Menstrual irregularities symptoms. Causes of menstrual irregularities

Disturbances of normal menstrual cycle can happen in the life of every woman. This situation, for example, a delay in menstruation, is not always a harbinger of pathology, since in most cases it signals an impending pregnancy. A physiological cycle is considered to last 21-35 days. That is, 21, 28, and even 31 days of cycle duration is the norm, it all depends on individual characteristics woman's body.

A menstrual cycle disorder is considered to be a delay lasting more than 10 days, as well as a reduction in duration (from 5 days or more), which is systematic. There are women who have a genetically determined long cycle, which is not a pathology, that is, there have already been similar cases in the family. The same applies to bloody discharge during the period observed 2 weeks before the onset of menstruation.

Causes of menstrual irregularities

The female menstrual cycle is very a complex system, which includes many important biochemical processes. In particular, the cerebral cortex, endocrine glands (adrenal glands, thyroid gland, ovaries), and subcortical centers take part in the regulation of the process. This means that any disruption in the functioning of these systems can cause disruptions in the female cycle. But sometimes this reason may lie in serious pathologies. various organs(tumor, ).

Pathologies of the endocrine organs, such as:

• inflammatory process in the ovaries;
• deficit;
• untimely exit of a mature follicle;
• ovarian hypoplasia;
• pathologies of the uterus of inflammatory origin;
• polycystic ovary syndrome.

Causes of menstrual cycle disorders from the cerebral cortex:

• time zone change;
• in a woman in the pre-dawn hours, when hormones that regulate the cycle are actively secreted;
• very strong stress shock.

Causes of MC disturbances from the subcortical centers (hypothalamus, pituitary gland):

• pituitary adenoma;
• neuroinfections of viral origin;
• other tumors.

Causes of menstrual cycle failure from other organs and systems:

• thyroid pathology;
• problems in the functioning of the adrenal glands;
• taking certain medications.

Symptoms of menstrual irregularities

Disorders of the monthly cycle can manifest themselves in a variety of various symptoms. In this case, the duration of menstruation, the nature of discharge, changes, painful sensations etc.

The main symptoms of disorders in various diseases:

• Hyperpolymenorrhea- a condition when very copious discharge during menstruation, but the cycle itself does not change.
• Amenorrhea– absence of menstruation for 6 months or more. It can be primary and secondary, the first is characterized by a violation of the cycle from the moment of menarche, and the second after normal menstruation. There is also physiological amenorrhea, which is observed in healthy women during pregnancy, lactation. In all other cases, you should definitely visit a doctor.
• Opsomenorrhea– a cycle in which there is very little bleeding and periods last 1 or 2 days.
• Oligoamenorrhea– a woman’s period comes once every 3 or 4 months, that is, rarely. It can be quite serious symptom, which indicates the presence of polycystic ovary syndrome. Especially if such additional signs such as enlarged ovaries (during bimanual examination), hirsutism (excessive body hair).
• . IN in this case there is an unstable menstrual cycle when periods are delayed or come ahead of schedule. Usually observed in those who often change time zones and climate (flight attendants, for example). In this case, acclimatization will bring everything back to normal.
• Menorrhagia. This disorder is characterized by a rather long and heavy period – 10 days or more.
• . This is a fairly common problem that many girls and women face. The main symptom of this menstrual cycle disorder is cycle failure, accompanied by pain in the lower abdomen, often of an aching nature. In this case, there are problems in the functioning of the intestines. Such a symptom complex can be observed from the age of 14 and bother the patient throughout her life. Sometimes it disappears after sexual activity or childbirth, but not always. In some cases, this condition is a sign or.
• Proyomenorrhea– menstruation occurs earlier than after 21 days (the shortest physiological cycle).
• Metrorrhagia– appearance bloody issues, both during menstruation and in the middle of the cycle.
• Algomenorrhea– a condition in which a woman suffers from very painful and heavy menstruation, due to which she cannot work normally, as her overall well-being is impaired. The regularity of the cycle is not disrupted.

Each of the above conditions requires a visit to a gynecologist, examination, and passing the necessary tests to establish and clarify the diagnosis. Therefore, if the above symptoms occur, you should not postpone an appointment with a specialist.

In what cases should you seek medical help?

Under no circumstances should you delay contacting a specialist if:

• there is a regular violation of the cycle, that is, it becomes shorter or longer by 5-7 days;
• absence of menarche in a girl aged 15 years;
• There are heavy periods resembling bleeding. Normally, no more than 250 ml of blood should be lost during one menstruation. Anything more is a symptom of hormonal imbalance that requires drug therapy;
• a year or two after the start of menstruation, the cycle has not established itself;
• There is the presence of spotting in the period before and after the menstruation itself. Often this symptom indicates;
• there is pain during ovulation. This condition is dangerous due to the possibility of ovarian rupture and is easily treated with medications selected by the doctor.

Treatment of menstrual disorders

Therapy in this case depends on the age of the patient, since there are a number of causes of cycle disorders that are typical for a particular age group.

Treatment of menstrual irregularities in women of reproductive age

This category of patients often experience bleeding: between periods, heavy, painful, etc. In this case, it is necessary to carry out diagnostic curettage in order to stop the bleeding and determine the cause of the condition (the resulting material is sent for histological examination).

Treatment of MC failures in teenage girls

Bleeding that occurs in girls in adolescence, are called juveniles. Such menstrual cycle disorders must be treated in several stages.

The following applies:

• Hemostasis, that is, stopping bleeding using hemostatic agents (Vikasol, Dicynon) and hormonal agents.
• Scraping– carried out in case of blood loss complicated by dizziness, general weakness, very low hemoglobin (below 70).
• Reception. They are prescribed when hemoglobin is 80 - 100 g/l, and only hormonal drugs are used. combination drugs with a low dosage of hormones (Novinet, Mercilon, Marvelon).
• Antianemic treatment. It includes the infusion of red blood cells, rheopolyglucin, blood transfusion, Tardiferon, Sorbifer.
• Vitamin therapy– reception, Pentovita, Aevita.

Treatment with hormones lasts for at least 3 months and is taken until hemoglobin levels normalize.

Treatment of menstrual irregularities in women during menopause

In case of bleeding during menopause, curettage of the uterine cavity is mandatory, because such disorders are often a sign of pathologies of the female genital area (endometrial hyperplasia, adenocarcinoma, adenomyosis). In this case, a histological examination of the resulting material during curettage is shown. In some cases, if indicated, the uterus may be removed.

A number of problems are treated by taking hormonal drugs, among which the most often prescribed:

• Gestrinone;
• 17-OPK;
• Danazol.

Treatment of menstrual irregularities in women at any age should be accompanied by:

• normalization of sleep and wakefulness patterns,
• nutritious food,
• stabilization of the psycho-emotional state,
• normalization of weight (this applies to both overweight and extremely thin women).

Traditional medicine for menstrual disorders

Alternative treatment is selected taking into account the type of disorder.

Recipes for oligomenorrhea

For rare periods, the following medicine is used: half a teaspoon of parsley seeds is ground into powder and taken three times a day with ½ glass of water with a spoon of honey.

Traditional medicine for amenorrhea

Pour 1 tbsp of crushed wormwood into 200 ml of boiling water. Keep the broth in a water bath for 15 minutes, let cool, strain. It is taken before meals, 1/3 glass 3 times a day.

Remedies for menorrhagia

For excessively heavy periods, a collection is used, which includes the following herbs, taken in equal proportions:

• yarrow;
• Oak bark;
• raspberry (leaves);
• Potentilla gossamer;
• strawberry (leaves).

1 tbsp. l of this mixture is poured with 200 ml of cold boiling water and infused for 4 hours, after which the infusion should be boiled for 5 minutes and strained. The finished decoction is taken during the day for a course of 5-8 days.

Traditional recipes for menstrual irregularities such as algomenorrhea

If a woman is bothered by pain during menstruation, then the following collection will help, which includes:

• buckthorn (bark),
• birch (leaves),
• blackberry (leaves),
• yarrow and mint.

A spoonful of this mixture is poured into a glass of boiling water, infused, filtered and drunk throughout the day.

Traditional medicine for menorrhagia

Horsetail has been used for many centuries as a hemostatic agent in the treatment of women with bleeding. One spoon of this herb is poured into 0.5 liters of boiling water, infused and taken 1 tbsp. l once every 2 hours until the bleeding stops. Next in medicinal purposes– 1 liter three times a day.

You can learn more about what tests are needed for menstrual irregularities from the video.

Nature intended that a woman’s menstrual cycle is a very precise mechanism. Its operation is influenced by many factors, from the characteristics endocrine system to the most complex biochemical reactions of the brain.

At the same time, as in the operation of any other mechanism, in female cycle Sometimes failures of various kinds occur. Let's find out what their features are and possible causes.

Failure of the menstrual cycle - symptoms

First of all, it should be noted that the duration of the cycle is an individual feature of each woman. On average, this is 28 days, but the medical norm is from 26 to 36 days.

If, for example, your cycle always lasts 35 days, then this is not a failure, but your personal distinctive feature. A variation of the norm can also be called a shift in menstruation by 2-3 days, because not everyone has them at equal intervals.

A failure, in turn, is a shift in the onset of menstruation by 5-7 days in one direction or another. And if this begins to happen systematically, then you should not postpone visiting the gynecologist. The doctor will help you understand the reasons for this and establish the cycle. This is very important not only for those who plan to become a mother in the near future, but also for women's health generally.

What to do if your menstrual cycle is disrupted?

First of all, you should establish the causes of the failure, and only then decide how to establish the cycle. This should, of course, be done with the help of a gynecologist. At the appointment, he will conduct a standard examination and ask questions that will help identify the origins of the problem. Additionally, you may need to take tests, perform an ultrasound of the uterus and ovaries, thyroid gland or other organs. Having determined the causes of menstrual irregularities, the doctor will prescribe appropriate treatment.

Therefore, if your monthly cycle is off, do not self-medicate, but be sure to seek help from a gynecologist. Only a doctor will correctly determine the cause that provoked the failure of the menstrual cycle and prescribe the correct treatment.

How to calculate the monthly cycle and determine the failure

The period of time from the onset of menstruation to the next is the menstrual cycle. Ovulation is the process of release into the fallopian tube of an egg ready for fertilization. It divides the cycle into two phases: follicular (the process of follicle maturation) and luteal (the period of time from ovulation to the onset of menstruation). In girls with a 28-day menstrual cycle, ovulation, as a rule, occurs on the 14th day from their onset. After ovulation, the level of estrogen in the female body drops, but bleeding does not occur, since the corpus luteum controls the production of hormones. Strong fluctuations in estrogen levels in one direction or another at the time of ovulation can cause uterine bleeding between, before and after menstruation.

The normal monthly cycle lasts 21-37 days, usually the cycle is 28 days. The duration of menstruation is usually 3-7 days. If the monthly cycle is off by 1-3 days, this is not considered a pathology. But if menstruation does not occur 7 days after the due date, you should consult a doctor for advice.

How to calculate your monthly cycle? The time interval between 1 day of the beginning of menstruation and 1-1 days of the next one is the duration of the cycle. In order not to make mistakes, it is better to use a calendar where you can mark the start and end of menstruation.

In addition, there are now quite a few computer programs that help with calculations. With their help, you can calculate the time of ovulation and even track the onset of premenstrual syndrome (PMS).

You can most accurately calculate your monthly cycle using graphs basal temperature. The temperature in the first days after menstruation stays within 37°C, after which it sharply drops to 36.6°C, and the next day it rises sharply to 37.5°C and remains within these limits until the end of the cycle. And then a day or two before menstruation it decreases. If the temperature does not drop, pregnancy has occurred. If it does not change throughout the entire cycle, ovulation does not occur.

Symptoms indicating menstrual irregularities:

• increasing the time interval between menstruation;
• shortening of the monthly cycle (cycle less than 21 days);
• scanty or, conversely, heavy periods;
• absence of menstruation;
• the appearance of spotting and/or bleeding.

Also negative symptom is the duration of menstruation less than three or longer than seven days.

The menstrual cycle is out of whack: reasons

1. Adolescence. In young girls, disruption of the monthly cycle is a fairly common phenomenon, since the hormonal balance is still being established. If two years have passed since the first menstruation appeared, and the cycle has not returned to normal, you should consult a gynecologist.

2. Great loss weight or obesity . Extreme diets, fasting and poor nutrition are considered by the body as a sign that hard times have come and pregnancy is not desirable. Therefore, it turns on natural defenses, causing a delay in menstruation. Too much speed dial weight also has a bad effect on the body and leads to irregularities in the menstrual cycle.

3. Acclimatization . Moving, air travel to another time zone, vacation in hot countries often cause disruption of the monthly cycle. A sudden climate change is a certain stress. Typically, the menstrual cycle returns to normal during acclimatization when the body gets used to new conditions.

4. Stress and physical overload. These factors quite often lead to disruption of the monthly cycle. When stressed, the body produces excessive amounts of the hormone prolactin. Its excess inhibits ovulation, and menstruation occurs with a delay. In this case, you should get enough sleep, spend more time on fresh air, and, on the recommendation of a doctor, start taking sedatives.

5. Hormonal disorders . Crash monthly cycle can be caused by problems in the pituitary gland and hypothalamus. In this case necessary treatment will be selected by an endocrinologist.

6. Diseases of the female genital organs . Possible causes are often pathologies of the cervix, inflammation of the uterus and its appendages, polyps and cysts. In most cases such gynecological problems are treated surgically.

7. Hormonal contraceptives . Reception birth control pills or refusing them may cause the monthly cycle to go wrong. In this case, you need to consult a gynecologist and take a break from taking oral contraceptives.

8. Pregnancy and lactation . Absence of menstruation during pregnancy and breastfeeding – normal phenomenon. After cessation of lactation, the normal monthly cycle is restored. In the presence of severe pain in the lower abdomen, you need to urgently consult a doctor, since the cause may be an ectopic pregnancy, untimely detection of which can even lead to fatal outcome due to painful shock and significant blood loss when the fallopian tube ruptures.

9. Premenopause At the age of 40-45 years, a disruption in the menstrual cycle can be a harbinger of menopause.

10. Forced or spontaneous abortions also have a bad effect on the condition of the uterus, cause delays in menstruation, and often cause infertility.

Also, the reasons for the failure of the menstrual cycle may be diseases of the thyroid gland and adrenal glands, infectious diseases, Availability bad habits(smoking, alcohol, drugs), taking certain medications, vaginal injuries, vitamin deficiency in the body.

Diagnosis of menstrual cycle disorders

Diagnostics consists of the following stages:

• interviewing the patient;
• gynecological examination;
• taking all smears;
• Ultrasound abdominal cavity or pelvis;
• determination of hormone levels in the blood;
• MRI (detailed examination of the patient for the presence pathological changes tissues and neoplasms);
• hysteroscopy;
• urine and blood tests.

The combination of these methods makes it possible to identify the reasons that caused the monthly cycle to go wrong and eliminate them.

Treatment of menstrual disorders

The main thing is to treat the underlying disease that caused the cycle to fail. As preventive measures It is recommended to eat rationally: eat foods rich in protein and iron at least 3-4 times a week, give up bad habits, relax in the fresh air, sleep at least 8 hours a day, take vitamin complexes.

At heavy bleeding, after ruling out bleeding disorders, your doctor may prescribe:

• hemostatic drugs;
• ε-Aminocaproic acid (to eliminate bleeding);
• in case of heavy bleeding - infusion of plasma into the patient, and sometimes donated blood;
• surgery(last resort for severe bleeding);
• hysterectomy (removal of the uterus);
• hormonal drugs;
• antibiotics.

Complications when the monthly cycle fails

Remember, your health depends only on you! You should not take menstrual cycle irregularities lightly, as irregular cycle menstruation can lead to infertility, and frequent heavy intermenstrual bleeding can cause fatigue and loss of ability to work. Late detection of pathologies that cause disruption of the menstrual cycle can lead to fatal outcome, although this can be quite successfully avoided by seeking help from a doctor in time. Treatment of menstrual irregularities is possible only under the supervision of a qualified specialist.

Menstrual irregularities- a reason to seek advice from a gynecologist. Critical days- This business card state of the woman's body. Any cycle failure is a signal calling you to pay attention to your health. This may be a delay in menstruation in the absence of pregnancy, scanty menstruation or, conversely, too heavy menstruation. If there are such violations of the monthly cycle, it is imperative to be examined, determine their cause and begin treatment. We must always remember that dangerous diseases can be hidden behind menstrual irregularities.

Menstrual irregularities. First about the norm

The reproductive period in a woman's life is accompanied by menstruation– periodic bleeding from the genital tract. This - natural process, with the help of which the body restores its readiness for pregnancy. It is cyclical; The duration of the cycle and its regularity are a mirror of a woman’s intimate health. Menstrual irregularities are an alarm signal and should never be ignored.

Menstruation usually begins at the age of 12-14 years. During the year after the first menstruation, there is no clear periodicity; the cycle is just being established.

The menstrual cycle is counted from the first day of one menstruation to the first day of the next. On average it is 28 days, but there may be individual deviations. The normal duration is from 21 to 35 days. The duration of the discharge itself is usually 3-5 days. Menstruation is often preceded by the so-called premenstrual syndrome– period feeling unwell. You may feel pain in the lower abdomen, swell your breasts, increase swelling, and have a headache.

No menstruation during. After childbirth, the menstrual cycle is restored. The earliest this can happen is 6 weeks after birth. When breastfeeding, menstruation returns much later; how much later depends on individual characteristics female body.

In anticipation, the menstrual cycle may become unstable, and the intervals between menstruation may increase. Such disorders at the age of 45-55 are not a pathology.

Types of menstrual irregularities:

• absence of menstruation for six months or more (amenorrhea). This condition is normal during pregnancy, breastfeeding, during menopause and in girls who have not yet reached puberty. In all other cases, this is a pathology;
• rare menstruation(menstrual cycle more than 35 days);
• frequent menstruation(menstrual cycle less than 21 days);
• irregular menstruation(too short – less than 2 days; too long – more than 7 days);
• too scanty menstruation(blood loss less than 20 ml.) or heavy (more than 150 ml.);
• menstruation outside the cycle.

Scanty menstruation

Insufficient development of the uterine mucosa is the main cause of scanty menstruation. However, hypomenstrual syndrome can also be a genetic feature of women. A change in menstruation towards reduction is considered normal if:

• The girl’s cycle has not yet fully established itself (puberty).
• In a woman aged 45 years or older, scanty menstruation indicates the approach of menopause.

It should be remembered that taking birth control pills significantly reduces the amount of menstruation.

List possible reasons is not exhausted. In order to establish the cause, a medical examination is required, and in some cases, a comprehensive examination.

Causes of menstrual irregularities

The cause of a disruption in the menstrual cycle may be mental trauma or emotional shock. It can also be caused by strong physical pain, overheating or hypothermia of the body, climate change when moving. If this is the case, then there should not be a repeat violation of the cycle unless the cause that caused it does not recur.

A number of gynecological diseases lead to cycle disruption:

Cycle disruption may be a consequence of a history of surgical intervention, such as abortion.

The menstrual cycle can also be disrupted as a result of non-gynecological infectious disease. It can be affected by exhaustion of the body and lack of nutrition. Ill-conceived diets often lead to cycle disruption.

Among the reasons, an important place is occupied hormonal disorders. In this case, menstrual irregularities may be accompanied by the appearance of hair in atypical places, the appearance of increased oily skin.

This list of possible reasons does not end there. In order to establish the cause, a medical examination is required, and in some cases, a comprehensive examination.

For what menstrual cycle disorders should you consult a doctor?

Any irregularity in the menstrual cycle is a good reason to contact a gynecologist. The absence of a clearly defined cycle means a violation reproductive function, which may affect the ability to become pregnant and bear a child. And the main thing is possible sign serious illness.

You should definitely visit a doctor if:

• a girl did not start menstruating at the age of 15;
• discharge is observed during pregnancy;
• menstruation is extremely painful, accompanied by pain in the lower abdomen (this may be a sign ectopic pregnancy);
• heavy bleeding is observed (this can occur with an ectopic pregnancy, spontaneous abortion, malignant tumor uterus).

Menstrual irregularities may long time reduce the performance of women, accompanied by deterioration of reproductive function (miscarriage, infertility), both immediate (bleeding, anemia, asthenia) and long-term (endometrial, ovarian, breast cancer) consequences and complications.

Causes of menstrual irregularities

Disruption of the menstrual cycle is mainly of a secondary nature, i.e., it is a consequence of genital (damage to the regulatory system and target organs of the reproductive system) and extragenital pathology, the impact of various unfavorable factors on the system of neurohumoral regulation of reproductive function.

To the leaders etiological factors Menstrual cycle disorders include:

• disturbances in the restructuring of the hypothalamic-pituitary system during critical periods of development of the female body, especially during puberty;
• diseases of the female genital organs (regulatory, purulent-inflammatory, tumor, trauma, developmental defects);
• extragenital diseases (endocrinopathies, chronic infections, tuberculosis, diseases of cardio-vascular system, hematopoiesis, gastrointestinal tract and liver, metabolic diseases, neuropsychiatric diseases and stress);
• occupational hazards and environmental problems (impact chemical substances, microwave fields, radioactive radiation, intoxication, sudden climate change, etc.);
• violation of diet and work habits (obesity, starvation, hypovitaminosis, physical fatigue, etc.);
• genetic diseases.

Menstrual irregularities can be caused by other reasons:

• Hormone imbalance. A decrease in progesterone levels in the body is often the cause of hormonal imbalance in the body, which leads to menstrual irregularities.
• Stressful situations. Menstrual irregularities caused by stress are often accompanied by irritability, headaches, and general weakness.
• Genetic predisposition. If your grandmother or mother had problems of this kind, it is quite possible that you inherited such a disorder.
• Lack of vitamins and minerals in the body, exhaustion of the body, painful thinness.
• Climate change.
• Reception of any medicines can provide side effect in the form of menstrual irregularities.
• Infectious diseases of the genitourinary system.
• Alcohol abuse, smoking.

It should be emphasized that by the time the patient goes to the doctor. The effect of the etiological factor may disappear, but its consequence will remain.

Phases of the menstrual cycle

Follicular phase

The menstrual phase includes the period of menstruation itself, which in total can range from two to six days. The 1st day of menstruation is considered the beginning of the cycle. When the follicular phase begins, menstrual flow stops and hormones of the hypothalamus-pituitary system begin to be actively synthesized. The follicles grow and develop, the ovaries produce estrogens, which stimulate the renewal of the endometrium and prepare the uterus to receive the egg. This period lasts about fourteen days and ends with the release of hormones into the blood that inhibit the activity of follitropins.

Ovulatory phase

During this period, the mature egg leaves the follicle. This is due to a rapid increase in the level of luteotropins. It then penetrates the fallopian tubes, where fertilization directly occurs. If fertilization does not occur, the egg dies within twenty-four hours. On average, the ovulatory period begins on the 14th day of the cycle (if the cycle lasts twenty-eight days). Small deviations are considered normal.

Luteinizing phase

The luteinizing phase is the last phase of MC and usually lasts about sixteen days. During this period, a corpus luteum appears in the follicle, producing progesterone, which promotes the attachment of the fertilized egg to the wall of the uterus. If pregnancy does not occur, the corpus luteum ceases to function, the amount of estrogen and progesterone decreases, which leads to rejection of the epithelial layer, as a result of increased synthesis of prostaglandins. This completes the menstrual cycle.

The processes in the ovary that occur during MC can be presented as follows: menstruation → follicle maturation → ovulation → production corpus luteum→ completion of the functioning of the corpus luteum.

Regulation of the menstrual cycle

The regulation of the menstrual cycle involves the cerebral cortex, the hypothalamus-pituitary-ovary system, uterus, vagina, the fallopian tubes. Before you begin to normalize the MC, you should visit a gynecologist and take all necessary tests. With accompanying inflammatory processes and infectious pathologies, treatment with antibiotics and physiotherapy may be prescribed. To strengthen immune system it is necessary to take vitamin-mineral complexes, balanced diet, rejection of bad habits.

Failure of the menstrual cycle

Failure of the menstrual cycle most often occurs in adolescents in the first year or two after the onset of menstruation, in women in postpartum period(until the end of lactation), and is also one of the main signs of the onset of menopause and the end of the ability to fertilize. If the disruption of the menstrual cycle is not associated with any of these reasons, then such a disorder can be provoked by infectious pathologies of the female genital organs, stressful situations, hormonal problems in the body.

Speaking about the disruption of the menstrual cycle, you should also take into account the duration and intensity of menstrual flow. Thus, excessively abundant discharge may signal the development of a neoplasm in the uterine cavity, and may also be the result of negative impact intrauterine device. A sharp decline contents secreted during menstruation, as well as changes in the color of the discharge may indicate the development of a disease such as endometriosis. Any abnormal bloody discharge from the genital tract may be a sign of an ectopic pregnancy, so if any abnormalities occur in monthly cycle, it is strongly recommended that you consult your doctor.

Delayed menstrual cycle

If menstruation does not occur within five days from the date of the expected period, this is considered to be a delay in the menstrual cycle. One of the reasons why menstruation does not occur is pregnancy, so a pregnancy test is the first thing to do if your period is late. If the test turns out to be negative, you should look for the cause in diseases that may have affected the MC and caused its delay. Among them are diseases of a gynecological nature, as well as endocrine and cardiovascular systems, neurological disorders, infectious pathologies, hormonal changes, lack of vitamins, injuries, stress, overexertion, etc. adolescence A delay in the menstrual cycle in the first year or two after the onset of menstruation is a very common phenomenon, since the hormonal background at this age is not yet stable enough.

Symptoms of menstrual irregularities

Hypomenaprual syndrome is a disorder of the menstrual cycle, which is characterized by a decrease in the volume and duration of menstruation until it stops. It occurs in both preserved and disrupted cycles.

The following forms of hypomenstrual syndrome are distinguished:

• Hypomenorrhea - scanty and short periods.
• Oligomenorrhea - delay of menstruation from 2 to 4 months.
• Opsomenorea - delay of menstruation from 4 to 6 months.
• Amenorrhea is an extreme form of hypomenstrual syndrome, which is the absence of menstruation for 6 months. and more during the reproductive period.

Physiological amenorrhea occurs in girls before puberty, in pregnant and breastfeeding mothers, and in postmenopausal women.

Pathological amenorrhea is divided into primary, when menstruation does not appear in women over 16 years of age, and secondary, when MC does not recover within 6 months. in a previously menstruating woman.

Different types of amenorrhea differ in the reasons that caused them and the level of damage in the reproductive system.

Primary amenorrhea

Menstrual cycle disorder, which is a lack of factors and mechanisms that ensure the start menstrual function. 16-year-old (and possibly 14-year-old) girls who do not have breast development by this age need examination. In girls with normal MC, the mammary gland should have an unchanged structure, regulatory mechanisms(hypothalamic-pituitary axis) should not be disrupted.

Secondary amenorrhea

The diagnosis is made in the absence of menstruation for more than 6 months (except pregnancy). As a rule, this condition is caused by disturbances in the activity of the hypothalamic-pituitary axis; the ovaries and endometrium are rarely affected.

Oligomenorrhea

This menstrual cycle disorder occurs in women with irregular sex life, when regular ovulation does not occur. During the reproductive period of life, the most common cause is polycystic ovary syndrome.

Menorrhagia

Heavy blood loss.

Dysmenorrhea

Painful menstruation. 50% of women in the UK complain painful menstruation, 12% for very painful.

Primary dysmenorrhea- painful menstruation in the absence organic cause. This menstrual disorder occurs after the onset of the ovarian cycle shortly after menarche; the pain is cramping in nature, radiating to the lower back and groin, maximum severity in the first 1-2 days of the cycle. Excessive production of prostaglandins stimulates excessive contraction of the uterus, which is accompanied by ischemic pain. A decrease in the production of prostaglandins and, as a consequence, pain is caused by taking prostaglandin inhibitors, for example mefenamic acid, at a dose of 500 mg every 8 hours orally. The pain can be relieved by suppressing ovulation by taking combined contraceptives (dysmenorrhea may be a reason for prescribing contraceptives). The pain decreases somewhat after childbirth when the cervical canal is stretched, but surgical stretching can cause cervical incompetence and is not currently used as a treatment.

Secondary dysmenorrhea caused by pathology of the pelvic organs, for example endometriosis, chronic sepsis; occurs in late age. It is more constant, observed throughout the entire period and is often combined with deep dyspareuia. The best way treatment - treatment of the underlying disease. When using intrauterine contraceptives (IUDs), dysmenorrhea intensifies.

Intermenstrual bleeding

Menstrual irregularities that occur in response to the production of estrogen in the middle of the cycle. Other causes: cervical polyp, ectropion, carcinoma; vaginitis; hormonal contraceptives(locally); Navy; complications of pregnancy.

Bleeding after coitus

Causes: cervical trauma, polyps, cervical cancer; vaginitis of various etiologies.

Bleeding after menopause

Menstrual irregularities that occur 6 months after the last menstruation. The cause, until proven otherwise, is considered to be endometrial carcinoma. Other causes: vaginitis (often atrophic); foreign bodies, for example pessaries; cervical or vulvar cancer; endometrial or cervical polyps; withdrawal of estrogen (with hormone replacement therapy for ovarian tumors). The patient may confuse bleeding from the vagina and rectum.

Pain syndrome with a preserved cycle

Pain syndrome with a preserved cycle, cyclic pain observed during ovulation, the luteal phase of MC and at the beginning of menstruation can be caused by a number of pathological conditions.

Ovarian hyperstimulation syndrome is a pain syndrome that occurs during hormonal drug stimulation of the ovaries, which in some cases requires emergency care.

Types of menstrual dysfunction

The degree of menstrual cycle disruption is determined by the level and depth of disturbances in the neurohormonal regulation of the MC, as well as changes in the target organs of the reproductive system.

Exist various classifications menstrual cycle disorders: according to the level of damage to the reproductive system (CNS - hypothalamus - pituitary gland - ovaries - target organs), according to etiological factors, according to the clinical picture.

Menstrual cycle disorders are divided into the following groups:

• Algodysmenorrhea, or painful periods, is more common than other disorders, can occur at any age and is observed in approximately half of women. With algodismenorrhea, pain during menstruation is combined with headache, general weakness, nausea, and sometimes vomiting. The pain syndrome usually lasts from several hours to two days.
• Dysmenorrhea. This disorder is characterized by instability of the circulatory system - menstruation can either be significantly delayed or begin earlier than expected.
• Oligomenorrhea is a disorder of the menstrual cycle, which is characterized by a reduction in the duration of menstruation to two or less days. Menstrual flow is usually scanty; the duration of the intermenstrual period can be over thirty-five days.
• Amenorrhea is the absence of menstruation for several cycles.

Treatment of menstrual disorders

Treatment for menstrual irregularities is varied. It can be conservative, surgical or mixed. Often for surgical stage followed by treatment with sex hormones, which plays a secondary, corrective role. This treatment can be either radical, pathogenetic in nature, completely restoring the menstrual and reproductive functions of the body, or play a palliative, replacement role, creating an artificial illusion of cyclical changes in the body.

Correction of organic disorders of the target organs of the reproductive system is usually achieved surgically. Hormonal therapy is used here only as an adjuvant, for example, after removing synechiae of the uterine cavity. In these patients it is most often used oral contraceptives(OK) in the form of cyclic courses for 3-4 months.

Surgical removal of gonads containing male germ cells is indicated in mandatory in patients with gonadal dysgenesis with karyotype 46XY due to the risk of malignancy. Further treatment carried out jointly with an endocrinologist.

Hormone replacement therapy (HRT) with sex hormones is prescribed after the end of the patient’s growth (closure of bone growth zones) at the first stage only with estrogens: ethinyl estradiol (microfollin) 1 tablet/day - 20 days with a break of 10 days, or estradiol dipropionate 0.1% solution 1 ml intramuscularly - 1 time every 3 days - 7 injections. After the appearance of menstrual-like discharge, they switch to combined therapy with estrogens and gestagens: microfotlin 1 tablet/day - 18 days, then norethisterone (Norkolut), duphaston, lutenil 2-3 tablets/day - 7 days. Since this therapy is carried out for a long time, for years, breaks of 2-3 months are allowed. after 3-4 cycles of treatment. Similar treatment can be carried out with OK high level estrogenic component - 0.05 mg ethinyl estradiol (non-ovlon), or HRT drugs for menopausal disorders (femoston, cycloproginova, divina).

Tumors of the pituitary-hypothalamic region (sellar and suprasellar) are subject to surgical removal, or undergo radiation (proton) therapy followed by replacement therapy sex hormones or dopamine analogues.

Hormone replacement therapy is indicated for patients with hyperplasia and tumors of the ovaries and adrenal glands with increased production of sex steroids of various origins, alone or as a postoperative stage of treatment, as well as for post-variectomy syndrome.

The greatest difficulty in therapy various forms amenorrhea represents a primary lesion of the ovaries (ovarian amenorrhea). Therapy for the genetic form (premature ovarian failure syndrome) is exclusively palliative (cyclic HRT with sex hormones). Until recently, a similar scheme was proposed for ovarian amenorrhea of ​​autoimmune origin (ovarian resistance syndrome). The frequency of autoimmune oophoritis, according to various authors, ranges from 18 to 70%. In this case, antibodies to ovarian tissue are detected not only in hypergonadotropic amenorrhea, but also in 30% of patients with normogonadotropic amenorrhea. Currently, to relieve the autoimmune block, the use of corticosteroids is recommended: prednisolone 80-100 mg/day (dexamethasone 8-10 mg/day) - 3 days, then 20 mg/day (2 mg/day) - 2 months.

Antigonadotropic drugs (gonadotropin-releasing hormone agonists), prescribed for up to 8 months, can also perform the same role. In the future, if there is an interest in pregnancy, ovulation stimulants (clostilbegit) are prescribed. In patients with hypergonadotropic amenorrhea, the effectiveness of such therapy is extremely low. For the prevention of estrogen deficiency syndrome, they are shown to use HRT drugs climacteric disorders (femoston, cycloproginova, divina, trisequence, etc.).

Diseases of the most important endocrine glands of the body, secondary to sexual dysfunction, require treatment primarily from an endocrinologist. Sex hormone therapy is often not required or is of an auxiliary nature. At the same time, in some cases, their parallel administration makes it possible to achieve faster and more stable compensation for the underlying disease ( diabetes). On the other hand, the use of ovarian TPD allows, at the appropriate stage of treatment, to select the optimal dose of the drug for pathogenetic effects both to restore menstrual and reproductive function and to compensate for the underlying disease.

Therapy for stages of hypomenstrual syndrome that are milder than amenorrhea is closely related to the degree of hormonal deficiency of MC. For conservative hormone therapy For menstrual dysfunction, the following groups of drugs are used.

Menstrual irregularities: treatment

For menstrual irregularities associated with hormonal imbalance and progesterone deficiency, use the drug cyclodinone. The drug is taken once a day in the morning - one tablet or forty drops at a time, without chewing and washed down with water. The general course of treatment is 3 months. In the treatment of various menstrual disorders, such as algodismenorrhea, amenorrhea, dysmenorrhea, as well as menopause, the drug remens is used. It promotes the normal functioning of the hypothalamus-pituitary-ovarian system and balances hormonal balance. On the first and second days, the drug is taken 10 drops or one tablet eight times a day, and starting from the third day - 10 drops or one tablet three times a day. The duration of treatment is three months.

Modern drugs for drug correction of menstrual dysfunction

Group of drugs	A drug
Gestagens	Progesterone, 17-hydroxyprotesterone capronate (17-OPK), uterozestane, duphaston, norethistrone, norcolut, acetomepregenol, orgametril
Estrogens	Estradiol dipropionate, ethinyl estradiol (microfollin), estradiol (estraderm-TTS, Klimara), estriol, conjugated estrogens
Oral contraceptives	Non-ovlon, anteovin, triquilar
Antiandrogens	Danazol, cyproterone acetate (Diane-35)
Antiestrogens	Clostilbegit (clomiphene citrate), tamoxifen
Gonadotropins	Pergonal (FSH+LH), metrodin (FSH), prophasy (LH) choriogonin
Gonadotropin-releasing hormone agonists	Zoladex, buserelin, decapeptyl, decapeptyl depot
Dopamine agonists	Parlodel, norprolact, dostinex
Analogues of hormones and other endocrine glands	Thyroid and antithyroid drugs, corticosteroids, anabolics, insulins

In patients with endocrine infertility, additional use of ovulation stimulants is indicated.

As the first stage of treatment for patients with infertility, it is possible to prescribe combined OCs (non-ovlon, triquilar, etc.) in order to achieve a rebound effect (withdrawal syndrome). OCs are used according to the usual contraceptive regimen for 2-3 months. If there is no effect, you should move on to direct ovulation stimulants.

• Antiestrogens - the mechanism of action of AE is based on the temporary blockade of LH-RH receptors of gonadotrophs, the accumulation of LH and FSH in the pituitary gland with the subsequent release of their increased amount into the blood with stimulation of the growth of the dominant follicle.

In the absence of effect from treatment with clostilbegit, stimulation of ovulation with gonadotropins is possible.

• Gonadotropins have a direct stimulating effect on the growth of follicles, their production of estrogens and egg maturation.

Menstrual irregularities cannot be treated with gonadotropins in the following cases:

• hypersensitivity to the drug;
• ovarian cysts;
• uterine fibroids and developmental abnormalities of the genital organs incompatible with pregnancy;
• dysfunctional bleeding;
• oncological diseases;
• pituitary tumors;
• hyperprolactinemia.
• Gn-RH analogues - zoladex, buserelin, etc. - are used to imitate the natural pulse secretion of LH-RH in the body.

It should be remembered that when an artificially induced pregnancy occurs against the background of the use of ovulation stimulants, the mandatory prescription of preserving hormonal therapy at its early, pre-placental stage (progesterone, uterozhestan, duphaston, turinal) is required.