Violation menstrual cycle most common in gynecology. Both adolescents and older women turn to doctors. Almost everyone had menstrual cycle failures, but this does not always indicate a pathology.

What is a normal menstrual cycle?

Normal periods last three to six days once a month. With secretions, an overgrown, but unclaimed endometrium comes out. After rejection of unnecessary tissues, the capillaries close, and the growth of a new mucosa begins. Therefore, normal blood loss during menstruation is small, does not cause anemia, asthenia. On average, during menstruation, up to 150 ml of blood comes out, without clots.

The full menstrual cycle is the follicular phase, when the egg matures in the ovary, ovulation, the growth of the endometrium and its preparation for the possible attachment of the fetal egg. Therefore, there may be anovulatory periods, and this does not apply to pathologies. They do not change the duration of periods or the interval between them.

They begin during puberty and indicate the body's readiness for conception. With normal development, the first menstruation appears at the age of 9-15 (more often at 12-14). The range of possible onset of full maturation depends on heredity, nutrition, nationality, health status, etc. called the climax. It occurs at about 46-50 years of age.

Types of violations

A violation of the menstrual cycle is considered if its duration increases by more than 7 days or the interval between discharges is reduced by a week. Moreover, they talk about diseases if such phenomena become systematic.

In this case, a complete examination is necessary.

Deviations of the normal course of menstruation are divided into several categories:

1. Amenorrhea. This is when menstruation is missing for several cycles. Amenorrhea can be primary when there is no discharge before the age of 16, but there are signs of puberty “on the face”. Secondary is called when menstruation began, but disappear for a long time.
2. Dysmenorrhea. Deviations in menstruation can be in any direction - reduction or increase. Dysmenorrhea can appear regardless of age. However, if the cyclicity is just beginning and not fully regulated (adolescent, postpartum periods), then this does not apply to pathologies.
3. Oligomenorrhea, when menstruation is very rare. Bleeding lasts no more than two days, there is little discharge. Primary oligomenorrhea occurs due to underdevelopment of the uterus, secondary - due to deviations in the hypothalamic-pituitary system, tumors, after infectious diseases. Typically, menstruation failures are characteristic of overweight women. Often there are problems with conception.
4. Hypomenorrhea. At the same time, a meager amount of discharge is observed - blood loss is less than 50 ml. Menstruation is delayed and accompanied by negative symptoms - nausea, lack of appetite, weakness in the legs, etc. The cause of hypomenorrhea can be dysfunction of the ovaries, pituitary gland, changes in the uterine mucosa.
5. Proyomenorrhea. This is a reduction of the period to 21 days. Most often, the periods are short - they last only a couple of days. Most of the discharge is small, but can be plentiful. Proyomenorrhea is often accompanied by ovulation, sometimes anovulatory periods.
6. Opsomenorrhea is when the cycle increases to at least 35 days (but not more than 3 months). At the same time, the discharge is scanty, menstruation is short. Often this is accompanied by infertility. Women with opsomenorrhea tend to be obese, may have some masculine traits, and often suffer from acne.
7. Polymenorrhea. Bleeding lasts more than a week.
8. Hypermenorrhea. At the same time, the volume of secretions increases greatly, but the duration of menstruation remains normal. This can be caused by gynecological diseases, a decrease in platelets in the blood, polyps, endocrine diseases.
9. Menorrhagia. The duration of menstruation increases, there is a lot of discharge.
10. Metrorrhagia. It is characterized by severe uterine bleeding caused by tumors, diseases, lack of ovulation.

Failures of the menstrual period are divided into several categories depending on the causes:

1. Hypothalomic deviations are caused by infectious-toxic damage, trauma, mental disorders. At the same time, the concentration of gonadotropic hormones remains normal, but the luteinizing hormone becomes less. The reactivity of the uterus decreases, secondary amenorrhea appears. Atrophic changes can be found in the genitals.
2. Pituitary develop due to a deficiency of gonadotropic hormones. This happens during pregnancy and childbirth. Further, atrophy of the ovaries and external genitalia, hair loss may occur. Violation of the menstrual cycle first manifests itself in the form of hypo- and oligomenorrhea, then - amenorrhea. Deviations are provoked by a pituitary tumor, Itsenko-Cushing's disease, hyperplasia.
3. Ovarian. This violation of the menstrual cycle can be hyper- and hypohormonal and is divided into hyper-estrogenic, progesterogenic. They appear as a result of a follicular cyst, purulent salpingo-oophoritis. Early atresia and scarring leads to hypo- and amenorrhea.
4. A large amount of progesterone is released. The cause may be luteal cysts, persistent corpus luteum (but this is rare). The structure of the endometrium is disturbed and if not restored, this leads to menorrhagia.
5. Another violation of the menstrual cycle -. They are primary or secondary when there is a deficiency of gonadotropic hormones. The reasons may be mental trauma, anatomical anomalies.

If necessary, it can be carried out surgery. If the reason for the failure of menstruation is another disease, it is treated first. Also, correction of mental disorders, infertility therapy is carried out.

Violation of the menstrual cycle almost always indicates disease. If the duration of menstruation (or the amount of discharge) is violated, you should immediately consult a doctor.

In this case, many terrible diseases are detected on initial stage when they can be cured. A timely appeal to a gynecologist in case of a violation of the cycle can save a life.

Nutritionist, healthy lifestyle trainer Elena Bogdanova

A frequent reason for a visit to a gynecologist is ovarian-menstrual cycle disorders (NMC) recorded in patients different ages- from adolescence to premenopausal and menopausal. Is it always necessary to be treated?

The cost of endocrinologist services at the University Hospital

Service	price, rub.
Reception (examination, consultation) of an endocrinologist with the highest qualification category	1700
Ultrasound examination of the thyroid gland	1300
Consultative appointment with combined endocrine and gynecological pathology based on the results of examination and treatment in other clinics (full cost of consultation and treatment without the need for subsequent visits)	2500
Treatment of infertility, endocrine pathology	1600
A complex of ovulation stimulation during 1 cycle (all necessary methods are included without limitation of multiplicity, appointments and changes in the scheme, folliculogenesis without limitation of multiplicity) excluding the cost of drugs	15000

What is the normal menstrual cycle

The natural ovarian-menstrual cycle is regular menstruation, lasting from three to six days and occurring at a frequency that is individual for each individual woman.

During the critical days, the uterus rejects the overgrown layer of the internal mucous membrane (endometrium), after which it, together with the blood, is excreted through the slightly opened cervical canal. At the same time, the uterus contracts intensively - this causes discomfort and pain in the lower abdomen.

Vessels and mucous membranes damaged during the discharge of the endometrium are quickly restored. This prevents anemia (anemia) from developing. On average, a woman loses about 150 ml of blood during her period.

The normal (without pathologies) menstrual cycle consists of two periods:

• During the first follicular phase, an egg matures in the ovary. Then she exits, breaking the follicle, into the fallopian tube.
• The second (secretory) phase is characterized by the growth of the endometrium and its preparation for implantation (attachment) of the fetal egg.

Healthy women of childbearing age may experience cycles without ovulation (anovulatory), during which the womancannot get pregnant because the egg does not mature. It is not considered a violation if the situation does not become the norm. But the constant lack of ovulation leads to infertility.

Normally, the menstrual cycle is 21-35 days, on average - 28 days. Monthly 2-6 days proceed.

AT adolescence and in the premenopausal period, the cycle can change, as well as the number of critical days. This is considered a physiological norm and does not require treatment. In teenage girls, the menstrual period will gradually even out, and critical days will come at a certain interval.

In the menopause at the beginning menstruation comes irregularly, and then stops completely

The mechanism of development of disorders of the ovarian-menstrual cycle

The ovarian-menstrual cycle refers to processes dependent on the female endocrine system, so most of its pathologies are caused by hormonal disorders.

Since the body is a whole, malfunctions in organs other than the reproductive system can cause menstrual dysfunction.

Often the problem is caused by several factors at once, related to each other., so determining the cause of NMC is a difficult task. It is possible to identify the causes of the violation after an extensive examination.

Causes of menstrual irregularities

• congenital anomalies. For example, false amenorrhea, in which the release of menstrual blood is prevented by the complete infection of the hymen or obstruction of the vagina.These NMCs are diagnosed during adolescence.
• Pathologies of the reproductive organs- ovaries, fallopian tubes, uterus. Menstrual disorders often accompany inflammatory processes and benign neoplasms. Menstrual dysfunction occurs with polycystic and oncopathologies of the genital area.
• Consequences of inflammatory gynecological diseases and past interventions on the ovaries and uterus - operations, chemotherapy and radiation exposure.
• Disorders of the endocrine glands- ovaries, adrenal glands, thyroid gland. In this case, violations menstrual cycle caused by hormonal imbalances.
• Disorders of the pituitary, hypothalamic-pituitary and cortical-hypothalamic departments brain, regulating exocrine function.
• Neoplasms of the pituitary gland, which can compress it, cause atrophy and disrupt work - for example, pituitary adenoma of any form (acidophilic, basophilic, chromophobic). Tumors of the adrenal glands (for example, adenoma), synthesizing hormones - androgens and cortisol, affecting sexual function.
• Neuropsychiatric disorders- schizophrenia, neurosis, anorexia nervosa, depression, chronic stress.
• Sharp jumps in hormones caused by miscarriage, abortion, taking drugs that affect hormonal function. Menstrual dysfunction causes medication - dopamine, norepinephrine, reserpine, metoclopramide, phenothiazine, monoamine oxidase, antidepressants, sedatives.
• Ovarian exhaustion caused by their hyperstimulation during IVF and other reproductive technologies.

Symptoms of menstrual disorders

• Algomenorrhea- painful critical days.
• Dysmenorrhea- headaches, pressure drops, nausea, swelling, lack of appetite and other uncomfortable conditions that occur during menstruation.
• Algodysmenorrhea- a condition characterized by both painful menstruation and the above signs of malaise.
• Amenorrhea- the absence of menstruation in a woman of reproductive age for 6 months or more.
• Proyomenorrhea and opsomenorrhea- change in the duration of the interval between menstruation - less than 21 days and more than 35 days.
• Oligomenorrhea and polymenorrhea- decrease or increase in the duration of the menstruation itself.
• Hypomenorrhea- scanty menstrual flow.
• Hypermenorrhea- large blood loss during menstruation.
• metrorrhagia- intermenstrual bleeding of varying intensity.

Not always increased bleeding, lengthening of the menstrual cycle are accompanied by complaints and disorders. Sometimes it's just a personality trait. Therefore, such patients need a comprehensive examination.

Features of menstrual disorders in different age groups

Juvenile period - menstrual disorders in adolescents

Violations of the ovarian-menstrual cycle in girls can be expressed by hypomenstrual syndrome and a tendency to juvenile (pubertal) bleeding.

There may be a delay in the first menstrual bleeding and primary amenorrhea - the absence of menstruation by the age of 15. Frequent menstrual irregularities and anovulatory cycles. During this period, the irregularity of menstruation can provoke stress, climate change and other factors..

reproductive period

In puberty, menstruation is absent during pregnancy, the postpartum period, during breastfeeding. Such amenorrhea is considered physiological.

In the pathological absence of menstruation, the egg does not leave the follicle, but dies inside it. A cyst is formed and the hormonal background is disturbed. The inner lining of the uterus grows and then begins to shed, causing bleeding. After several months of absence of critical days, a multi-day bloody daub appears, which gradually turns into prolonged bleeding. In this case, you have to do curettage of the uterus and remove the overgrown endometrium

Profuse prolonged menses and acyclic uterine bleeding, are often responsible for the development iron deficiency anemia due to blood loss.

A woman develops weakness, fatigue, palpitations, low blood pressure, fainting. There may be deterioration in the condition of the skin, hair and nails. These symptoms are the reason for.

Pre-menopause and menopause

Menstrual irregularities often occur during the period leading up to menopause. This age is characterized by an increase in the number of anovulatory cycles, a tendency to delay menstruation and the development of signs of menopause (climacteric syndrome).

Uterine bleeding during menopause is a cause for concern, as spotting can signal the presence of a malignant neoplasm.

The possibility of pregnancy with NMC

It is possible to conceive and give birth to a healthy child with disorders of the ovarian-menstrual cycle, but the likelihood of this depends significantly on the degree of hormonal imbalance, the full development of the uterus and other circumstances. Situations when problems with the cycle lead to infertility, unfortunately, are not uncommon.

Failures in the work of the endocrine system cause the inferiority of the functional layer of the endometrium and complicate the process of implantation of the embryo into the uterus, which increases the risk of abortion in the early stages. A woman may not even know about the onset of fertilization, taking a failed pregnancy for another delay.

If it is not possible to eliminate the pathology with conservative methods of treatment, one has to resort to assisted reproductive technologies.

Sometimes, after the birth of the first child, menstrual disorders disappear without treatment and further pregnancies no longer cause problems.

If a woman is unable to conceive and bear a child on her own, donor programs and surrogacy come to the rescue.

Examination for menstrual irregularities

In most cases, NMCs can be successfully corrected, but for this it is necessary to identify the cause of the violations. Making the correct diagnosis will allow you to choose adequate therapy, and, if necessary, to perform surgery.

For this, the following is carried out:

• Careful collection of information about the "women's health" of the patient. The doctor receives information about the age of the onset of the first menstruation, existing diseases reproductive system, the use of contraceptives, undergone surgical interventions on the genitals, the number of pregnancies, their duration and outcome (abortion, miscarriage or childbirth).
• Instrumental examination by a gynecologist of the vagina and cervix using a special mirror and manual examination of the pelvic organs. Gynecological examination reveals existing diseases of the reproductive sphere.
• , allowing you to fully examine the uterus, its neck, surrounding tissue, blood vessels and regional lymph nodes. Gynecological ultrasound is an affordable and informative way to visualize the internal organs. Diagnosis using ultrasound is carried out transvaginally (through the genital tract) and abdominally (through the abdomen). and transrectal (through the rectum).
• Computed (CT), magnetic resonance (MRI) and positron emission (PET) tomography of the pelvic organs.
• Determination of endocrine status. Examinations are carried out for the main hormones that affect the functioning of the ovaries and the course of the menstrual cycle - estrogen, progesterone, prolactin, luteinizing (LH) and follicle-stimulating (FSH). Sometimes an additional analysis is required to evaluate the functioning of the thyroid gland and adrenal glands, since they are also associated with the activity of the ovaries.
• Taking swabs for urogenital (sexually transmitted) infections (STIs) and the degree of purity from the organs of the genitourinary system - the walls of the vagina, urethra and sponges cervical canal.
• Taking a smear from the cervix for cytological analysis aimed at finding malignant neoplasms. It is especially important to conduct such a study in the presence of pathological foci on the cervix.
• Separate diagnostic curettage the uterine cavity and its cervix for a histological analysis of the endometrium (the inner lining of the uterus).

Principles of treatment of menstrual irregularities

Therapy of violations consists of several components:

• Stop bleeding with hormonal drugs that affect uterine contractility and blood clotting.
• Selection of an individual scheme for the correction of hormonal disruptions, taking into account the endocrine profile of the patient. This measure helps prevent menstrual irregularities in the future.
• Surgical treatment of pathologies that provoke NMC.
• Physiotherapy, herbal medicine, vitamin therapy.
• Elimination of concomitant pathologies caused by menstrual irregularities.
• Medication adjustments. The drugs taken are replaced by others that do not affect the menstrual cycle. Amendments to the existing treatment plan are made by the attending physician of the relevant profile (psychiatrist, neurologist, etc.).
• Complex therapy of infertility with the use of conservative and operative (endoscopic) measures.
• Applications of IVF and other assisted reproductive technologies

Thanks to the introduction of new medical methods of treatment, most forms of NMC can be successfully corrected. With timely treatment, it is possible to maintain women's health, avoid complications and normalize reproductive function.

Critical days are “a very strange subject”: we suffer so much with their arrival and sowe torment ourselves with different thoughts when they suddenly linger or pass not asusually. Menstruation did not come on time, became scarce or, on the contrary, plentiful? Let'sfind the probable cause.

1. Pregnancy

Delayed menstruation is one of the main signs of pregnancy. Perhaps you don't havereasons to worry and a small miracle is already growing in your tummy. Check it out by doingpregnancy test or blood test for hCG, contact your gynecologist forconfirmation. Just remember: any bleeding in a pregnant woman (even similar tomonthly) are not the norm and require a doctor's consultation!

2. Stress

Problems at work, loss of loved ones, quarrels, scandals, divorce, seriousexperiences break your morale. The hormonal system also suffers from this. Notbe surprised if, after the shock you experienced, the critical days come earlier,late or delayed indefinitely.

3. Acclimatization

This is a real summer reason. You came to relax in a beautiful tropicalparadise, soak up the sea coast, breathe in the crystal clear mountain air,returned home from a long-awaited vacation. But what happened? Critical days arecame or, on the contrary, caught you by surprise in the middle of the rest. Don't be surprised - changeweather conditions can also cause fluctuations in the level of sex hormones.

4. Changing the way of life

Starting gym classes, changing work hours, sleep and wake schedules,abstinence or, conversely, an increase in sexual activity - all this can affectyour menstrual cycle. But such changes are most often short-term and reversible.

5. Weight gain or drastic weight loss

Passion for debilitating diets, or vice versa, the cult of gluttony is no gooddoes not lead. Did you know that your critical days depend on the presence of adipose tissue inbody? So, if it is less than 20% of body weight, the cycle becomesirregular, less than 15% - monthly and completely stop. If the amount of fattissue is 15-20% higher than your norm - a failure cannot be avoided either.

6. Infectious and cold diseases

Have you had rubella, chickenpox, influenza, SARS or other diseases? Maybe,they caused the failure of your menstrual cycle. Chicken pox and rubella caninfluence the laying of follicles in the ovaries and thereby cause long-termmenses delay. If after the disease you have a delay of more than 7days and the pregnancy test is negative, contact your gynecologist immediately!

7. Hormonal disorders

A woman's menstrual cycle is dependent on many hormones. If suddenly it happens systematic failure for no apparent reason (pregnancy is excluded), it is worthcheck for hormonal imbalances. Delay, scanty or profusemenstruation can be caused by dysfunction of the thyroid gland, adrenal glands, ovaries...

8. Taking medication

Some medications can cause menstrual irregularities. antibiotics, hormonal preparations, contraceptives, emergencycontraception - all of these drugs affect your periods. So don't botherself-treatment - contact the professionals!

9. Gynecological diseases

There are a lot of them: polycystic ovaries, ovarian cyst, uterine fibroids, cervical cancer, cervical erosion ... this list dangerous diseases can go on for a long time.Note that the violation of the menstrual cycle is only one of the not most terribleconsequences. Go see your gynecologist and eliminate the risk of these diseases!

10. Childbirth or abortion

After childbirth, the reproductive function of a woman is restored, therefore, criticaldays are missing for a while - it's natural. Interruption is another matter.pregnancy - the body is under severe stress due to hormonal imbalancesbalance and damage uterine tissues.

How to deal with menstrual irregularities? It is better to trust high-quality and proven non-hormonal agents.

For example, a complex based on herbs. This remedy contains components of plants used for centuries in medicine to relieve the symptoms of the menstrual cycle and prevent infertility caused by an imbalance in female hormones. Its phyto-components - racemose symplokos, racemose asparagus, licorice, long turmeric - help to establish the physiological balance of female hormones and normalize the menstrual cycle. Before use, you need to consult with your gynecologist about the indications for using the complex to normalize your critical days.

Do not worry! Perhaps the reason for the change in the nature of menstruation lies in your constant experiences. Everything is fixable and curable. Be healthy.

In an adult healthy woman, the menstrual cycle should be regular. Irregularity, a change in the number of days of the cycle, or its complete cessation outside the period of pregnancy are reasons for visiting a doctor.

How to calculate the monthly cycle in women

The cycle is counted from the first day of menstruation to the first day of the next. On average, the ovarian-menstrual cycle lasts 25-35 days. To track the regularity of the cycle, you need to mark dates on the calendar for at least three months. And it is better to mark the dates constantly - this will help track any changes in the cycle in a timely manner.

It is necessary to monitor the regularity of the cycle for:

• health care. Any changes may indicate disease.
• pregnancy planning. This will help calculate the day of ovulation.
• personal feeling of comfort. This will help you plan vacations, workouts in advance, as well as stock up on feminine hygiene products.

Symptoms of menstrual irregularity

• an increase or opsomenorrhea - the duration of the cycle is more than 35 days;
• reduction or proyomenorrhea - the cycle lasts less than three weeks;
• cessation of menstruation or amenorrhea;
• cycle instability;
• the duration of menstruation is more than seven and less than three days;
• too much or too little discharge.

Any problems, delays and other changes in the cycle or discharge should alert and become a reason for contacting a gynecologist.

Dangers of menstrual cycle failure

Any changes in the cycle - the duration, color and abundance of secretions, should be taken very seriously. If the changes in the cycle are more than 5 days, consult a doctor. Behind the diagnosis can be such serious diseases as tumors of the brain, ovaries, uterus, ectopic pregnancy, tuberculosis and other hormonal problems.

Causes of menstrual cycle failure

• diseases of the pelvic organs;
• hormonal disorders;
• infectious diseases;
• diabetes;
• benign and malignant tumors;
• pregnancy;
• childbirth or abortion;
• taking antibiotics or other medications;
• stress;
• sudden weight loss or weight gain;
• acclimatization;
• chronic fatigue;
• change in the rhythm of life;
• lack of vitamins.

It is considered normal to change the cycle within 3-5 days. A longer delay, instability, cessation of menstruation is a reason to undergo an examination in gynecology.

Failure of the menstrual cycle

At each age, failures of the menstrual cycle are associated with different reasons.

In adolescence

The first menstruation begins in girls at the age of 12-13. During the first year, the cycle may be irregular, but during this period there must be at least 8 cycles. If menstruation does not start after the age of 14 or the cycle does not become regular within a year, you should consult a doctor.

During menopause

This period occurs in 45-50 years. During premenopause, the production of the female sex hormone estrogen begins to decrease. This process takes two to ten years. Menopause is the period when the last menstruation passes. If after that there is no menstruation for a year, this means the cessation of the ovaries and the onset of the postmenopausal period. There are serious changes in the body.

After pregnancy and childbirth

After giving birth, a woman may need time to recover. There is no specific time period during which menstruation should begin again. On average, up to five months. The first months of the cycle may be irregular. It should be noted that in the postpartum period, women may experience permenstrual syndrome, as well as some changes during menstruation. For example, to disappear pain, if they were before.

When breastfeeding

The lactation period affects the female body. This is due to the production of the hormone prolactin, which is responsible for the secretion of breast milk. It suppresses the work of the ovaries, throwing the forces of the female body to feed the child. Therefore, menstruation may not occur until the end of breastfeeding.

After taking antibiotics

Menstruation is not a reason to delay antibiotic treatment if necessary. However, after this, some changes are possible: slight changes in the dates of the cycle, the amount and shade of the discharge. As a rule, antibiotics themselves do not cause changes. To a greater extent, the cycle is affected by dysbacteriosis, malnutrition during illness, stress, and inflammatory processes.

After taking birth control

Modern oral contraceptives are popular not only as a highly effective method of protection against unwanted pregnancy. With the help of such hormonal drugs, you can improve the condition of the skin, get rid of excess weight and stabilize the cycle. When choosing drugs, you must consult a doctor so as not to harm the body.

While taking oral contraceptives, the ovaries rest. Menstruation is the result of the action of medications. The first 1-2 months the body is rebuilt, so the cycle may be unstable.
After the drug is discontinued, the body returns to its previous state, and this restructuring may also take time. The ovaries begin to function again after rest, so the first couple of months the cycle can be unstable.

After sports

Playing sports can also introduce instability into the normal cycle. There are several reasons:

• high load on the body - especially on the pelvic muscles;
• chronic fatigue;
• decrease in the percentage of adipose tissue;
• taking steroid drugs.

The cycle can change for a couple of days - this is considered the norm. For more serious changes, visit your doctor's office immediately.

After the stress

Stress has a huge impact on the state of the body. After the difficulties experienced, women quite often experience a delay in the cycle. In this case, not only failures are observed, but also a change in the number of allocations.

Stressful situations for the body can also be considered the restructuring of the body of a woman in adolescence and premenopausal age. During these periods, cycle instability can also be observed.

Treatment of menstrual irregularity

The cycle change itself is not a disease, but only a symptom. The main task will be the diagnosis and treatment of the disease that led to the failure of the cycle.

For diagnosis, the following types of examinations can be carried out:

• examination by a gynecologist;
• taking smears;
• general blood analysis;
• blood biochemistry;
• hormone analysis;
• scraping from the cervix;
• Ultrasound of the pelvic organs;
• blood clotting analysis;
• Analysis of urine;
• hysteroscopy;
• biopsy.

The information obtained will help determine the cause of cycle violations.

Next, you need to cure the underlying disease that caused the violation of the cycle. For this, surgery, antibiotics, hormonal drugs, physiotherapy, psychotherapist consultations and more can be used - depends on the nature of the disease.

Preparations for recovery

To restore the hormonal background of the female body, additional medication may be required. They are prescribed depending on the cause of the violations. With an increased amount of testosterone - preparations "Janine", "Diana -35". With violations of the production of progesterone - "Duphaston", "Progesterone", "Utrozhestan". In case of violations of estrogen production - "Estradiol" or analogues.

Do not choose the drug yourself, so as not to be mistaken. It's better to see a doctor.

Traditional medicine

It is possible to maintain the health of the body during treatment not only with the help of drugs. Diet and lifestyle also play an important role. It will be useful:

• stick to proper nutrition, consume large amounts of protein;
• taking vitamins and iodine;
• tea with herbs - wormwood - 1-6 days of the cycle, sage - 6-15 days, goose cinquefoil - 16-25 days;
• moderate physical activity.

However, remember that these methods are not a treatment, but complement the main course of treatment, if there are no contraindications.

Ovarian-menstrual cycle disorders (OMMC) are perhaps the most common cause visits to the gynecologist. Moreover, such complaints can be made by patients aged from puberty to the premenopausal period - that is, during the entire potentially reproductive phase of life.

What cycle is considered normal?

The external manifestation of the natural ovarian-menstrual cycle is menstruation, which occurs with a frequency characteristic of every woman and most often lasts 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. Peristaltic contractions of its walls contribute to the natural cleansing of the uterine cavity, which can cause some physical discomfort.

The gaping vessels after tissue rejection quickly close, 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 disability. The average volume of blood loss is up to 150 ml, while there are no blood clots in the secretions.

But the menstrual cycle is not only the 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 fetal egg. A healthy woman of reproductive age also has anovulatory cycles, which is not considered a pathology. They normally do not lead to a change in the duration or nature of menstruation and do not affect the duration of the intermenstrual interval. In such cycles, a woman is not fertile, that is, she cannot become pregnant.

Menstruation begins at puberty. Their appearance indicates the readiness of the reproductive system for conception. The first menstruation (menarche) is observed at the age of 9-15 years, most often between 12 and 14 years. It depends on many factors, the main of which are heredity, nationality, general health, nutritional adequacy of the girl.

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

NOMC Development Mechanism

The ovarian-menstrual cycle in the female body is an endocrine-dependent process. Therefore, the main cause of its violations is dishormonal disorders. They can initially arise at different levels, including with the involvement of seemingly non-reproductive glands of internal secretion. This is the basis for the classification of menstrual disorders. According to her, they distinguish:

• Central disorders with damage to the higher centers of neuroendocrine regulation of the reproductive system. Cortical-hypothalamic, hypothalamic-pituitary and only pituitary structures can be involved in the pathological process.
• Violations at the level of peripheral structures, that is, the organs of the reproductive system itself. Can be ovarian and uterine origin.
• Disorders associated with dysfunction of other endocrine glands (adrenal glands, thyroid gland).
• Violations caused by genetic and chromosomal abnormalities with congenital hyper- or hypoplasia of organs, a violation of the secretion process of key biologically active substances and a disorder of the so-called feedback between peripheral organs and neuroendocrine structures.

Failures at any level will eventually appear anyway. various types NOMC. After all, hormonal imbalance leads to a change in the functioning of the ovaries, even if they do not have structural abnormalities. A natural consequence of this is a violation of the secretion of the main sex hormones (estrogen and progesterone). And their main target is the functional layer of the mucous membrane of the uterus, it is he who is rejected with blood at the end of the next cycle. Therefore, any dishormonal changes in the body can lead to a violation of the nature and regularity of menstruation.

Endocrine pathology is the main cause of menstrual dysfunction. Only in a fairly small percentage of cases it is not caused by hormonal disorders. Violations of the menstrual cycle 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 exit naturally due to vaginal atresia or complete infection of its outlet with the hymen.

Causes of dysfunction

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

The most likely ones are:

• Various types of pituitary adenomas (acidophilic, basophilic, chromophobic), which can be hormonally active or lead to compression and atrophy of the adenohypophysis. Disease and Itsenko-Cushing's syndrome.
• Taking drugs that affect the synthesis and metabolism 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 the adrenal tissue.
• Some mental disorders accompanied by a violation of the central neuroendocrine regulation. These can be moderate and severe depressive states of various origins, endogenous diseases (schizophrenia) in the acute stage, anorexia nervosa, reactive disorders, and adaptation disorders during chronic stress.
• Hypo- or hyperthyroidism of various origins.
• (Stein-Leventhal).
• Suppression of ovarian function and impaired feedback between them and the hypothalamic-pituitary system after long-term use of COCs and their abrupt withdrawal.
• and premature gonadal wasting syndrome. They can also have an iatrogenic genesis, for example, due to the repeated participation of a woman in protocols of assisted reproductive technologies with hyperovulation stimulation.
• Sharp non-physiological changes in the hormonal background, which can be caused by spontaneous or medical abortion, taking drugs to quickly suppress lactation.
• Malformations and anomalies in the development of the uterus, including those caused by chromosomal diseases.
• The 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 synechia up to the development of atresia of the uterine cavity, removal of the gonads and uterus.
• . And clinical significance can have not only malignant, but also large benign neoplasms with secondary atrophy of the ovarian tissue.

Violation of the menstrual cycle after 40 years in most cases due to increasing age-related changes in the 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 the extinction of reproductive function. These changes become most pronounced in the premenopausal period, when the cycle becomes more and more irregular with a tendency to and the addition of psychovegetative disorders.

Violation of menstruation in girls of puberty is most often due to 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 anomalies in the development of internal organs of the reproductive system.

In addition, adolescent girls often have disorders eating behavior with the formation of alimentary deficiency of key nutrients and especially fats. This leads to a pronounced decrease in the synthesis of steroid (including sex) hormones, which is most often manifested by secondary amenorrhea.

Possible manifestations of NOMC

According to the presence of a previous period of normal menstruation, all possible violations can be divided into primary and secondary.

Symptoms of menstrual irregularities may include:

• Change in the length of the intermenstrual period. Possible proyomenorrhea (with a cycle duration of less than 21 days) and opsomenorrhea (its lengthening over 35 days).
• Delay of the next menstruation in the absence of previous cycle disorders.
• Lack of menstruation for 6 or more months () in a woman of reproductive age.
• Change in the volume of menstrual blood loss. Perhaps both its increase (hypermenorrhea) and decrease (). Excessive blood loss is referred to as menometrorrhagia.
• Change in the duration of the menstruation itself in the direction of shortening () or lengthening (polymenorrhea).
• The appearance of intermenstrual bleeding, which can be different in intensity - from spotting to profuse. With acyclic profuse uterine bleeding, the term "metrorrhagia" is used.
• Clinically significant local pain during menstruation, which is called algomenorrhea.
• The appearance of general extragenital symptoms accompanying menstruation. These include headaches of a different nature, fluctuations blood pressure, nausea and changes in appetite, other vegetatively conditioned manifestations. This condition is referred to as, and when it is combined with a pain syndrome, they speak of algomenorrhea.

Hypermenstrual syndrome with polyhypermenorrhea and/or acyclic dysfunctional uterine bleeding is usually the cause of chronic posthemorrhagic iron deficiency anemia. Her symptoms often become a reason to see a doctor. At the same time, the woman is worried about fatigue, palpitations, general weakness, a tendency to lower blood pressure, fainting is possible. The condition of the skin, hair and nails worsens, a decrease in the productivity of mental activity is possible, up to the development of moderate cognitive impairment.

Many women of reproductive age also experience infertility - the absence of natural conception within 1 year of unprotected regular sex. It is due to severe violations of the allocation of the 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 not make any special complaints about menstruation disorders on her own, 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 rather than a pathological sign.

Features of menstruation disorders in different age groups

Juvenile period

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

Juvenile bleeding occurs in anovulatory cycles due to hormonal disturbances in follicle atresia. They usually alternate with uneven periods, often combined with hair loss, underweight or overweight. In this case, a neuro-emotional overstrain, a sharp change in the climatic and time zone, a violation of the sleep-wake cycle can act as a provoking factor.

reproductive period

In the reproductive age, cycle disorders can be manifested by a failure of the cycle, a delay in the next menstruation, followed by bleeding. At the same time, one should distinguish physiological changes from pathological. Normally, the temporary disappearance of menstruation may be due to the onset of pregnancy, the postpartum period and against the background of breastfeeding. In addition, a change in the cycle and nature of menstrual flow occurs against the background of the use of hormonal contraception and after the installation of intrauterine devices.

The lengthening of 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 grow in size with the formation of various sizes. In this case, the hormonal background corresponds to the 1st phase of the cycle with hyperestrogenism, which leads to a progressive growth of the endometrium. In this case, the delay in menstruation can reach 6-8 weeks, after which metrorrhagia occurs. Such uterine bleeding is classified as dysfunctional. Another reason for their development is the insufficiency of the luteal phase. In this case, bleeding occurs during the ovulatory period, they are usually not heavy, but protracted.

Changes in the ovaries during a typical menstrual cycle

There may also be menstrual irregularities after an abortion. It can be spontaneous (with spontaneous termination of pregnancy in the early stages) or medical using various methods of removal of the ovum / embryo. In this case, a lengthening of the subsequent cycle is usually noted, and the restoration of menstrual function is expected within 3 months. If the abortion was accompanied by complications, a protracted rehabilitation period with acyclic bloody discharge, algomenorrhea is not excluded.

Premenopausal period and menopause

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

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

Possibility of pregnancy

Pregnancy with a violation of the menstrual cycle is possible. But the probability of its occurrence depends on the severity of dyshormonal disorders, the full development of the uterus and many other factors. In many cases, menstrual disorders are accompanied by infertility. And it is not always possible to eliminate it by conservative methods, often the onset of pregnancy is possible only with the help of assisted reproductive technologies. And sometimes a woman cannot conceive and carry 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 thus make it difficult for the normal implantation of the fetal egg. This, coupled with insufficient production of progesterone and hCG, significantly increases the risk of abortion at very early and early stages. At the same time, a woman may not be aware of conception, regarding the onset of a delay in menstruation as another dysfunction.

Prior menstrual dysfunction is considered a potentially complicating factor in pregnancy. Such women require special attention. Often, for the prolongation of pregnancy, they need to take certain hormonal drugs. According to statistics, in a number of women after childbirth, menstrual irregularities are independently corrected (about the timing of menstruation recovery, in our article on). And subsequent pregnancies can occur without much difficulty.

Survey

In most cases, NOMCs have a favorable prognosis, as they are caused by changes that are not life-threatening for a woman. But we should not forget that up to 10% of cases are due to oncogynecological diseases. different localization. Therefore, the diagnosis of such a condition requires a thorough examination to establish the true cause of menstrual dysfunction, to determine the nature and severity of the existing changes. It is this tactic that will allow you to choose the optimal corrective therapy or timely conduct radical treatment.

The baseline examination should include:

• Careful collection of an obstetric and gynecological history, specifying the time of appearance of complaints, a possible connection with any factors, the fact of pre-existing menstrual disorders, the age of menarche (first menstruation) and the likelihood of conception. Be sure to find out past diseases and operations, the number and duration of abortions and childbirth, the course and outcome of previous pregnancies. Also important is the fact of taking any drugs, the nature.
• Gynecological examination of the vagina and cervix in the mirrors, bimanual palpation of the pelvic organs. In this case, structural changes in the visible mucous membrane (defects, growths, deformations, discoloration, 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 the 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.
• Exclusion of pregnancy. To do this, conduct a urinary express test or determine the level of hCG in the 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), FSH (follicle-stimulating), prolactin. In many cases, it is also advisable to determine the performance of the thyroid gland and adrenal glands, because violations of the functioning of these glands are also reflected in the work of the ovaries.
• Ultrasound of the pelvic organs. Most often, transvaginal and abdominal sensors are used. This is enough for a full examination of the uterus and its cervix, appendages, parametric tissue, blood vessels and regional lymph nodes. With a preserved hymen, 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 visualization of internal organs.
• Histological examination of the endometrium obtained by separate diagnostic curettage of the cervix and uterine cavity. This is shown mainly in hypermenstrual syndrome and metrorrhagia.

If there are indications at the 2nd stage of the examination, high-tech diagnostic methods(CT, MRI, PET and others). Most often they are prescribed for suspected oncogynecological pathology.

Principles of treatment

Treatment of menstrual disorders includes several areas:

• Stop bleeding. For this purpose, hormonal drugs, agents that affect blood coagulation 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 endocrine profile of the patient.
• Deciding the question of expediency 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 methods, cyclic vitamin therapy, herbal medicine are widely used.
• Correction of concomitant disorders (psychovegetative disorders, anemic syndrome, etc.).
• Correction of received therapy for the underlying disease. For example, when receiving psychotropic drugs it may be recommended to replace them with more modern, narrowly targeted drugs. Of course, the final decision on the correction of therapy is made not by the gynecologist, but by the attending physician (for example, a psychiatrist, a 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 is not decreasing, despite the achievements modern medicine. Fortunately, many forms of such disorders can be corrected. And with timely treatment of a woman to a doctor, it is often possible to avoid complications, maintain a high quality of life for patients, and even cope with concomitant diseases.