Various menstrual irregularities (NMC) are very common these days, almost every second woman is familiar with the problems of an irregular cycle. The diagnosis of NMC in gynecology is made if:

• monthly scanty (less than 50-80 ml) or abundant (more than 150 ml);
• the duration of the menstrual cycle is less than 21 days or more than 35 days;
• menstrual bleeding lasts less than 3 days or more than 7 days;
• menstruation is accompanied by severe girdle pain in the lower abdomen.

Causes and treatment of NMC

It is important to remember that the diagnosis of NMC in gynecology is just a symptom of a specific disease, the presence of which led to a malfunction of the hormonal system.

The causes of NMC are very diverse. A temporary violation of the cycle can be triggered by stress and unrest, a longer one - by infectious, inflammatory and even tumor diseases of the genital and other internal organs, traumatic injuries or endocrine disorders.

In gynecology, there is a tendency when the diagnosis of NMC is made to those girls and women who have a hereditary predisposition to this disease. Congenital anomalies of the female genital organs are also possible.

To determine the cause and prescribe adequate treatment for NMC, at least three diagnostic measures are required:

• study of the hormonal profile of a woman;
• bacteriological;
• Ultrasound - ultrasound in case of NMC is necessary in order to exclude congenital and acquired pathologies of the pelvic organs.

Treatment of NMC is aimed at eliminating the root cause of the disorder. So, a woman may need hormone therapy, physiotherapy, nutritional and vitamin complexes, taking anti-inflammatory and antibacterial drugs, and even surgery.

NMC in the reproductive period is always a problem for a woman who wants to get pregnant. Fortunately, with the help of modern therapy techniques, the nature of the course of the menstrual cycle can be significantly adjusted, even with the diagnosis of NMC, pregnancy occurs in most cases.

The most commonly diagnosed types of menstrual irregularities are:

Anxiety should be caused by too frequent periods or, on the contrary, rare ones. Their absence for several months is a serious cause for concern. Scarcity of secretions, abundance, short-term (one or two days), prolonged duration - deviations from the norm. The following types of NMC are most often diagnosed in gynecology:

1. Hyperpolymenorrhea: a short menstrual cycle of 14 to 21 days is accompanied by a long period of heavy bleeding - from 7 to 12 days. It is fraught with blood loss, and this is a big burden on the body and subsequently leads to violations of the adaptive mechanism. Such NMC often indicates serious problems of women's health.
2. Oligomenorrhea occurs in 3% of cases. The interval between periods can last 40-180 days, they themselves occur in two to three days. It is diagnosed more often in young women. The disease is accompanied by an increase in body weight, problems with conception.
3. Polymenorrhea is a common disorder. With an undisturbed cycle duration, abundant and prolonged blood loss is observed: more than seven days.
4. Almost half of women under the age of 50 are diagnosed with algomenorrhea. It manifests itself as cramping, pronounced or muffled pain in the lumbar region, headache, nausea, and malaise. Symptoms can go away after a few hours, sometimes after a day.

For several years, fluctuations in the duration of the cycle, changes in the amount of discharge in women after forty years are observed. These are signals of the extinction of the activity of the ovaries, which leads to a decrease in the efficiency of their work. In this case, the diagnosis of NMC indicates the onset of premenopause. The condition is considered physiological, natural and continues until entering menopause.

Some women have a long menstrual cycle due to genetics. Very often, psychophysical factors become the cause of violations: overwork, moving to another place of residence with a change in time zone, stress, anxiety before a responsible exam, taking certain medications, and even extreme heat in summer.

Systematic lack of sleep has a powerful negative effect: in the pre-morning hours, a woman's body actively synthesizes hormones that regulate monthly cycles. A completely banal cause of failure can be a urethrogenital infection: mycoplasmas, chlamydia, uroplasmas.

Conscientious anti-inflammatory treatment will get rid of problems. Uncontrolled dieting causes a general distortion of metabolism and entails NMC. The consequences of diabetes mellitus, obesity, thyroid disease, hypertension, anorexia can be NMC.

Violations of the menstrual cycle may indicate serious gynecological diseases, and may only mean a feature of a particular woman's body. The diagnosis of NMC is made even when the bleeding is accompanied by pain, and its duration and cycle length do not change.

Dysmenorrhea (cramps)

Almost half of the fair sex monthly suffer from severe cramping pains in the lower abdomen, which indicates the onset of menstruation. The pain can last from 12 hours to 32 hours, that is, more than a day. The nature of the pain can vary from periodic "contractions" to incessant discomfort, which can even cause disability.

Dysmenorrhea can be primary or secondary. In primary, spasms occur from the anatomical contraction of the walls of the uterus, and this is a normal process. With secondary dysmenorrhea, pain and cramps during menstruation (especially if they were not there before) indicate the presence of some kind of gynecological disease (endometriosis, malignant diseases, cyst). In this case, you should immediately consult a doctor.

The cause of dysmenorrhea can be a violation of blood flow in the arteries of the uterus, the germination of the endometrium outside the uterus (endometriosis), a genetic predisposition to such pain.

menorrhagia

The term "menorrhagia" in medicine refers to prolonged, too plentiful, more than 80 ml., menstruation and breakthrough bleeding between them. This may be normal for young women who have recently cycled, and small drops of blood on underwear in the middle of the cycle occur in young women around the time of ovulation.

Amenorrhea

Amenorrhea is called the absence of menstruation, distinguish between primary and secondary amenorrhea. If a girl at the age of 15-16 has not yet begun menstruation, then this is an occasion to consult a doctor to diagnose primary amenorrhea. If bleeding was, but disappeared and does not come within three months, such amenorrhea is called secondary.

Secondary amenorrhea, in particular, can overtake overly thin girls diagnosed with anorexia, since weight loss affects the body's production of hormones (namely, they control the process of organizing the cycle).

Oligomenorrhea

Weak, rare periods, the distance between which is more than 35 days, are called "oligomenorrhea". Most often, this pathology occurs in young girls with an unsteady monthly cycle.

PMS - premenstrual syndrome - is one of the most common causes of NMC in gynecology. Increased emotionality, tearfulness, increased sensitivity to stressful situations - these symptoms are probably familiar to every woman. Approximately a week before the onset of menstrual bleeding, some women begin PMS, which should not be tolerated, since when contacting a doctor, some of its manifestations can be corrected, reduced.

Violation of the menstrual cycle is a fairly common disease in gynecology. Random failures caused by stress, according to statistics, occur in every second woman. But you should be wary if:

• delays have increased
• discharge during menstruation became abundant or scarce,
• the number of bleeding days increased or decreased,
• there were menstrual pains.

The duration of the cycle is counted from the beginning of the previous menstruation to the beginning of the next. The minimum period between them is 21 days, the maximum is 35 days.

If your monthly cycle for many years was 22 days, and then suddenly increased by several days, this is also a violation. The reverse situation can also be an alarm.

As soon as you notice that your periods have changed, you need to make an appointment with a gynecologist to identify the cause of the failures.

Violation of the menstrual cycle appears due to infections of the genitourinary system and due to a malfunction in the hormonal system.

NMC can occur for the following reasons:

• due to frequent stress
• hormonal changes,
• infectious and non-infectious diseases of the internal genital organs,
• genetic predisposition,
• when taking medications,
• due to a sudden change of residence,
• radiation and poisoning
• malnutrition,
• bad habits.

The most common cause of menstrual irregularities is a pelvic infection. If pathogens are not detected during the examination, then anti-inflammatory treatment is sufficient, after which the normal cycle is restored.

Hormonal disruptions that disrupt the menstrual cycle occur at different levels of hormone formation. An important role for their appearance is played by genetic predisposition, mental trauma, beriberi.

Why is it necessary to urgently treat violations of the menstrual cycle? During a delay in menstrual function, hormones begin to work in slow motion. For this reason, the growing layer of the endometrium does not come out in a timely manner, and hyperplasia gradually forms in the uterus, polyps grow. If you do not get rid of them in a timely manner, cancer may appear.

Also, due to NMC, fibroids, ovarian cysts and other diseases can appear. They cause great pain.

In connection with the inferior production of hormones with an irregular cycle, there is a threat of infertility. Due to violations, the eggs do not have time to mature, and even if you manage to get pregnant, the threat of a miscarriage will hang over you for the entire period of bearing a child.

To identify the cause of NMC, the doctor just needs to talk with the patient. Sometimes he may order an examination.

In gynecology, there are four types of diseases associated with an irregular menstrual cycle:

Algodysmenorrhea. This is the most common diagnosis. If you have algomenorrhea, you experience aching,

Menstruation may not be for various reasons, and this is not always associated with gynecological pathology, that is, the diagnosis of NMC is not always made. Consider the main reasons for the absence of menstruation.

• Pregnancy. When an interesting situation occurs, menstruation stops. That is, it is precisely because of the absence of menstruation that women can suspect pregnancy. Some argue that their periods continue during pregnancy, but this is not menstruation itself, but bleeding, which can only indicate a threat of miscarriage or other problems with the fetus, this condition requires an immediate visit to a gynecologist.
• Breast-feeding. Three stages: pregnancy, childbirth and breastfeeding - this is a single cycle of hormonal changes in a woman's body. The hormones produced when feeding a child warn the body that a new pregnancy cannot yet occur, and menstruation does not begin, the cycle is not restored. But there are exceptions to every rule, and it is impossible to build a system of protection against a new pregnancy on this fact. The gynecologist will advise you to choose a barrier method of contraception after childbirth or take special hormonal contraceptives that will not affect the health of the baby.
• Periods stop at menopause. This does not happen immediately, the cycle gradually lengthens, and on average, at the age of 50-51, menopause occurs. After its onset, any bleeding from the uterus is an occasion to urgently visit a doctor.

Methods of diagnosis and treatment

Based on the woman's complaint, the doctor prescribes an examination. In this case, the violation of the menstrual cycle is only a symptom. Diagnostic activities typically include:

• study of the hormonal state of the body;
• conducting an ultrasound examination to exclude pathologies in the pelvic organs;
• laboratory analysis of a smear from the vagina.

The gynecologist will ask the patient in detail about the so-called obstetric history, namely: when were the last periods, whether there were miscarriages and abortions, how many births there were, at what age the bleeding began and what character they were, and much, much more. To find out the causes of menstrual irregularities appoint:

• General blood test and hormones (estrogen, progesterone, thyroid hormones, etc.);
• Ultrasound of the small pelvis - helps to determine pregnancy, diseases of internal organs (uterus, ovaries), pathologies of the structure of the reproductive system, etc .;
• Hysteroscopy (viewing the inside of the uterus with a small flashlight and a video camera)
• Diagnostic laparoscopy (examination of the state of internal organs through 3 punctures of the abdominal wall, usually performed under general anesthesia);
• Endometrial biopsy (microscopic examination of a tiny piece of the inner layer of the uterus to determine various diseases).

Sometimes for the treatment of changes in the nature of the monthly cycle and violations of the cycle of menstruation, it is enough to change the lifestyle, diet, caution when choosing sexual partners.

Daily routine, adequate sleep, healthy food rich in vitamins and nutrients - these factors affect women's health very much.

During menstruation, sexual contact should be avoided, since during this period the woman's body is most vulnerable and less resistant to infections and diseases of the genital area.

Since anemia (due to large blood loss) can become a complication of the diagnosis of NMC, the treatment will be aimed at preventing this, iron preparations are prescribed.

For pain during bleeding, non-steroidal anti-inflammatory drugs, painkillers can be prescribed.

The problem of irregular periods can be solved by prescribing oral contraceptives (OC), which can only be selected by a doctor, taking into account many factors, including after a blood test for hormones.

If the violations of the cycle are secondary, then the underlying disease is initially treated, and gradually the problem goes away.

A woman's body is a complex system, the slightest lifestyle changes or stress can lead to menstrual irregularities. This diagnosis leads to both outpatient treatment and observation of the woman in the hospital.

NMC in gynecology: causes and treatment.

Adequate measures are chosen by the attending physician, based on the results of the examination. In the arsenal of methods: hormone therapy, physiotherapy, anti-inflammatory drugs, antibacterial. In some cases, surgery is possible. Often, gentle methods, for example, homeopathic remedies, have a corrective effect.

Uterine fibroids are benign tumors. It is one of the most common (10-27%) tumors of the female reproductive system. Uterine fibroids are currently found in women aged 30-40 years; uterine fibroids are often found at 20-30 years of age and younger. This tumor is found in 15-20% of women over 30 years old and in almost 40% over 40 years old. 80% of indications for surgical gynecological interventions appear due to the presence of uterine fibroids and its complications.

Myoma (leiomyoma, fibromyoma) is formed from the muscular and connective tissue of the uterus. To date, there is no consensus on the causes of uterine fibroids. Most researchers give priority to hormonal disorders and hormone dependence of the growth of myoma nodes. Others talk about the influence of infection in the development of fibroids (intrauterine contraceptives, abortion, inflammation, sexually transmitted infections).

Classification.

In cases where the submucosal tumor is located mainly in the muscle layer (more than 1/3 of the volume of the node), the term "intermuscular uterine myoma with centripetal growth" is used. Among the submucosal nodes of fibroids, a special form is distinguished - giving birth to tumors, the growth of which into the uterine cavity occurs towards the internal pharynx.

The location of the fibroids in relation to the muscular layer of the uterus.

Menstruation- this is one of the periods of the menstrual cycle, which is an important aspect in the life of any woman. Most often, menstruation begins at the age of 10-14, depending on the individual characteristics of the woman's body, genetic predisposition plays a significant role. Over the next 30-40 years, this process accompanies the woman. During this time, 70% of women experience various kinds of menstrual irregularities. Such violations can occur at any age, neither girls nor women are immune from this. Even with external similarities, the causes of such disorders and their symptoms are different.

The physiological changes that occur in the body with the onset of menstruation are a complex chain of interconnected processes. The changes taking place in the body indicate that the child's body is being rebuilt and the girl is entering reproductive period. But this does not mean at all that she is already ready to conceive a child. The onset of menstruation is only the first stage in the transformation of a girl into a woman. For a complete transformation in the female body, many processes must go through before it is ready to conceive and carry a pregnancy.

The duration of the menstrual cycle is different for everyone, the most optimal period is considered to be 28 days. But a deviation from this number of days per week will not be considered a violation. Therefore, the norm is considered to be 21-35 days. As a rule, by the age of 15 this period evens out, but sometimes regularity is established only after the first pregnancy. The duration of the course is controlled by hormones produced by the ovaries and pituitary gland. There are several hormones, but the most authoritative among them are FSH (follicle-stimulating), estradiol, LH and progesterone. Menstruation itself also takes place at different times, on average, the whole process takes no more than 7 days. During this period, a woman loses 80-100 ml of blood.

The menstrual cycle consists of the following phases.

• First period called follicular. At this stage, the maturation of the follicles occurs. But not all ripen, only dominant ones, the rest atrophy. This period lasts 1-3 weeks.
• Second period - ovulation. The membrane of the dominant follicle breaks, and the egg comes out of it. From the ovary, it moves to the uterus, if fertilization does not occur at this stage, the egg is destroyed.
• Third period- luteal. Takes 12-14 days. The remains of the follicle are converted into the corpus luteum. Active production of progesterone and estrogen begins. This allows you to prepare the walls of the endometrium for a possible pregnancy. If conception does not take place, the body dissolves, the content of progesterones and estrogens decreases. As a result, the process of detachment of the endometrium begins.

The menstrual cycle does not always pass in a timely manner, from time to time a woman may experience menstrual irregularities (NMC).

What is NMC? NMC is any kind of deviation from the norm of the menstrual cycle.

There are certain signs NMC, according to which any woman can guess about the problems that have arisen in the body:

• Scanty or overly heavy periods. The norm is considered to be 80-100 ml per cycle, the change of pads in the first days occurs four times. If a woman's periods pass too quickly and their volume is too small, this phenomenon is called menorrhagia. The disease may be a consequence of inflammatory processes caused by ovarian dysfunction, neoplasms in them. In adolescence, this phenomenon becomes the result of hormonal failure. The situation with too heavy periods (more than 150 ml per cycle) is called hypermenorrhea. Bleeding too profusely, requiring frequent pad changes. This condition is fraught with anemia, fainting, dizziness.
• Prolonged menstruation- polymenorrhea, as a rule, this disease is paired with hypermenorrhea. The duration of menstruation in this case is more than a week.
• Too short period- oligomenorrhea, menstruation lasts less than 3 days. Often associated with menorrhagia.
• Menses pass with severe aching pains. A painful sensation seems to encircle the entire lower abdomen. This condition is called algomenorrhea. In this case, the pain spreads to the lumbar region, sacrum and thigh. The condition appears in a woman on the eve of menstruation or in the first days. It is caused by uterine contractions. This is primary dysmenorrhea and is not considered a deviation. The secondary stage of this syndrome develops as a result of uterine fibroids, endometriosis and other severe pathologies.
• Irregular menstruation. If the interval between periods is longer than 40 days - a reason to think. Such a deviation is not the norm. Sometimes the interval reaches six months. Often, this disease is marked by abundant acne on the face and body, libido decreases. Throughout the body - on the arms, stomach, legs, abundant vegetation appears - such a violation is associated with an increase in male hormones. This is a consequence of a malfunction in the endocrine system. The reason for this condition may be an abortion or anorexia.
• Bleeding not related to menses- metrorrhagia. Blood may go in clots or slightly noticeable bleeding. Sometimes there is pain, as with menstruation, but more often this condition is asymptomatic. This phenomenon occurs in adolescents during the onset of menstruation or in women during menopause.
• Absence of menstruation for more than six months- amenorrhea. Most often, this condition occurs during pregnancy and lactation, in this case it is a natural process. If neither one nor the other is present, and menstruation does not occur for a long time, an urgent consultation with a gynecologist is required. It is possible that the cause was a disease of the reproductive system. There is primary amenorrhea - if the girl does not have menstruation by the age of 15. Secondary amenorrhea is noted in the case when a sexually mature woman suddenly stopped menstruating for more than three months.
• Menstruation is regular, but the interval between them is too long - from 35 days. The main reason is a hormonal failure or a genetic feature of the body.

The main causes of NMC

NMC itself is not a disease, it is only a consequence of some disease, but symptoms abnormalities can help in the correct diagnosis of the true disease. There can be several reasons for the same ailment, therefore, consultation with a specialist is extremely important for proper treatment.

The reasons for the failure of the menstrual cycle are very different - from psychosomatic to the genetic characteristics of the organism of this particular woman. Often, violations are ovarian disease and uterus.

• Polycystic- hormonal disorders of the ovaries, may be accompanied by an increase in the ovaries, the appearance of fluid in them and an increase in estrogen levels.
• Adnexitis- inflammation in the fallopian tubes, in a chronic form, can lead to infertility.
• fibromyoma- a benign neoplasm in the uterus. May be the result of a failed abortion.
• endometriosis- one of the most common diseases of women of reproductive age, characterized by the growth of the endometrium throughout the uterine mucosa.
• anomalies development are most often congenital.

The cause of malfunctions in the functioning of the reproductive system can be injuries and unsuccessful operations, in particular, abortions. Not the last role is played by general diseases of the body - diabetes mellitus, diseases of the heart system, kidneys, liver, and even oncology. But still most often problems with menstruation associated with external factors.

• Deficiency of vitamins and microelements entering the body. Against this background, the body switches to the energy saving mode, against which duration of the menstrual cycle is significantly reduced.
• Physical stress.
• Being overweight and obese can also cause NMC.
• Stress and mental disorders.
• Change of climatic zones sometimes leads to menstrual failure.
• Prolonged hypothermia can cause serious disruptions in the functioning of the reproductive system, and overheating can cause no less harm.
• Radiation exposure is carried out in oncological treatment and can also cause NMC.
• Taking certain medications can lead to NMC.

Often the cause of untimely menstruation is hormonal disruptions most often they occur in adolescents. The body has not yet developed its own system of the menstrual cycle and often the frequency of the cycle fluctuates in different directions. It is considered normal at this age to fluctuate within a radius of 20-40 days. The volume of blood and the duration of the course of menstruation may vary from cycle to cycle. Not too abundant discharge is considered normal, their duration is 3-7 days. But if every cycle ends too heavy menstruation- a reason to consult a gynecologist for advice. Most likely this is associated with a number of deviations in the girl's health.

The most common disorders in adolescent girls are the following:

hypothalamic syndrome. This syndrome often becomes the culprit of improper hormonal development, it can serve as reason for the lack menstruation, cause serious malfunctions of the cardiovascular system, provoke metabolic disorders in a teenager, cause mental instability. Often, girls note increased fatigue, frequent headaches, and frequent mood swings.

delayed sexual development- a similar diagnosis is made to adolescents with mild or generally unexpressed secondary sexual characteristics. They begin to appear during puberty - the appearance of rounded shapes, swelling of the breasts, the appearance of pubic hair and the menstrual cycle. In terms of menstruation, scanty discharge is most often noted, menstruation or even missing, or lasts only 2-3 days. NMC can be caused by malnutrition as a result of an unbalanced diet. Excessive diet also does not lead to women's health. Excessive sports can lead to such a failure. Any load at this age should be balanced. Delayed sexual development can be the cause of heredity. Sometimes such delays affect not only sexual development, but affect the intellect and psyche, accompanied by poor memory, inattention, and apathy.

Juvenile uterine bleeding- menstruation lasts too long, a week or more. The cause of this disease lies in the dysfunction of the ovaries, which results in an increased production of estrogens. Most often, this symptom disappears by the age of 18. The biggest drawback of this condition is that the fragile body of a teenager loses a large volume of blood, as a result, anemia and vitamin deficiency can occur, accompanied by a general decline in strength and health. Often, against this background, there is a headache, loss of appetite.

But if in adolescents the cause of NMC is due to the instability of the menstrual cycle, then in women aged 45-50 years this is due to the approach of menopause. The reason for these age-related changes is also the transformation of the hormonal background. Menopause is an inevitability that every woman will have to face sooner or later. With its onset, a woman loses her ability to reproduce. Changes in hormonal levels can occur with varying intensity. The organism, entering the process of restructuring, can react differently to this vital cycle, including NMC.

The first thing the doctor does is ask the patient:

• date of the last menstruation;
• cycle duration;
• the amount of bleeding also matters;
• how painful the period is and what symptoms are accompanied;
• the patient's lifestyle;
• it is important to inform the gynecologist about the drugs and dosages taken, this can help in establishing the true causes of the patient's poor health;
• the age of the patient;
• a psychological condition can also cause the disease, so it should be reported to the doctor;
• it is important to know what alarming symptoms and when the patient has;
• the number of pregnancies, abortions, childbirth, miscarriages help diagnosis;
• undergone gynecological surgeries;
• working conditions - the patient is a worker of physical or mental labor;
• knowledge of diseases in the next of kin will also help in diagnosis;
• The nature of the diet can also help in the diagnosis.

The doctor will not manage with just conversations, an obligatory part of the visit is an examination in the gynecological chair. At this moment, the gynecologist takes the biomaterial for analysis. This will help identify existing sexual infections. For further diagnostics causes NMC may require additional procedures.

Since many diseases in gynecology are the result of a hormonal failure, and the NMC is no exception, a detailed study of the patient's hormonal background will be required. Blood is taken from a vein, to obtain a qualitative result, you need to pass an analysis according to all the rules. Many hormones should be taken on a specific day of the menstrual cycle.

The results of the ultrasound of the organs of the pelvis and abdominal cavity will also provide an expanded picture of the patient's health status. Urinalysis, biochemical blood test, thyroid examination - only a set of studies will help to establish an accurate diagnosis gynecological character. Hysteroscopy will help to obtain a layered image of the pelvic organs. If necessary, a sample of the epidermis is taken from the uterus, obtained by scraping.

Treatment of NMC

Treatment of NMC directly depends on the results of studies.

• hormone therapy. It is often used to eliminate NMC caused by a lack of a particular hormone. Treatment is carried out with drugs based on hormones produced by the ovaries or the thyroid gland - it all depends on the test results. For medicinal purposes, oral hormonal contraceptives may be prescribed. This is especially true when treating an unstable menstrual cycle.
• Painkillers and antispasmodics. This group of drugs is prescribed for painful periods.
• Hemostatic agents and uterotonics. This treatment is carried out with too heavy bleeding during menstruation. They are also prescribed for poor blood clotting. Aminocaproic acid, contained in the preparations, allows you to stop the bleeding that has opened.
• Homeopathy and physiotherapy. Treatment often comes down to taking drugs based on herbs and natural ingredients. The courses are complemented by a complex of physiotherapy.
• Phytotherapy. To improve hormonal levels, eliminate pain during menstruation, heavy bleeding treating doctor can form treatment based on herbs. Teas, infusions, douches based on tansy, shepherd's purse, elecampane, prutnyak, valerian will help eliminate many problems.
• Surgical intervention. Such treatment is highly undesirable for girls, but in the presence of neoplasms and pathologies of various genesis, surgical intervention by a doctor is required. In case of serious diseases of the female organs, their partial removal may be required. For these procedures, the patient lies down in the department gynecology and is under close supervision. doctor before and after surgery.
• A course of antibiotics and anti-inflammatory. Such a treatment specialist antenatal clinic prescribes for the detection of various kinds of inflammatory diseases of the reproductive system. The complex in each case is selected according to the situation.

Comprehensive preventive measures will prevent some gynecological diseases. There are the following rules for this:

• In food, use only high-quality and correct products, vegetables and fruits are very useful. They carry the body a rich set of trace elements, fiber and vitamins.
• It is important to avoid stressful situations, to respond to emerging situations without excessive emotions.
• Physical activity is important in every woman's life. A set of special exercises will prevent a number of gynecological problems. But it is worth understanding that the load should be adequate, not exhaust the body, but train and harden. Excessive passion for strength training can lead to an increase in the level of testosterone - the male hormone, which will inevitably affect menstruation.
• Being overweight is an extra problem. Often obesity leads to disruptions in the hormonal background, which should not be allowed.
• In no case do not apply rigid diets, especially in adolescence. The body loses vitality, which negatively affects the menstrual cycle.
• You should visit your gynecologist regularly. Even if a woman has no complaints and she feels great, she should visit a doctor at least once every six months. There are a number of problems that do not cause any discomfort at the initial stage of development. But if a woman often has various kinds of NMC, this should be done much more often.

This material reproduces one of the lectures given by the author of this resource at advanced training courses for nursing staff.

Menstrual cycle- These are regular cyclic changes that occur in the reproductive system of a woman and indirectly cause cyclic changes throughout the body. The essence of these changes is to prepare the body for pregnancy. In the absence of fertilization, the menstrual cycle ends with bleeding, called "menstruation" - the crying of the uterus with bloody tears for a failed pregnancy.

The menstrual cycle continues from the first day of the last menstruation to the first day of the next. In most women, the cycle lasts 28 days, however, a cycle of 28 +\- 7 days with a blood loss of 80 ml can be considered normal.

Violation of the menstrual cycle is a symptom of various gynecological and endocrine diseases, sometimes leading to the loss of a woman's reproductive function or the development of precancerous and cancerous processes in the female genital organs.

The menstrual cycle may be irregular for up to 2 years after the first period and up to 3 years before menopause. If it is irregular during the rest of the reproductive period, this is a pathology and requires appropriate examination and treatment.

At present, the issues of etiology and pathogenesis of NMC have not been studied enough, and therefore their rational classification is impossible. Numerous NMC classifications have been proposed, however, most of them are not based on the etiological and pathogenetic principle, but take into account only the clinical symptoms of a cycle disorder (amenorrhea or bleeding, preservation of a two-phase cycle or its absence, pathology of the development of the follicle or corpus luteum, disorders of the hypothalamic-pituitary system, etc.). .d.)

Factors leading to disorders of menstrual function are:

1. strong emotional upheaval
2. mental or nervous diseases (organic or functional);
3. malnutrition (quantitative and qualitative),
4. beriberi,
5. obesity of various etiologies;
6. occupational hazards (exposure to certain chemicals, physical factors, radiation);
7. infectious and septic diseases;
8. chronic diseases of organs and systems
9. transferred gynecological operations;
10. injuries of the genitourinary organs;
11. inflammatory diseases and tumors of the female genital organs
12. brain tumors;
13. chromosomal disorders;
14. congenital underdevelopment of the genital organs;
15. involutional restructuring of the hypothalamic centers in the menopause.

Considering that there are 5 levels of regulation of the menstrual cycle in the reproductive system, the listed factors may affect one of them. Depending on the level of damage to neurohumoral regulation, groups of these disorders are distinguished, classifying them according to the mechanism of pathogenesis:

1. cortical-hypothalamic
2. hypothalamic-pituitary
3. pituitary
4. ovarian
5. uterine
6. NMC in extragenital diseases (thyroid gland, adrenal glands, metabolism)
7. Genetic disorders

Classification by the nature of violations

1. NMC against the background of organic disorders
2. Functional NMC

Classification according to the content of gonadotropins

1. hypogonadotropic
2. normogonadotropic
3. hypergonadotropic

Classification by clinical manifestations

1. amenorrhea - absence of menstruation
2. hypomenorrhea - scanty menstruation that comes on time
3. hypermenorrhea or menorrhagia - heavy menstruation that comes on time
4. metrorrhagia - intermenstrual bleeding
5. polymenorrhea - prolonged menstruation for more than 6 - 7 days
6. oligomenorrhea - short (1-2 days), cyclical menstruation
7. proyomenorrhea, tachymenorrhea - shortening of the duration of the menstrual cycle (less than 21 days)
8. opsomenorrhea - infrequent menstruation, at intervals of 35 days to 3 months
9. algomenorrhea - painful menstruation
10. hypomenstrual syndrome - a combination of rare scanty menstruation with a shortening of their duration

Since we begin the appointment with the clarification of the patient's complaints, it is rational to start the analysis based on the classification according to clinical manifestations. Thus, the classification can be narrowed down to three groups:

1. Amenorrhea
2. Dysfunctional uterine bleeding

Amenorrhea is the absence of menstruation between the ages of 16 and 45 for 6 months or more without taking hormonal drugs.

Distinguish:

1. False amenorrhea - a condition in which cyclic processes in the hypothalamus-pituitary-ovaries-uterus system are normal, there is no external discharge of menstrual blood, most often it is atresia (infection) of the vagina, cervical canal or hymen - surgical treatment
2. True amenorrhea, in which there are no cyclic changes in the hypothalamus - pituitary gland - ovaries - uterus, and menstruation is clinically absent. True amenorrhea can be physiological and pathological, as well as primary and secondary.

Physiological amenorrhea is observed in girls before puberty, during pregnancy, lactation, and in the postmenopausal period. Pathological primary amenorrhea - when menstruation has never been, and secondary - when, after a sufficiently long period of a regular or irregular menstrual cycle, menstruation has stopped. As a result of taking drugs (gonadotropin-releasing hormone agonists (zoladex, buserelin, triptorelin), antiestrogen (tamoxifen), gestrinone, 17-ethynyltestosterone derivatives (danazol, danol, danovan), pharmacological amenorrhea is observed.

Generally The causes of amenorrhea can be divided into two groups:

1. amenorrhea due to dysfunction of the gonads
   1. Gonadal dysgenesis - due to genetic defects, which result in malformations of the gonads. There are 4 clinical forms of gonadal dysgenesis: typical or classic (Shereshevsky-Turner syndrome, karyotype 45X0), erased (the karyotype has a mosaic character 45XO / 46XX), pure (karyotype 46XX or 46XY (Swyer's syndrome)) and mixed (karyotype 45XO / 46XY ). Gonads have a mixed structure. Diagnosis: genetic study (karyotype and sex chromatin). Treatment: in the presence of Y - surgical removal of the gonads (malignancy is possible), in other cases, HRT
   2. Testicular feminization syndrome (Morris syndrome, false male hermaphroditism) - 46XY karyotype, complete (NPO female, blind vagina, inguinal hernia) and incomplete (NPO male) forms. Treatment - operative + HRT
   3. Premature ovarian failure (syndrome of "resistant ovaries", exhausted ovary syndrome) - underdevelopment of the ovarian follicular apparatus and a decrease in their sensitivity to the action of gonadotropins. Diagnosis - determination of gonadotropins and sex steroids, laparoscopy and biopsy of the gonads. Treatment - HRT.
   4. Polycystic ovary syndrome (primary polycystic ovaries-Stein-Leventhal syndrome) - a violation of steroidogenesis in the ovaries due to a lack of enzyme systems, excessive testosterone synthesis
   5. Amenorrhea associated with androgen-producing ovarian tumors (ovarian androblastoma), excess testosterone.
   6. Amenorrhea due to damage to the ovaries by ionizing radiation or removal of the ovaries (post-castration syndrome).
2. amenorrhea due to extragonadal causes
   1. congenital adrenogenital syndrome (congenital hyperplasia of the adrenal cortex) - increased production of androgens. The karyotype is female, but NPO virilization is noted. At birth, a girl is mistaken for a boy. Diagnosis - ACTH, hormones of the adrenal cortex, test with glucocorticoids. CT scan of the adrenal glands. Treatment with glucocorticoids, NPO plastic surgery and the formation of the entrance to the vagina
   2. hypothyroidism. Diagnosis - TSH and thyroid hormones. Treatment - thyroid medications
   3. destruction of the endometrium and removal of the uterus - the uterine form of amenorrhea. Causes - tuberculosis, damage to the endometrium due to rough curettage and removal of the basal layer, damage to the endometrium due to chemical, thermal burns or cryodestruction, Asherman's syndrome (intrauterine synechia)
   4. damage to the central nervous system and hypothalamic-pituitary region (central forms of amenorrhea) - wartime amenorrhea, psychogenic amenorrhea (false pregnancy), anorexia nervosa, amenorrhea in mental illness (treatment by a psychiatrist), trauma, tumor, infectious lesions (meningoencephalitis, arachnoiditis), amenorrhea in combination with galactorrhea (Del-Castillo-Forbes-Albright syndrome - amenorrhea due to mental trauma or a tumor of the hypothalamic-pituitary region in nulliparous women, and Chiari-Frommel syndrome - amenorrhea and galactorrhea that occur as a complication of the postpartum period. Amenorrhea due to Morgagni's syndrome -Stuart-Morel (frontal hyperostosis).A hereditary disease of an autosomal dominant type is accompanied by a lesion of the hypothalamic-pituitary region as a result of calcification of the diaphragm of the Turkish saddle.
   5. pituitary secondary true amenorrhea develops as a result of an organic lesion of the adenohypophysis by a tumor or a violation of blood circulation in it with the development of necrotic changes: Sheehan's syndrome (postpartum hypopituitarism) - the disease develops due to necrosis of the anterior pituitary gland against the background of spasm of arterial vessels as a reaction to massive blood loss during childbirth or bacterial shock, Simmonds syndrome - an infectious lesion or injury, circulatory disorders or pituitary tumors. Itsenko-Cushing's disease - pituitary adenoma producing ACTH, acromegaly and gigantism - a tumor producing growth hormone.

Thus, amenorrhea is not a disease, it is a symptom of many diseases, the correct diagnosis of which depends on the effectiveness of treatment.

Therefore, detailed complaints, anamnesis, general and special examination are in the first place. Based on the totality of these data, the direction of additional research methods is determined. And only after laboratory and instrumental confirmation of the presumptive diagnosis, treatment is prescribed.

Dysfunctional uterine bleeding (DUB) is a violation of the menstrual cycle, which is based on a violation of the rhythmic secretion of sex hormones.

DMK, like amenorrhea, is a polyetiological disease, its causes are certain adverse effects that have a pathogenic effect on the reproductive system at various stages of the formation, formation and development of the female body.

The occurrence of DMC is facilitated by: unfavorable course of the perinatal period; emotional and mental stress; mental and physical stress; traumatic brain injury; hypovitaminosis and nutritional factors; abortions; transferred inflammatory diseases of the genitals; diseases of the endocrine glands and neuro-endocrine diseases (postpartum obesity, Itsenko-Cushing's disease); taking neuroleptic drugs; various intoxications; professional hazards; solar radiation; adverse environmental factors.

Depending on age, DMC are divided into:

1. Juvenile uterine bleeding (JUB).
2. DMC of reproductive age.
3. DMK premenopausal, postmenopausal (climacteric) period.

The diagnosis of dysfunctional uterine bleeding is made when all other causes of bleeding (blood diseases, etc.) are excluded. The word "bleeding" must be understood as follows: even spotting spotting is also bleeding, which will only be treated differently (for example, profuse bleeding - immediately curettage to stop), spotting requires examination according to functional diagnostic tests and planned diagnostic curettage .

So, DMK is a violation of the system of regulation of the menstrual cycle. In each case, it is important to determine the point at which the violation occurred: the hypothalamic-pituitary system, the ovary, or extragenital diseases.

Full regulation of the menstrual cycle can only be achieved when the feedback between the pituitary and ovary is well preserved and the normal amount of hormones switches the production of FSH and LH. It is also necessary to remember in the event of DMC that all endocrine organs are very interconnected and a violation of any endocrine organ in the first place can lead to a violation of the production of gonadotropic hormones of the pituitary gland.

In the anterior lobe - the adenohypophysis, gonadotropic hormones - FSH and LH are produced, these are the most delicate structures of the pituitary gland. Moreover, a violation of the production of any other tropic hormone leads to a decrease in the production of follicle-stimulating and luteinizing hormone. For example, ACTH, if there is an increased production of ACTH, then adrenal hyperplasia occurs, hyperplastic adrenal glands produce an increased amount of androgens. And the very high content of ACTH in the pituitary gland inhibits the production of FSH and LH, and the increased amount of androgens coming from the adrenal glands also inhibit ovarian function. As a result, we have menstrual dysfunction in the form of opsomenorrhea (rare menstruation), in some cases - amenorrhea (complete absence of menstruation).

Or take somatotropic hormone - the same situation. Beautiful high growth, athletic physique and at the same time genital infantilism. If these women become pregnant, then their pregnancy may be accompanied by miscarriage, early termination of pregnancy, miscarriage, they may also suffer from infertility, because. somatotropic hormone depresses FSH and LH since childhood, and normal gonadotropic function is not formed. Even if they menstruate regularly, they still have a defective cycle.

The same is true for thyroid diseases. Women with thyroid disease suffer from both NMC and infertility. Pancreas - diabetes mellitus, women suffer from NMC, DMC, rare menstruation, with severe diabetes - amenorrhea. Therefore, when a woman has DMC, especially if these bleedings are cyclical, it is necessary not only to work in the pituitary-ovary-uterus system, but also to work on the entire endocrine system, because if we missed the thyroid gland, then we will not do this woman well. let's fly, i.e. there will be no etiopathogenetic treatment, and we will carry out only symptomatic treatment, which will give a temporary effect, only for the time of taking hormonal drugs, and as soon as we remove hormonal therapy, the situation will repeat itself.

Diseases that must be excluded when making a diagnosis of dysfunctional uterine bleeding (differential diagnosis in reproductive age):

1. disturbed uterine pregnancy of early terms
2. ectopic pregnancy
3. placental polyp
4. hydatidiform mole
5. chorionepithelioma
   differential diagnosis will depend on whether this bleeding first occurred or whether it is repeated. If a woman has bleeding for the first time against the background of a delay in menstruation, a differential diagnosis should be made with a disturbed uterine pregnancy or ectopic pregnancy. But if there are repeated violations of the menstrual cycle, for example, for half a year, menstruation comes with a delay of two weeks, passes more abundantly than usual, then naturally this is not a disturbed pregnancy.
6. inflammatory diseases of the uterus and appendages - endometritis, can give intermenstrual spotting for a long time with a clear release of menstruation. There is no pain syndrome and the woman feels practically healthy. Then think, first of all, about endometrial cancer, a hyperplastic process - polyposis, an inflammatory disease - endometritis. Then anti-inflammatory treatment, diagnostic curettage, there are no pathological processes in the uterus, the state of the endometrium corresponds to the phase of the menstrual cycle and leukocyte infiltration of the remaining stroma, which indicates the presence of endometritis.

   Inflammatory processes of the appendages often give violations of an acyclic nature according to the type of metrorrhagia (i.e., there is a delay, and then copious spotting), then we carry out a differential diagnosis with an ectopic pregnancy, because there is pain, delayed menstruation and prolonged spotting.

7. submucosal uterine fibroids (very small, it practically does not affect the size of the uterus, the uterus may be slightly larger, but of normal consistency with a smooth surface), because mixed or subserous uterine fibroids, we expose immediately during the initial examination. We differentiate when a woman has cyclic disorders, heavy and prolonged menstruation, but the cycle is preserved, comes regularly and has a characteristic pain syndrome in the form of cramping pains during menstruation.
8. endometriosis of the uterus - we differentiate with repeated menstruation, profuse, prolonged, and there are spotting spotting and pain before and after menstruation.

   With DMC, there is no pain, sometimes organic diseases proceed without pain, for example, endometriosis of the uterine body.

9. hyperplastic process of the endometrium (endometrial polyposis, atypical glandular hyperplasia - endometrial adenomatosis). The group of hyperplastic processes of the endometrium also includes glandular and glandular-cystic hyperplasia, but we will say that these hyperplasia can be a manifestation of DMC, i.e. ovarian dysfunction that leads to these changes and we will expect this histological result and take this result as confirmation of DUB.
10. Cancer of the body of the uterus and cervix. We will immediately see the cervix, we reject it during colposcopy. Remember the old rule that any bleeding should be considered bleeding due to cancer, as long as we do not rule out its presence in any age period.
11. Ovarian sclerocystosis is differentiated if there is a violation of the menstrual cycle according to the type of opsomenorrhea (rare menstruation), although sclerocystosis can occur without a delay in menstruation according to the type of DMC, which can occur before the period of menstruation at first, and then, as the disease develops, opsomenorrhea is formed, which smoothly turns into amenorrhea if the woman is not treated.
12. Blood diseases

Ovarian dysfunction (primary, secondary due to dysfunction of the pituitary gland, but all forms of ovarian dysfunction are the same, regardless of the level of damage). In the course of the examination of these women, we will conduct a differential diagnosis and at the same time identify the level of the lesion. Now this is done simply: a study of the level of hormones of the thyroid gland, adrenal glands and pituitary gland, (prolactin - in high doses inhibits the level of FSH and LH, therefore, in women with infertility and menstrual irregularities, it is the first to examine prolactin). Regardless of the level of damage in the primary ovary or in the pituitary gland, the forms of the disorder will be the same.

Forms of infringement.

1. Slow development of the next follicle. Clinic: menstruation turns into DMC and spotting occurs up to 14 days. Or menstruation has passed for 3-5 days, ended and a day later spotting began again, continues for several days and stops on its own.
2. Persistence (prolonged existence) of an immature follicle - a delay in menstruation or menstruation on time. Bleeding is not profuse and not too long. The main manifestation is a delay in menstruation and complaints of infertility.
3. The persistence of a mature follicle is the only one of all DMC, accompanied by profuse bleeding, anemic for the patient, occurs after a delay or during menstruation. Often they end up in a hospital for curettage in order to stop bleeding.
4. Follicle atresia (reverse development) - a long delay (up to 2 - 3 months), sometimes on or before the period of menstruation. Bleeding is moderate, closer to meager
5. Intermenstrual spotting (a drop in hormone levels after ovulation) - spotting in the middle of the cycle, stops on its own. In abundance, they can resemble menstruation, then the woman will say that she had three menstruation in one month.
6. Persistence of an immature corpus luteum - bleeding before the onset of menstruation, at term, or after a delay at a reduced progestogen level (low progesterone in the second phase)
7. Persistence of the mature corpus luteum - bleeding on time or after a delay, not abundant, but prolonged. The reason is a stressful situation transferred in the second phase of the cycle. Very difficult to treat. If a woman does not immediately apply, then bleeding in duration with each cycle will increase all the time (2 weeks, a month, a month and a half and up to 2 months). At the same time, the woman will feel the early signs of pregnancy, and if she comes with a temperature chart, we will make the only diagnosis - a disturbed early pregnancy. This is due to the high level of gestagens. Treatment is less effective - only taking COCs
8. Syndrome of luteinization of the unovulated follicle - the follicle without ovulation turns into a corpus luteum. The reason is unknown. Complaints about infertility. Menstruation on time, of normal duration and intensity, a two-phase cycle according to rectal temperature. Diagnosis only by ultrasound: after ovulation, the follicle should disappear, and with this pathology we will see the follicle (liquid formation), which begins to decrease in size (it is delayed by the corpus luteum). Then laparoscopy in the second phase, after a rise in temperature: we should see the stigma of ovulation (a rounded hole with inverted edges), and we will see a yellowish formation - this will be an unovulated follicle undergoing luteinization. Treatment: ovulation stimulation
9. Atresia of the corpus luteum - bleeding before the period of menstruation, on time or after the delay of menstruation. The onset depends on the time of death of the corpus luteum: abrupt death - before the deadline, slow death - the temperature decreases gradually and menstruation on time, if it dies even more slowly, the temperature goes beyond 37 ° C, it stays like this for some time and only then against the background of a delay bleeding starts. Normally, the temperature decreases one day before menstruation, if it decreases more days before the onset of menstruation, then the corpus luteum is atreziruetsya

All these disorders at the first admission are called (put down in the diagnosis) NMC against the background of ... (indicate the clinical manifestation, symptoms) opsomenorrhea, hyperpolymenorrhea, etc. In the future, we examine the woman according to TFD, confirm them with the results of histology and reach a clinical diagnosis: DMC of the reproductive period against the background (indicate the form of the violation), for example, delayed development of the next follicle. In substantiating the diagnosis, we write: on the basis of tests of functional diagnostics (TFD), a decrease in estrogen levels at the beginning of the cycle, a discrepancy between the histological result and the day of the menstrual cycle, this diagnosis was made.

Treatment: complex

1. stopping bleeding - hemostasis (medical or surgical), if operational - a mandatory histological examination of endometrial scrapings. With profuse bleeding - funds aimed at increasing blood clotting and uterine contractility + blood and plasma substitutes. If there is no effect, further measures are hormonal hemostasis and preparation for emergency curettage.

   Surgical hemostasis in girls is used for ineffective hormonal hemostasis, as well as in cases of hypovolemic shock and severe anemia (Hb less than 70 g/l and Ht less than 20%).

   At the present stage, surgical hemostasis should be carried out under the control of hysteroscopy to exclude organic causes of bleeding (myomatous node, polyp, etc.).

   An auxiliary method for curettage of the uterine mucosa in the perimenopausal period can be cryodestruction of the endometrium, laser vaporization and electroextraction (ablation) of the endometrium, which give a lasting therapeutic effect. Your textbook says that such manipulations lead to the absence of the need for further hormone therapy. This is not true! It must be remembered that in addition to the endometrium, a woman has other target organs for sex steroids, therefore

2. therapy aimed at maintaining and normalizing menstrual function is required!

   Menstrual function is not menstruation, it is a combination of the ovarian and uterine cycles, and if the uterine cycle (endometrial growth and its rejection) is eliminated, this does not mean that the ovarian cycle will be eliminated. The ovary will also continue to produce hormones that will act on target tissues, including breast tissue. There are no contraindications (except for oncopathology, and then, with some degree, we can say relative ones) to hormone therapy, there is a contraindication to a specific hormone, and it is up to the doctor to find the hormone that suits the woman.

Prevention of recurrent bleeding - depends on the cause of its cause

1. rational nutrition (increase in body weight),
2. general strengthening therapy (adaptogens) and vitamin therapy (E and C)
3. physiotherapy (phototherapy, endonasal galvanization), which enhances the gonadal synthesis of steroids
4. elimination of excessive stress factors
5. identification of etiological (extragenital) causes of DMC and their elimination or correction (diseases of the liver, gastrointestinal tract, metabolic disorders, etc.), sanitation of foci of infection
6. Additional treatment for anemia
7. In women of reproductive age, hormone therapy with COCs before pregnancy is planned (as a prophylaxis and a method of contraception)

Uterine bleeding in postmenopause- an indication for diagnostic curettage. No therapeutic measures before scraping! The appearance of bloody discharge in postmenopause is a symptom of malignant neoplasms (adenocarcinoma or hormonally active ovarian tumor), and there may also be inflammatory changes against the background of endometrial atrophy, senile colpitis. In any case, we first exclude oncopathology.

The main sign of a normal menstrual cycle is regular menstruation - spotting from the genital tract. They occur every 21-35 days and go within 3-7 days.

How to recognize violations?

Everything is very simple and logical: if the menstruation is normal, then everything is in order, if not, the menstrual cycle is disturbed. The most pronounced form of cycle disorders is amenorrhea: the complete absence of menstruation for more than six months. In addition, too meager or, conversely, too heavy periods, as well as their irregularity (very frequent or rare), are considered suspicious. A woman should be wary of bleeding that lasts only 1-2 days or more than a week.

Causes

Menstrual disorders are not a disease, but just a sign that some kind of malfunction has occurred in the work of the internal genital organs. The origins of cycle disorders are usually defects in the hormonal system. Moreover, it is not at all necessary that these defects relate specifically to sex hormones. The culprits could easily be thyroid hormones, adrenal glands, and even the pituitary gland (an important part of the brain). There can be several reasons for such hormonal disruptions:

• constant stress or damage to the nervous system;
• infectious and non-infectious diseases of the internal genital organs;
• serious diseases of other internal organs and systems (liver, kidneys, lungs, blood);
• severe infectious diseases;
• hereditary predisposition;
• taking certain medications;
• abrupt change of residence (for example, moving from Syktyvkar to Murmansk);
• radiation and poisoning;
• irrational nutrition (weight loss or beriberi, or vice versa - obesity).

At the same time, sanitary tampons, contrary to some misconceptions, do not have a negative effect on the menstrual cycle (although they can lead to other problems).

What is dangerous?

Sometimes very serious diseases can be behind a slight violation of the menstrual cycle: ectopic pregnancy, benign and malignant tumors of the ovaries or uterus, tuberculosis, brain tumors.

Diagnostics

Noticing that menstruation suddenly became not the same as usual, a woman should immediately go to an appointment with a gynecologist. The sooner the cause of menstrual irregularities is found out, the better. First of all, the doctor will prescribe a study of the hormonal profile of the patient. It is also necessary to do an ultrasound to find out if there are any diseases or damage to the internal organs. Another necessary study is a check for infections: a regular vaginal smear or a more complex PCR diagnosis. Depending on what the analysis of hormones showed, the patient may need to consult a specialist endocrinologist.

Treatment

The disturbed menstrual cycle must be made normal. At the same time, it is not the violation of the cycle itself that is treated, but the causes that led to it are removed:

• infectious and inflammatory processes are treated with special pills and physiotherapy;
• with initial hormonal disorders, hormone therapy is prescribed;
• in the case of tumors, surgery may be required;
• to support a weakened body will help physical education, balanced nutrition, vitamins.