Causes of irregular menstruation and treatmentmenstrual disorders

Update: October 2018

It’s hard to meet a woman, especially now
at least once did not fail or menstrual abnormality
cycle. Similar shifts in the form of delays, both long and
short, or manifested by shortening the cycle, completely unsafe
for the female body, because regular menstruation reflect
mental and physical condition of a woman.

The menstrual cycle (many women call it their own way, like
�”Menstruation cycle”) plays the role of biological clock
body and any violations are the first bell is not yet
recognized diseases. Why does menstrual dysfunction occur?
cycle – the question interests not only the representatives of the weaker sex,
but also doctors.

A bit about menstruation and the menstrual cycle

The first menstruation or menarche occurs in girls around 12–14
years, and the more the child lives to the south, the earlier
begin monthly. Ends about 45 – 55 years of age.
(this period is called premenopausal).

Menstruation is the rejection or desquamation of a functional
layer of uterine lining in response to reduced progesterone production.
That is why gynecologists like to repeat that menstruation is
bloody tears of the uterus for unimplemented pregnancy. To
deal with this definition is worth remembering the physiology
менструального cycle. TOак известно, месячный цикл женщины делится
in 3 phases:

  • In the first, follicular phase, estrogens are produced, the action
    which causes the maturation of follicles. Of these follicles
    the main or dominant follicle is released, subsequently from
    which leaves a ripe egg cell.
  • The second phase is the shortest (about a day), during this period
    the main follicle is torn, and the mature egg leaves “on
    Freedom ”, ready to meet with“ zhivchikov ”and fertilization.
  • In the third phase, luteal, progesterone synthesis begins
    the corpus luteum, which arose at the site of a ruptured follicle.
    It is progesterone that causes the endometrium to be prepared for
    implantation of a fertilized egg. In the event that conception
    did not occur, the yellow body slowly “dies” (regresses),
    progesterone production falls and endometrial rejection begins,
    that is, monthly.
  • Next, estrogen production and cycle are gaining momentum.
    repeats.

From all this, it becomes clear that menstrual
cycle is called cyclic changes occurring in the body
after a strictly defined time.

  • The normal duration of the monthly cycle is 21 – 35.
    days Deviation from the usual rhythm in one direction or another on 3 – 5
    days is not a pathology, and longer shifts should
    to alert the woman.
  • Monthly normally last from three days to a week and do not deliver
    pronounced discomfort to the woman.
  • TOоличество теряемой крови в период менструации не превышает 100
    – 140 ml.

The regulation of the menstrual cycle coincides on 5 levels:

  • The first is considered the cerebral cortex, that is all
    emotional experiences can lead to irregular periods.
    For example, it is known that in wartime for women
    were absent, that has its name – “amenorrhea military
    time.
  • The second level of regulation is the hypothalamus, in which
    synthesized releasing factors that affect
    following.
  • The third level is the pituitary gland. In the latter, hormones are produced:
    follicle-stimulating and luteinizing, or gonadotropic
    hormones.
  • Under their influence in the ovaries – the fourth level begins
    synthesized estrogens or progesterone (depending on the phase
    cycle).
  • The fifth level of regulation is the uterus, fallopian tubes and
    vagina. In the uterus changes occur endometrium, fallopian tubes
    peristaltic, helping to meet the egg and sperm, during
    vagina updated epithelium.

What breaks the cycle of menstruation?

The causes of menstrual irregularities are numerous and
varied. Conditionally they can be defined in 3 groups.

TO первой относятся внешние факторы, то есть физиологическое
impact on the cycle. In this case we are talking about the impact
etiological factors on the first level of regulation of menstrual
cycle – the cerebral cortex:

  • climate change
  • nervous exhaustion
  • persistent and prolonged stress
  • character warehouse
  • change in diet and other.

TOо второй относятся различные патологические состояния не только
in the area of ​​the reproductive system, but also the whole body of a woman in
whole

TO третьей группе можно отнести воздействие лекарственных
drugs, both at their reception, and at their cancellation. It can be
hormonal contraceptive pills (see contraceptive damage
tablets), glucocorticoids, anticoagulants and antiplatelet agents,
anticonvulsant drugs and antidepressants, and others.

Factors due to pathological conditions:

  • Conditioned by ovarian pathology

TO ним относятся нарушенная связь между яичниками и гипофизом,
medication ovulation stimulation, ovarian cancers,
failure of the second phase of the cycle, professional harmfulness
(vibration, radiation, chemical exposure), ovarian surgery
(removal of most ovarian tissue), urinary trauma
organs and the formation of fistulas and so on.

  • Impaired interaction between the hypothalamus and the anterior lobe
    pituitary gland

Insufficient or excessive release of releasing factors and
гонадотропных гормонов, опухоли pituitary gland, кровоизлияние в гипофиз
or necrosis, brain tumors, squeezing
pituitary / hypothalamus.

  • Endometriosis

It does not matter genital or extragenital endometriosis,
in any case, the disease is hormonal in nature and leads to
hormonal imbalance.

Read also on the topic:

  • Lean monthly causes
  • How to reduce pain during menstruation
  • Brown discharge instead of menstruation
  • Mid-cycle spotting – causes
  • Causes of painful menstruation
  • Yellow discharge from women
  • White discharge from women
  • Borovaya uterus for conception
  • All questions about douching
  • Transparent stretching mucous discharge
  • Fishy smell
  • Symptoms and treatment of PMS
  • Discharge in early pregnancy
  • Causes of lower abdominal pain in women
  • Causes of pain during intercourse
  • All about menopause in women
  • How to reduce hot flashes during menopause

  • Impaired blood clotting (hemophilia, genetic
    pathology).
  • Diseases of the liver and gallbladder disease.
  • Scraping the uterus – artificial interruption
    pregnancy or therapeutic and diagnostic scraping contribute
    endometrial damage that interferes with its growth or may be complicated
    inflammation of the uterus and appendages.
  • Hormone-dependent tumors – cancer of the breast, uterus,
    adrenal glands, thyroid gland.
  • Adrenal diseases (tumors, injuries, etc.).
  • Polyps mucous membrane of the uterus.
  • Chronic endometritis – not formed full
    endometrium.
  • Rapid weight changes – losing weight or obesity leads to failure
    menstrual cycle because fatty tissue produces
    estrogens.
  • Anomalies of the uterus – sexual infantilism, a septum in the uterus,
    double uterus and others.
  • Infections – negatively affect the ovaries can both
    previous infections in childhood (rubella, chickenpox) and
    sexually transmitted.
  • Pathology of the uterus – this item includes tumors of the uterus and
    endometrial pathology (hyperplasia).
  • Mental illness (schizophrenia, epilepsy, alcohol
    psychosis).
  • Endocrine pathology.
  • Chromosomal abnormalities (for example, the 46HU karyotype in female
    phenotype).
  • Arterial hypertension (see drugs for elevated
    pressure).
  • Bad habits (smoking, alcohol abuse).
  • Hypovitaminosis and avitaminosis.

How does a menstrual cycle disorder manifest?

Different shifts during the monthly cycle are defined as
violation. The monthly cycle may vary in duration,
and the nature of menstrual bleeding:

  • With amenorrhea, menses are absent for half a year and
    more (allocate primary amenorrhea, when the violation of the cycle began
    since the onset of menstruation, and secondary amenorrhea –
    disturbed cycle appeared after his normal period
    flow);
  • Oligomenorrhea – in case menstruation occurs once a
    3 – 4 months;
  • Oppensenorea – short and extremely scarce periods (no more than 1 –
    2 days);
  • Hyperpolymenorrhea – very abundant periods, but
    cycle time does not change;
  • Menorrhagia is prolonged and abundant menstruation
    (lasts more than 10 days);
  • Metrorrhagia – irregular spotting that
    may appear in the middle of the monthly cycle;
  • Proiomenorrhea – the duration of the menstrual cycle is less than three
    weeks (i.e. frequent periods);
  • Algomenorrhea – extremely painful menstruation, leading to
    disability (also subdivided into primary and
    secondary);
  • Dysmenorrhea – any violations of the menstrual cycle,
    accompanied by pain during menstruation and
    autonomic disorders: headache, emotional
    lability, excessive sweating, nausea / vomiting).

Irregular periods during adolescence

In adolescent girls, menstrual irregularity occurs
often enough. This is due to physiological reasons. Thats
there is, hormones have not yet been established and the duration as
The cycle itself and menstruation can be different each time.
The norm is the formation of a cycle for 1 – 2 years.

For pathological factors, the causes of irregular menstruation can
include:

  • head injuries
  • infectious lesions of the brain and its membranes
  • propensity for colds
  • vegetative dystonia
  • obesity
  • sclerocystic ovaries and genital infections.

Equally important is the craze for girls
diets, which not only leads to significant weight loss,
but also to hypovitaminosis and irregular menstruation. Besides
In addition, the nature of the menstrual cycle affects the regularity
girls (too emotional, impulsive or aggressive).

Also play a role in violation of the cycle:

  • early and promiscuous sex
  • bad habits
  • malformations of the reproductive system

Disrupted menstrual cycle in girls can turn into such
complication, like juvenile uterine bleeding. In this case
monthly lasts more than a week and abundant, which leads to
anemization of the child (see iron preparations for anemia). Usually
juvenile bleeding is provoked by either an infectious process,
or nerve strain.

Violation of the premenopausal cycle

With menopause, which, as indicated above, occurs in the region of 45 –
55 years, in addition to irregularities in the menstrual cycle arise
metabolic disorders and metabolic disorders
psycho-emotional state (hot flashes, emotional
lability, osteoporosis).

Menstrual disorders in premenopausal menstruation are associated with
угасанием детородной функции, то есть на уровне pituitary gland
frustrated production of gonadotropins, which leads to impaired
the process of maturation of follicles in gonads, luteal
insufficiency on the background of hyperestrogenia.

This causes a pathological rearrangement of the endometrium in both
cycle phases, acyclic and cyclic bleedings, since
endometrial hyperplasia develops. If the cycle disorder
menstruation by the type of rare and irregular menstrual or acyclic
bleeding occurred after 40 years, most likely it is
evidence of premature ovarian depletion (early
menopause) and requires hormone replacement therapy.

Violation of the cycle while taking hormones

Often with contraceptive use
(combined contraceptives or progestin drugs
long-acting, such as Depo-Provera)
intermenstrual bleeding in the first 3 months of use
hormones (see contraindications for oral
contraceptives).

This is considered normal, as the body must re-tune to
hormones coming in from the outside and suppress the production of your own. If a
same acyclic bleedings last longer than the specified period, this
due to improper selection of the drug (too high or
low dose of hormones) or inappropriate pills.

The same situation may lead to the development of algomenorrhea.
High likelihood of massive uterine bleeding
and when using emergency contraceptive pills that
associated with the “elephant” hormone levels in such drugs
(therefore, gynecologists recommend to resort to fire contraception
no more than 1 time per year, see Postinor – side effects).

Amenorrhea is often due to the use of progestin drugs or
injections of progestins of the prolonged action. Therefore
progestins are usually prescribed to premenopausal women
or suffering from endometriosis (when artificial
menopause).

In case of menstrual irregularities, treatment is selected.
according to the reason that led to cycle failures, age
women / girls, clinical manifestations and the presence of concomitant
pathology.

Treatment of a disturbed cycle of menstruation in adolescence
age

Violation of the cycle, which is complicated by juvenile bleeding,
subject to two-stage therapy.

  • In the first stage, hemostasis is carried out by hormonal
    drugs and hemostatic (dicine, Vikasol,
    aminocaproic acid).
  • If a у больной кровотечение длительное и выраженное и
    accompanied by symptoms such as weakness, dizziness,
    low hemoglobin (70 g / l or less), then the girl needs
    scrape. To prevent rupture of the hymen last
    cut off 0,25% novocaine. Scraping, respectively, sent to
    histological examination. If a же гемоглобин находится в
    within 80 – 100 g / l, hormonal pills are prescribed
    (low dosage combination contraceptives: Marvelon,
    Mersilon, Novinet and others).
  • In parallel with surgical and hormonal hemostasis
    antianemic therapy is carried out (blood transfusion,
    erythrocyte mass, reopoliglukina, infukola, and also shown
    taking iron supplements: sorbifer-durules, tardiferon and
    others).
  • Hormonal treatment lasts at least three months, and
    anemia therapy until hemoglobin levels rise to normal
    numbers (this is the second stage of treatment).
  • In uncomplicated cases, menstrual disorders in
    girls (when menstrual function becomes established) are assigned
    cyclic vitamin therapy. Vitamins in case of violation are taken by
    scheme (to stimulate the production of its own hormones in the ovaries):
    the first phase of vitamins B1 and B6 or a complex of vitamins of group B
    (Pentovit), whereas in the second phase vitamins A, E (“aevit”),
    ascorbic acid and folic acid.

Пример из практики: В гинекологическое
the department was sent a girl 11 years old with juvenile
bleeding. Admission Diagnosis: Premature Sexual
development. Violation of the menstrual cycle. Juvenile bleeding. TO
Fortunately, the patient’s bleeding was not large but lasted
more than 10 days. Hemoglobin is reduced to 110 g / l. My colleague
of course, did not cure and began to stop bleeding
with symptomatic hemostasis. The treatment had no effect, therefore
it was decided to switch to hormonal hemostasis. On reception
Novinet at the girl by the end of the first the day of the allocation is practically
disappeared (therapy was carried out according to the scheme: first 4 tablets per
during the day, then 3 tablets, then 2, and then one to
end of packing). The girl still for three months
took Novinet, no bleeding was observed on the background of treatment,
nor after discontinuation of the drug. Today, the former patient 15
years, the menstrual cycle is established, recurrence of bleeding is not
It was.

Treatment of an impaired cycle in women in childbearing
age

Treatment, in principle, is similar to therapy in adolescents. When
the occurrence of bleeding, regardless of its severity, such
patients undergo diagnostic curettage as with
therapeutic purpose (surgical hemostasis), and with
diagnostic

After histological findings are assigned
hormone therapy:

  • These may be combined oral contraceptives.
    conventional scheme
  • When неполноценной лютеиновой (второй) фазы назначаются
    progesterone analogs Duphaston or Utrozhestan in the second half
    цикла либо 17-ОПTO или Норколут.
  • Be sure to fill the circulating blood volume.
    (colloid solutions), antianemic therapy (see drugs
    iron for anemia) and symptomatic hemostasis.
  • If a выскабливание полости матки не принесло результатов,
    the issue of ablation (burning) of the endometrium or
    hysterectomy.
  • Also indicated is the treatment of associated diseases that
    led to a cycle disorder (hypertension – limiting
    salts and fluids, prescription of antihypertensive drugs, pathology
    liver – adherence to clinical nutrition, taking hepatoprotectors and
    other).
  • Failures of the menstrual cycle can cause infertility
    therefore, for the purpose of the possibility of pregnancy, pergonalal and
    choriogonin (stimulate the development of active follicles) and clomiphene
    (stimulation of ovulation).

TOровотечение в климактерическом периоде

If a кровотечения появились в климактерическом периоде, женщина
necessarily subject to curettage of the uterus,
since such bleeding can be signs of adenocarcinoma
endometrium or atypical hyperplasia. In this case решается
the question of hysterectomy (see the indications for removal of the uterus). After
results of histological examination:

  • endometrial glandular hyperplasia
  • small myoma nodes
  • and / or adenomyosis of 1 degree

назначаются гестагены: 17-ОПTO, дюфастон, Депо-провера. maybe
prescription and anti-estrogen drugs, such as danazol,
17a-ethynyl testosterone, gestrinone in continuous mode.

Неважно, в каком age возникло нарушение менструального
cycle, this pathology is only a consequence of any
the main disease, it is therefore necessary to identify and treat the main
pathology, because only after removing the cause is possible
restore the normal cycle. And, of course, you must remember
normalization of the regime of the day and rest, good nutrition and
minimizing stress. When obesity is often enough only
normalize weight to restore the menstrual cycle. Thats же
the same applies to exhausted women (in this case it is shown
high-calorie diet).

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