special attention should be paid to health-improving and strengthening measures in order to harden the body.
If dysfunctional uterine bleeding still could not be avoided, then the next action should be an action aimed at restoring menstruation and its cycle, as well as preventing possible recurrence of bleeding. To implement the latter, the use of estrogen-progestogenic contraceptives is prescribed (usually from the 5th to the 25th day of menstrual bleeding, during the first three cycles, and from the 15th to the 25th day for the next three cycles). The use of hormonal contraceptives is an excellent prevention of DMK. Moreover, such contraceptives reduce the frequency of possible abortions.
