Home Stomatitis Failure of the menstrual cycle causes. What is a menstrual cycle disorder? Causes in women depending on age

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Failure of the menstrual cycle causes. What is a menstrual cycle disorder? Causes in women depending on age

Almost always, the causes of menstrual irregularities are associated with ovarian dysfunction and the resulting disruption of the body’s hormonal levels. This deviation manifests itself either as a delay in menstruation or irregular menstruation.

Often women consider such phenomena to be a feature of the body’s functioning, without paying due attention to it. As a result, they turn to the help of a qualified doctor untimely and learn about a possible disease that may pose a health hazard too late.

Normally, in women, the duration of menstruation ranges from three days to one week. The cycle should be repeated every 21-35 days. If the normal order of things has changed, it is necessary to look for the causes of menstrual irregularities, which may belong to the following groups:

External (physiological).
Pathological.
Medication.
Psychological.

Physiological factors do not have a direct impact on a woman’s body, affecting its work indirectly. TO external factors relate:

Stress.
Changes in climatic conditions.
Changes in lifestyle (sudden physical activity for which the body was not prepared).
Wrong nutrition. For example, different diets, eating insufficient amounts of food, possible refusal to eat.
Large weight gain or, conversely, weight loss.
Excessive consumption of caffeine and alcohol.
Smoking.

Reasons pathological disorders menstruation is various diseases, ranging from a common cold or inflammatory process in the body, ending with serious illnesses.

Often, such conditions are caused by a spontaneous miscarriage caused by the woman herself, or complications that arise after an abortion performed in a hospital. After surgical intervention Heavy bleeding, delayed menstruation, etc. are possible.

Drug therapy can have an adverse effect on the menstrual cycle and also lead to its disruption. Certain medications that the patient takes as prescribed by the doctor may have side effects, in particular, negatively affect work internal organs and systems, which in some cases leads to disruption reproductive function women.

An example of the psychological causes of menstrual irregularities are those experienced by a woman stressful situations or prolonged nervous tension. Bright negative emotions negatively impact a woman’s mental health and at the same time have a detrimental effect on her physical health. Examples of such disorders include moving, a change in work environment, quarrel and conflict in the family or close circle, fear of losing a loved one, etc.

The intrauterine device also causes changes in the course of menstruation. Even its correct installation can cause disruption of the menstrual cycle. If the procedure was carried out with errors, serious cycle disturbances and even bleeding in the uterus may occur in the future.

During adolescence, girls' periods can also be unstable. IN in this case everything is explained by the fact that the maturing body undergoes significant changes associated with hormonal changes. This period lasts for a certain time before everything returns to normal.

So, a teenage girl’s first menstruation can last for weeks or come irregularly. But then this process stabilizes and takes place as usual, within a few days. In rare cases, a teenager may need the help of a gynecologist to normalize the menstrual cycle.

The postpartum period in a woman is always characterized by menstrual irregularities, which is not considered a deviation. The absence of menstruation is also normal when a woman is breastfeeding.

Disruptions of the menstrual cycle are divided into 2 groups according to the nature of the changes that occur. If there are disturbances in the duration and frequency of the menstrual cycle, specialists consider such pathological conditions:

- amenorrhea (menstruation does not come for 6 months or longer);
- oligomenorrhea (menstruation with an interval of more than 35 days);
- polymenorrhea (period of menstruation less than 22 days).

Depending on the causes of menstrual irregularities, changes may also occur in the nature of menstruation. In this case, pathologies such as:

- hypomenorrhea (menstruation duration is less than three days);
- hypermenorrhea (menstruation lasts more than a week);
- menorrhagia (bloody discharge observed for two weeks);
- metrorrhagia (bleeding from the uterus between menstruation);
- algodismenorrhea (severe pain during menstruation);
- pronounced premenstrual period.

Menstruation accompanied by severe pain (algomenorrhea) is observed in girls and women aged 14 to 44 years. Algomenorrhea requires compulsory treatment, as it may be a symptom of endometriosis or inflammation of the appendages.

With dysmenorrhea, menstruation may occur earlier than expected or menstruation may be delayed. Often such deviations occur in women if their work involves flying and staying in places with different climatic conditions. The menstrual cycle, after the body gets used to new conditions, can recover on its own.

Infrequent menstruation, infertility, larger than normal ovarian size, obesity and increased hairiness characteristic of oligoamenorrhea. Such symptoms may indicate polycystic ovary syndrome.

Amenorrhea is considered the most severe type of menstrual irregularity, in which menstruation may be absent for 6 months or longer. Natural causes Such phenomena are pregnancy, breastfeeding, menopause.

However, if amenorrhea occurs in a girl aged 17-18, you should immediately consult a doctor.

Symptoms

Regardless of what the menstrual irregularity is associated with, its symptoms are as follows:

for six months or more;
irregularity (different number of days between discharges in each month);
excessive and intense discharge (more than 150 ml);
discharge that contains large;
spotting instead of menstruation;

Forms

Depending on the causes of cycle disruption in girls and women and what the manifestations are, the following types of pathology are distinguished:

Algodysmenorrhea is the occurrence of severe painful sensations. Appear in the lower abdomen and lower back, during or before menstruation. Associated symptoms – headache, dizziness, nausea, mood changes.
Algomenorrhea – painful periods.
Amenorrhea is the absence of menstruation for six months or longer.
Hypomenorrhea – menstruation occurs rarely (once every 35 days or more).
Dysmenorrhea is a general feeling of discomfort during critical days. Symptoms are nausea and headaches, emotional instability.
Menorrhagia, another name for hypermenorrhea, is heavy periods or prolonged periods (lasting more than a week). Regularity has been maintained.
Metrorrhagia is bleeding between periods.
Oligomenorrhea – short menstruation – 2 days or less.
Polymenorrhea – frequent periods (once every 21 days or more often).

Causes of menstrual irregularities

Regularity is the principle underlying the functioning of the female body. This implies a monthly cycle, which should be normal. Responsible for this various organs– cerebral cortex, subcortical centers, ovaries, thyroid, adrenal glands.

Failure of any of these organs leads to problems in functioning reproductive system.

Possible disorders of the menstrual cycle in women from the endocrine system:

inflammatory processes internal genital organs;
lack of progesterone;
excess estrogen production;
PCOS or polycystic ovary syndrome.

Possible following reasons menstrual cycle disorders, which consist of lifestyle changes:

the day and night routine is disrupted;
insufficient amount of sleep;
Not balanced diet;
abuse of caffeine, nicotine, alcohol;
stress;
climate change.

Other reasons:

diet and, as a result, a sharp decline weight;
obesity and rapid weight gain;
high blood pressure;
diabetes;
taking certain medications.

Age problems

When determining the causes of pathology, it is necessary to take into account age:

In adolescents, irregularity is the norm for a year and a half after the onset of the first menstruation (this is usually the age of 12-14 years).
In women after childbirth, failure is also possible.
After 40 years, irregularities in the onset of menstruation should also not be considered a deviation. A gradual decline in reproductive function appears, ovarian activity decreases, and menstruation becomes irregular. This points to .

After the age of 35, such problems may indicate ovarian wasting syndrome. There are many reasons for this; the pathology can be treated.

Diagnosis and treatment

How to treat menstrual irregularities is a question that worries girls and women. So as not to be stepped on unpleasant consequences, you must immediately make a visit to the doctor if characteristic symptoms are detected.

The examination includes:

inspection;
passing general tests;
determination of hormone levels;
checking for hidden infections;

The menstrual cycle must be brought back to normal. Therapy is not aimed at eliminating symptoms, but at the immediate cause of the failure:

in the presence of infection and inflammatory processes, medications and physiotherapy are prescribed;
hormonal imbalance treated with hormone therapy;
When tumors are detected, surgery is performed.

Problems with immunity and general weakness of the body can be solved by normalizing the daily routine, balanced nutrition, taking vitamins, and physical activity.

Video about the problem

Let's start with what exactly is a menstrual cycle disorder - it is a consequence of a violation hormonal function ovaries. It can manifest itself as delays or irregular menstruation. Many women very often do not pay attention to this problem, believing that it is a feature of their body. Although often a violation of menstruation may indicate a health hazard. A normal menstrual cycle should last no more than 3-7 days and the interval between menstruation should be 21-35 days.

Causes of menstrual irregularities

In most cases, menstrual irregularities can be caused by physical or emotional stress.

TO psychological reasons disorders include nervous overstrain, which can cause either or abnormal periods. Many changes in your life can affect not only the emotional, but also the physical condition. These could be changes such as a change of job, place of residence, breakup of a relationship, fear of losing a loved one.

Physical stress includes strenuous exercise and dieting. Losing or gaining weight over a short period of time has a negative effect on a woman’s hormonal system.

Long-term abstinence may cause menstrual irregularities

Sometimes even minor changes in your lifestyle can have a significant impact on irregularities in your menstrual cycle. Many women have repeatedly asked this question:

So, if a girl has renewed her sex life after a long pause, then the absence of menstruation may be the body’s response to the resumption of activity. But we shouldn’t rule out that this could also mean pregnancy.

It can often be unpredictable for those who have recently reached puberty (in teenage girls). The body needs time to accept these changes and return to normal.

The first periods may be very heavy and last several weeks, but then stabilize for up to five days. Very often, in order to regulate the menstrual cycle, you need the help of professional gynecologists.

If you don't start timely treatment problems with menstrual irregularities in teenage girls, then in the future they may experience Negative consequences and complications.

Treatment of menstrual irregularities

It is always necessary to correct menstrual irregularities. Treatment for menstruation disorders can be different, but first of all it is necessary to identify and treat the disease that caused this syndrome. If it is an infectious and inflammatory process, then they help antibacterial drugs and physical therapy. Regular and balanced nutrition and physical exercise will help support a weakened body. It is also recommended to take vitamin preparations in case of menstrual irregularities.

Today, herbal remedies for menstruation disorders are very popular; they have significantly expanded their capabilities for treating gynecological diseases. In some cases of treatment, they can even replace hormonal medications. The effect of herbal preparations is much milder than hormonal drugs, and they are also much safer.

Vitamins for menstrual irregularities

Many women have faced the problem of menstrual irregularities. This pathology can be caused by various reasons, but if the doctor does not find any pathological reasons, then in this case the woman needs to adhere to a special diet, as this may be caused by the body’s lack of necessary vitamins and microelements.

First of all, nutritionists recommend reducing the amount of liquid you drink before the start of the menstrual cycle, with the exception of dairy products, since on the contrary, they should prevail in the diet. Try to include more dairy products such as cottage cheese, kefir, milk, and sour cream in your diet.

During the period of desquamation, a woman needs to pay attention to products such as sauerkraut, pumpkin, tomatoes, poultry, beef liver, and it also wouldn’t hurt to take multivitamins on menstruation days.
Four days from the start of menstruation, vitamins can be replaced with red cabbage, apples, raspberries, gooseberries, cherries, turkey meat, and spinach.

This diet increases estrogen levels and will help relieve uterine vascular spasms.

Vitamin E is often of great importance for menstrual irregularities. It is prescribed in combination with other vitamins to regulate the menstrual cycle.

Video: Everything every girl needs to know about the menstrual cycle

Starting from the age of 11-12, every woman in her life facing menstruation. It is a sign that the body has matured and is physically ready to bear offspring. This phrase may scare you - few people can imagine expectant mother, who herself still plays with dolls.

But the fact remains that if menstruation comes, the girl becomes a girl. Her body begins to produce female sex hormones responsible for possibility of conception and bearing a child.

Menstruation becomes a common occurrence in a woman’s life and continues until the onset of menopause– a period when hormone production decreases and a woman ceases to be able to bear children. However, not everyone's menstrual cycle runs like clockwork. Cycle failures, too heavy or scanty periods, two periods in one month or a delay not related to pregnancy - every woman can face this.

Why do disruptions occur in the menstrual cycle? What are the consequences of such violations? How to identify them and how to treat them? The answers to all these questions are in this article.

Reasons why woman's menstrual cycle can give a sudden failure, differ in nature. They can be physiological, psychological and caused by taking certain medicines. Most common cause, according to which a woman’s menstrual cycle begins to go astray, becomes age factor.

When you reach a certain age, the body stops producing the required amount sex hormones, responsible for the stable functioning of a woman’s reproductive system. Menopause sets in - a difficult emotional and physical condition for a woman. Following menopause, during which menstruation usually continues, menopause occurs. And from this age a woman actually becomes infertile.

During this period, there are often cases of prolonged menstrual bleeding, during which it may develop anemia, significant disruptions in the arrival of menstruation: the time intervals between cycles are either halved or extended to several months.

After childbirth, women also experience problems with cycle instability. This is due to significant hormonal changes during pregnancy, childbirth and subsequent breastfeeding.

According to statistics, in 30% of women the menstrual cycle is restored to its previous state 3-4 months after childbirth, in 20% the cycle is restored within six months, in the rest - either after the end of breastfeeding, or within several years after the birth of the baby.

Most common reasons for failure in the menstrual cycle:

severe stress;
recent abortion or miscarriage;
taking hormonal medications;
taking medications that affect the thyroid gland;
climate change (temporary failure);
chronic depression;
chronic bacterial infections pelvic organs;
inflammatory processes of the reproductive system;
oncological diseases;
recent severe colds and antibiotic use;
birth of a child;
recent onset of menstruation, adolescence;
recent onset of sexual activity;
metabolic disease;
the beginning of menopause;
menopause;
strict diets.

All of these factors can cause a serious disruption in the functioning of the body and the female reproductive system, which leads to the fact that the monthly cycle becomes unstable. If you are concerned about the symptoms described in one of the sections below, this is a reason to consult a doctor.

Symptoms: how to determine that the cycle has gone wrong?

A serious menstrual cycle disorder is considered deviation from the norm. Some women begin to worry when their periods do not come on time, or come several days earlier. Such short-term failures are normal as long as they do not occur too frequently.

Up to a certain point, my periods came steadily, the cycle was equal in time, but there was a glitch. Has changed cycle length, became unstable, the duration of menstruation changed.
During menstruation, the discharge became too heavy and painful; or its duration has shortened, and allocations have become scarce. The latter may indicate serious problems with the ovaries(polycystic).
Menstruation comes several times a month, proceeds as usual (polymenorrhea).
Menstruation is delayed by more than 2 weeks, but pregnancy not confirmed. (Amenorrhea).
My period disappeared and did not appear for more than two months.
Cycle duration is less than 21 days, or more than 34 days.

As you can see, cycle disruption Both changes in its duration and the intensity of discharge and sensations during menstruation are considered. The appearance of severe pain, which was not there before, or heavy bleeding is a sufficient reason to seek advice from a doctor.

Causes of failure in adolescents

Most often, problems with the cycle occur in completely young girls. In most cases, gynecologists urge not to see this as a cause for alarm. The young body has just entered the maturation phase, the hormonal levels are still has not stabilized during puberty.

During the first few years, a teenage girl’s menstrual cycle is just establishing itself. Menstruation may come irregularly, with long intervals between cycles.

Often there are anovulatory cycles, as a result of which menstruation does not occur. The internal reproductive organs continue to form, menstruation can be painful, prolonged and heavy. Sometimes the situation manifests itself in the opposite form: menstruation rarely come, it takes no more than 2-3 days.

There is no need to worry too much about such disruptions, since for most women a stable cycle is established only by the age of 18-20 or after the birth of a child. But it is necessary to monitor the situation by regularly visiting gynecologist. To regulate the menstrual cycle, girls are often prescribed light oral contraceptives allowing to normalize hormonal levels. Taking pills on your own without consulting a doctor Not recommended so as not to harm the developing organism.

In women of childbearing age

Often the cycle goes wrong and adult woman with fully formed reproductive organs and stable hormonal levels. The main reason for this phenomenon is severe stress affecting work. thyroid gland. This, in turn, provokes disturbances in the production of hormones, and the female menstrual cycle suffers.

Diets, severe weight loss, taking hormonal contraception without a doctor's prescription, abortion pills, inflammatory processes in the pelvic organs - all this becomes cause of failure. In a woman with a stable cycle, deviations from the norm that occur more than once are a reason to immediately consult a doctor and conduct a full examination.

What women mistake for a disruption in the menstrual cycle may turn out to be pregnancy - normal or ectopic. Therefore, pay special attention to your body during a long delay. If tests do not show pregnancy, this does not guarantee its absence.

After childbirth

Disruptions in the menstrual cycle after the birth of a baby are absolutely normal. The first reason is the need to restore organs that were stretched or damaged during childbirth.

More often the uterus suffers, which greatly stretches during the development of the child. While the organs are recovering and returning to their natural state, the menstrual cycle will either be absent or become irregular.

The second reason for the absence of menstruation after childbirth is the active production of hormone prolactin affecting ovarian function. This hormone is actively produced during breastfeeding and suppresses ovulation. In the absence of ovulation, menstruation does not come, because standard process during the cycle (menstruation, egg maturation, ovulation, in the absence of conception - menstruation) is suppressed.

The timing of recovery of the cycle after childbirth depends on when it ends breastfeeding period. If a woman constantly breastfeeds her baby “on demand,” wait for the cycle to resume no earlier than the first year after birth. If the baby’s diet is mixed or he is switched to complementary feeding from 6 months, menstruation will be restored six months after birth. If a woman does not breastfeed, the ovulatory cycle will be restored by 13-14 weeks after birth, and soon after it they will begin your period is coming.

After 40 years

The main cause of menstrual irregularities after 40 years is the arrival of menopause. This phase in a woman’s life is a period of regular hormonal changes, and is accompanied by changes in mood, deterioration in well-being, and cycle disruptions.

Hormones responsible for the maturation of the egg and the arrival of menstruation are produced worse, in smaller quantities, and unstable. The cycle changes accordingly. Menstruation may disappear for a long period time.

Don't be afraid of this natural process. Menopause is the stage preceding menopause - the period sexual rest(rest from childbirth). A woman can also enjoy sexual intimacy, but becomes unable to birth of a child.

If menopause is severe, you need to consult a doctor to prescribe medications that normalize hormonal levels.

After 50 years

After 50 years in a woman's body menopause occurs. This process is characterized by a disruption of the menstrual cycle, and then its complete absence. The level of hormones in the body decreases, eggs stop maturing, and ovulation is absent.

During this period there may still be changes in the nature of menstruation: for example, an increase in its duration or the appearance heavy discharge. Then menstruation stops completely.

As mentioned above, menopause occurs in every woman and this is an absolutely natural process. On average, for most women this period occurs for 50-56 years. Menopause does not require being under medical supervision or taking any medications.

Treatment

Depending on the cause of the disruption in the menstrual cycle and the age of the patient, gynecologists resort to various measures for his treatment.

Most often the patient is prescribed hormone therapy in order to restore hormonal levels.

If problems arise due to stress, consultations with a psychologist and antidepressants are prescribed. If the failure factor is gynecological diseases- carry out the appropriate course of treatment.

One thing is important: if you have disruption of the menstrual cycle, do not self-medicate, this can only cause harm. Entrust the solution to the problem to a qualified specialist who will determine both the cause of the failure and prescribe the correct treatment.

Ovarial-menstrual cycle disorders (OMC) are perhaps the most common reason for visiting a gynecologist. Moreover, such complaints can be made by patients aged from puberty to the premenopausal period - that is, throughout the entire potentially reproductive phase of life.

What cycle is considered normal?

External manifestation natural ovarian-menstrual cycle - menstruation, which occurs with the frequency characteristic of every woman and lasts most often 3-6 days. At this time, the entire overgrown functional layer of the endometrium (uterine mucosa) is rejected. Together with the blood, its fragments exit through the slightly opening cervical canal into the vagina and then out. The natural cleansing of the uterine cavity is facilitated by peristaltic contractions of its walls, which can cause some physical discomfort.

The vessels that gape after tissue rejection quickly close, and the resulting total defect of the mucous membrane regenerates. Therefore, normal menstruation is not accompanied by significant blood loss and does not lead to the development of anemia, severe asthenia and loss of ability to work. The average volume of blood loss is up to 150 ml, and there are no blood clots in the discharge.

But the menstrual cycle is not only a stage of endometrial renewal. Normally, it also includes the follicular phase with the maturation of the egg in the ovary, and the subsequent secretory phase with the growth of the endometrium and its preparation for the potential implantation of the fertilized egg. A healthy woman of reproductive age also has anovulatory cycles, which is not considered a pathology. They normally do not lead to changes in the duration or nature of menstruation and do not affect the duration of the intermenstrual interval. During such cycles, a woman is not fertile, that is, pregnancy is impossible for her.

Menstruation begins during puberty. Their appearance indicates the readiness of the reproductive system for conception. The first menstruation (menarche) occurs between the ages of 9 and 15 years, most often between 12 and 14 years. This depends on many factors, the main ones being heredity, nationality, general state health, nutritional sufficiency of the girl.

The end of the reproductive period is characterized by the onset of the complete and final cessation of menstruation. This is preceded by menopause, which normally occurs on average at 46-50 years of age.

NOMC development mechanism

The ovarian-menstrual cycle in the female body is an endocrine-dependent process. Therefore, the main cause of its disorders is dishormonal disorders. They may appear primarily on different levels, including the involvement of endocrine glands that seem to be unrelated to the reproductive system. This is the basis for the classification of menstrual disorders. According to it, there are:

Central disorders with lesions higher centers neuroendocrine regulation of the reproductive system. IN pathological process Cortico-hypothalamic, hypothalamic-pituitary and only pituitary structures may be involved.
Disturbances at the level of peripheral structures, that is, the actual organs of the reproductive system. May be of ovarian or uterine origin.
Disorders associated with dysfunction of other endocrine glands (adrenal glands, thyroid gland).
Disorders caused by genetic and chromosomal abnormalities with congenital hyper- or hypoplasia of organs, disruption of the secretion process of key biological active substances and a disorder of the so-called feedback between peripheral organs and neuroendocrine structures.

Failures at any level will ultimately still manifest themselves in various types of NOMC. After all, hormonal imbalance leads to changes in the functioning of the ovaries, even if they do not have structural anomalies. A natural consequence of this is a violation of the secretion of the main sex hormones (estrogens and progesterone). And their main target is the functional layer of the uterine mucosa; it is this layer that is rejected with the blood at the end of the next cycle. Therefore, any dishormonal changes in the body can lead to disruption of the nature and regularity of menstruation.

Endocrine pathology– the main cause of menstrual dysfunction. Only in a fairly small percentage of cases is it not caused by hormonal disorders. Menstrual irregularities can be caused, for example, by pronounced changes in the endometrium. And sometimes false amenorrhea is diagnosed, when menstrual blood and sloughing endometrium are unable to escape naturally due to vaginal atresia or complete fusion of its exit with the hymen.

Causes of dysfunction

There are many reasons for the occurrence of menstrual dysfunction. Moreover, a woman can have several etiological factors, leading to functional failures at various levels.

The most likely of them:

Pituitary adenomas of various types (acidophilic, basophilic, chromophobic), which can be hormonally active or lead to compression and atrophy of the adenohypophysis. Itsenko-Cushing's disease and syndrome.
Taking drugs that affect the synthesis and exchange of dopamine and norepinephrine in brain structures, which leads to dysfunction of the hypothalamic-pituitary system. These include reserpine, MAO inhibitors, typical and atypical antipsychotics, antidepressants of various groups, metoclopramide, phenothiazine derivatives and a number of other drugs.
Adrenal adenomas and other tumors that produce androgens and cortisol. Adrenogenital syndrome due to congenital hyperplasia of adrenal tissue.
Some mental disorders accompanied by a violation of central neuroendocrine regulation. It can be depressive states moderate and severe degrees of various origins, endogenous diseases(schizophrenia) in the acute stage, anorexia nervosa, reactive disorders, adaptation disorders with chronic stress.
Hypo- or hyperthyroidism of various origins.
(Stein-Leventhal).
Suppression of ovarian function and disruption of feedback between them and the hypothalamic-pituitary system after long-term use of COCs and their abrupt withdrawal.
and premature gonadal wasting syndrome. They may also have an iatrogenic origin - for example, due to a woman’s repeated participation in assisted reproductive technology protocols with stimulation of hyperovulation.
Sharp non-physiological changes in hormonal levels, which can be caused by spontaneous or medical abortion, taking drugs to quickly suppress lactation.
Defects and anomalies in the development of the uterus, including those caused by chromosomal diseases.
Consequences of surgical interventions on the ovaries and uterus, radiation and chemotherapy, inflammatory diseases reproductive organs. This can be a significant decrease in the volume of functioning ovarian tissue, intrauterine synechiae up to the development of atresia of the uterine cavity, removal of the gonads and uterus.
. Moreover, not only malignant, but also large benign neoplasms with secondary atrophy of ovarian tissue.

Menstrual irregularities after 40 years of age are in most cases caused by increasing age-related changes reproductive system. Their cause is the natural depletion of the ovarian follicular reserve with an increase in the number of anovulatory cycles, progressive hypoestrogenism and decline in reproductive function. These changes become most obvious in the premenopausal period, when the cycle becomes more and more irregular with a tendency to and the addition of psychovegetative disorders.

Menstruation disorders in pubertal girls are most often caused by uneven maturation of the hypothalamic-pituitary and ovarian systems. But do not forget that it is during this period that they can debut clinical manifestations some congenital syndromes, chromosomal diseases and developmental abnormalities of the internal organs of the reproductive system.

In addition, adolescent girls often experience disorders eating behavior with the formation of nutritional deficiency of key nutrients and especially fats. This leads to a pronounced decrease in the synthesis of steroid (including sex) hormones, which most often manifests itself as secondary amenorrhea.

Possible manifestations of NOMC

Based on the presence of the previous period normal menstruation all possible disorders can be divided into primary and secondary.

Symptoms of menstrual irregularities may include:

Change in the duration of the intermenstrual period. Proyomenorrhea (with a cycle duration of less than 21 days) and opsomenorrhea (its lengthening over 35 days) are possible.
Delay of the next menstruation in the absence of previous cycle disorders.
Absence of menstruation for 6 months or more () in a woman of reproductive age.
Changes in the volume of menstrual blood loss. It is possible that both its increase (hypermenorrhea) and its decrease (). Excessive blood loss is referred to as menometrorrhagia.
Changing the duration of menstruation itself towards shortening () or lengthening (polymenorrhea).
The appearance of intermenstrual bleeding, which can vary in intensity - from spotting to profuse. For acyclic heavy uterine bleeding, the term “metrorrhagia” is used.
Clinically significant local pain syndrome during menstruation, which is called algomenorrhea.
The appearance of general extragenital symptoms accompanying menstruation. These include headaches of various types, fluctuations blood pressure, nausea and changes in appetite, other vegetatively caused manifestations. This state is denoted as , and when combined with pain syndrome talk about algodismenorrhea.

Hypermenstrual syndrome with polyhypermenorrhea and/or acyclic dysfunctional uterine bleeding is usually the cause of the development of chronic posthemorrhagic iron deficiency anemia. Its symptoms often become a reason to consult a doctor. In this case, the woman is worried about increased fatigue, palpitations, general weakness, a tendency to lower blood pressure, possible fainting states. The condition of the skin, hair and nails deteriorates, and a decrease in mental productivity is possible, up to the development of moderate cognitive disorders.

Many women of reproductive age also experience infertility - the absence of natural conception within 1 year of unprotected regular sexual activity. It is caused by pronounced disturbances in the excretion dominant follicle in one of the ovaries, the process of maturation of the egg in it and the absence of spontaneous ovulation.

It is important to understand that in the presence of anovulatory cycles, a woman may independently and not make any special complaints about menstrual irregularities, although a targeted survey in most cases reveals various symptoms. In this case, the patient usually considers the lengthening of the menstrual cycle characteristic of her as her individual feature, and not a pathological sign.

Features of menstruation disorders in different age groups

Juvenile period

NOMC in adolescents can occur according to the type or with a tendency to so-called juvenile (pubertal) bleeding. The nature of the disorders depends on the etiology and existing dyshormonal disorders. Perhaps later menarche or development of primary amenorrhea. It is said to occur if menstruation does not begin by the age of 15.

Juvenile bleeding occurs in anovulatory cycles due to disorders hormonal status with follicular atresia. They usually alternate with uneven periods and are often combined with impaired hair growth, insufficiency or excess body weight. Neuro-emotional stress, a sharp change in climate and time zone, and disruption of the sleep-wake cycle can act as a provoking factor.

Reproductive period

During reproductive age, cycle disorders can manifest themselves as a failure of cyclicity, a delay in the next menstruation with subsequent bleeding. In this case, it is necessary to distinguish physiological changes from pathological ones. Normally, the temporary disappearance of menstruation may be due to the onset of pregnancy, postpartum period and against the background of breastfeeding. In addition, changes in the cycle and nature of menstrual flow occur during the use of hormonal contraception and after the installation of intrauterine devices.

Lengthening the cycle is most often due to the persistence of the follicle. In this case, ovulation of a mature egg does not occur. It dies, and the follicle continues to increase in size, forming various sizes. In this case, the hormonal background corresponds to the 1st phase of the cycle with hyperestrogenism, which leads to progressive growth of the endometrium. The delay in menstruation can reach 6-8 weeks, after which metrorrhagia occurs. Such uterine bleeding classified as dysfunctional. Another reason for their development is luteal phase deficiency. In this case, bleeding occurs during the ovulatory period; it is usually not profuse, but prolonged.

Changes in the ovaries during a typical menstrual cycle

Menstruation irregularities after an abortion are also possible. It can be spontaneous (with spontaneous abortion at early stages) or medically using various techniques for removing the fertilized egg/embryo. In this case, a prolongation of the subsequent cycle is usually noted, and restoration of menstrual function is expected within 3 months. If the abortion was accompanied by complications, a protracted rehabilitation period with acyclic bleeding, algodismenorrhea.

Premenopausal period and menopause

Most often failures normal cycle menstruation occurs in premenopausal age. The decline of reproductive function is often accompanied by a significant increase in anovulatory cycles, a tendency to delays and bleeding against the background of follicular atresia, loss of cyclical changes and the development of the so-called.

The resumption of uterine bleeding during menopause is an extremely alarming sign. After all, restoration of reproductive function is no longer possible, and spotting and bleeding during this period usually indicate the presence of malignant tumor.

Possibility of pregnancy

Pregnancy with menstrual irregularities is possible. But the likelihood of its occurrence depends on the severity of dishormonal disorders, the full development of the uterus and many other factors. In many cases, menstrual irregularities are accompanied by infertility. And it is not always possible to eliminate it conservative methods, pregnancy is often possible only with the help of assisted reproductive technologies. And sometimes a woman cannot conceive and bear a child on her own. In this case, she is offered the services of a surrogate mother and donor programs.

In addition, we should not forget that endocrine disorders often lead to inferiority of the functional layer of the endometrium and thereby complicate the normal implantation of the fertilized egg. This, coupled with insufficient production of progesterone and hCG, significantly increases the risk of miscarriage in the very early and early stages. In this case, a woman may not be aware of conception, regarding the delay in menstruation as just another dysfunction.

Previous menstrual dysfunction is considered a factor that potentially complicates the course of pregnancy. Such women demand special attention. Often, to prolong pregnancy, they need to take certain hormonal medications. According to statistics, in a number of women after childbirth, menstrual irregularities self-correct (about the timing of the restoration of menstruation, see our article on). And subsequent pregnancies can occur without any particular difficulties.

Survey

In most cases, NOMCs have a favorable prognosis, since they are caused by changes that are not life-threatening to the woman. But we should not forget that up to 10% of cases are gynecological cancers various localizations. Therefore, the diagnosis of this condition requires a thorough examination to establish the true cause of menstrual dysfunction and determine the nature and severity of existing changes. It is this tactic that will allow you to select the optimal corrective therapy or carry out radical treatment in a timely manner.

The basic examination should include:

Careful collection of obstetric and gynecological history with clarification of the time of onset of complaints, possible connection with any factors, the fact of previously existing menstrual disorders, age of menarche (first menstruation) and the likelihood of conception. Be sure to find out previous illnesses and operations, the number and duration of abortions and births, the course and outcome of previous pregnancies. The fact of taking any medications and the nature of the drug are also important.
Gynecological examination vagina and cervix in speculum, bimanual palpation of the pelvic organs. In this case, structural changes in the visible mucous membrane (defects, growths, deformations, color changes, swelling), varicose transformation of superficial veins, changes in the contours, size, position and consistency of the uterus and appendages can be detected. The nature of discharge from the vagina and from the cervical canal is also assessed.
Taking smears from the walls of the vagina, sponges of the cervical canal, urethra for major urogenital infections (STDs), degree of purity.
A smear for oncocytology from the cervix, which is especially important if there are pathological foci on it.
Exception of pregnancy. To do this, perform a rapid urinary test or determine hCG level in blood.
Determination of endocrine status. It is necessary to assess the level of the main hormones that regulate the functioning of the ovaries and the menstrual cycle. These include estrogen, progesterone, pituitary hormones - LH (luteinizing hormone), FSH (follicle stimulating hormone), prolactin. In many cases, it is also advisable to determine the performance of the thyroid gland and adrenal glands, because dysfunction of these glands also affects the functioning of the ovaries.
Ultrasound of the pelvic organs. Transvaginal and abdominal sensors are most often used. This is enough for a full examination of the uterus and its cervix, appendages, parametric tissue, vessels and regional lymph nodes. If the hymen is preserved, a rectal sensor is used instead of a vaginal one, if necessary. Ultrasound is the most accessible and at the same time quite informative method of visualizing internal organs.
Histological examination of endometrium obtained by separate diagnostic curettage cervix and uterine cavity. This is indicated mainly for hypermenstrual syndrome and metrorrhagia.

If there are indications, high-tech technologies are used at stage 2 of the examination. diagnostic techniques(CT, MRI, PET and others). Most often they are prescribed for suspected gynecological oncological pathology.

Principles of treatment

Treatment of menstruation disorders includes several areas:

Stop bleeding. For this purpose, hormonal drugs, agents that affect blood clotting and uterine contractility, and sometimes curettage can be used.
Correction of existing hormonal disorders, which is the prevention of repeated menstrual disorders. The treatment regimen is selected individually, based on the patient’s endocrine profile.
Deciding on the advisability of surgical treatment to eliminate the main causative factor or correct existing developmental anomalies.
If necessary, measures aimed at stimulating the development of the uterus and activating the work of the ovaries. Various physiotherapeutic techniques, cyclic vitamin therapy, and herbal medicine are widely used.
Correction comorbid disorders(psychovegetative disorders, anemic syndrome and etc.).
Correction of therapy received for the underlying disease. For example, when taking psychotropic drugs, it may be recommended to replace them with more modern, narrowly targeted drugs. Certainly, final decision correction of therapy is decided not by the gynecologist, but by the attending physician (for example, psychiatrist, neurologist).
If you want to conceive - complex treatment infertility using conservative and, if necessary, surgical (endoscopic) techniques, timely decision-making on the advisability of using assisted reproductive technologies.

Menstrual irregularities are a very common problem. And its relevance does not decrease, despite the achievements modern medicine. Fortunately, many forms of such disorders can be corrected. And when a woman consults a doctor in a timely manner, it is often possible to avoid complications, maintain a high quality of life for patients, and even cope with accompanying complications.