Failure of the menstrual cycle

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

What cycle is considered normal?

The external manifestation of the natural ovarian-menstrual cycle is menstruation, which occurs with the 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. The natural cleansing of the uterine cavity is facilitated by peristaltic contractions of its walls, which can cause some physical discomfort.

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

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

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

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

NOMC development mechanism

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

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

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

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

Causes of dysfunction

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

The most likely of them:

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

Menstrual irregularities after 40 years of age are 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 decline in reproductive function. These changes become most obvious in the premenopausal period, when the cycle becomes more and more irregular with a tendency to and the addition of psychovegetative disorders.

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

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

Possible manifestations of NOMC

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

Symptoms of menstrual irregularities may include:

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

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

Many women of reproductive age also experience infertility - the absence of natural conception within 1 year of unprotected regular sexual activity. It is caused by severe disturbances in the release 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 independently and not make any special complaints about menstrual irregularities, although a targeted survey in most cases reveals various symptoms. In this case, the patient usually considers her characteristic lengthening of the menstrual cycle to be her individual feature, and not a pathological sign.

Features of menstruation disorders in different age groups

Juvenile period

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

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

Reproductive period

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

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

Changes in the ovaries during a typical menstrual cycle

Menstruation irregularities after an abortion are also possible. It can be spontaneous (with spontaneous abortion in the early stages) or medical using various techniques to remove the fertilized egg/embryo. In this case, a prolongation of the subsequent cycle is usually noted, and restoration of menstrual function is expected within 3 months. If the abortion was accompanied by complications, a protracted rehabilitation period with acyclic bleeding and algomenorrhea cannot be ruled out.

Premenopausal period and menopause

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

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

Possibility of pregnancy

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

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

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

Survey

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

The basic examination should include:

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

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

Principles of treatment

Treatment of menstruation disorders includes several areas:

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

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

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

Causes of menstrual irregularities

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

To the leaders etiological factors Menstrual irregularities include:

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

Menstrual irregularities can be caused by other reasons:

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

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

Phases of the menstrual cycle

Follicular phase

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

Ovulatory phase

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

Luteinizing phase

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

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

Regulation of the menstrual cycle

The cerebral cortex, the hypothalamus-pituitary-ovary system, the uterus, vagina, and fallopian tubes take part in the regulation of the menstrual cycle. Before you begin to normalize the MC, you should visit a gynecologist and undergo all the necessary tests. For concomitant inflammatory processes and infectious pathologies, antibiotic treatment and physiotherapy may be prescribed. To strengthen the immune system, it is necessary to take vitamin and mineral complexes, a balanced diet, and giving up bad habits.

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

Speaking about the disruption of the menstrual cycle, you should also take into account the duration and intensity of menstrual flow. Thus, excessively abundant discharge may signal the development of a neoplasm in the uterine cavity, or may also be the result of the negative effects of the intrauterine device. A sharp decrease in the contents released during menstruation, as well as a change in the color of the discharge, may indicate the development of a disease such as endometriosis. Any abnormal bleeding from the genital tract may be a sign of an ectopic pregnancy, therefore, if any irregularities occur in the monthly cycle, it is strongly recommended to consult a doctor.

Delayed menstrual cycle

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

Symptoms of menstrual irregularities

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

The following forms of hypomenstrual syndrome are distinguished:

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

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

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

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

Primary amenorrhea

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

Secondary amenorrhea

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

Oligomenorrhea

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

Menorrhagia

Heavy blood loss.

Dysmenorrhea

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

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

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

Intermenstrual bleeding

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

Bleeding after coitus

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

Bleeding after menopause

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

Pain syndrome with a preserved cycle

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

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

Types of menstrual dysfunction

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

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

Menstrual cycle disorders are divided into the following groups:

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

Treatment of menstrual disorders

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

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

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

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

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

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

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

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

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

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

Menstrual irregularities: treatment

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

Modern drugs for drug correction of menstrual dysfunction

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

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

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

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

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

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

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

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

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

The basis of women's health is a regular monthly cycle. There are times when he gets confused. The reasons for this phenomenon are varied. We will consider them further. Although it is best to immediately contact a qualified gynecologist if you have problems with your cycle. After all, self-medication can only harm your health.

Cycle

What is the monthly period of time from the onset of menstruation to the next one? The process of release of an egg ready for fertilization into the fallopian tube is called ovulation. It divides the monthly cycle into the follicular and luteal phases. What is this? The follicular phase is the period when the follicle matures. Luteal period refers to the period of time from ovulation to the onset of menstruation.

For those girls whose cycle lasts 28 days, ovulation usually occurs on the fourteenth day from the beginning. After it, the woman’s estrogen levels drop. But during this period, bleeding has not yet occurred. Since the production of hormones is controlled by the corpus luteum. Strong fluctuations in estrogen in any direction during the period of ovulation can cause uterine bleeding between periods, before or after them.

Cycle calculation

Normally, the cycle length is 21-37 days. As a rule, for most girls it is 28 days. The duration of menstruation itself is approximately three to seven days. If you have missed your period for two or three days, no treatment is required. Since such a phenomenon is not a pathology. But if menstruation does not occur even seven days after the required period, then you need to consult a doctor.

How to calculate the cycle? The period of time between the first day of your period and the first day of your next period is the length of your cycle. In order not to make mistakes in calculations, it is better to use a calendar on which to mark the beginning and end of menstruation.

Symptoms of failure

Let's now look at the signs of menstruation failure:

absence of menstruation;
shortening of the cycle (less than twenty days);
increase in time between periods;
the appearance of bloody discharge;
heavy or, conversely, scanty periods.

Another symptom of a malfunction is the duration of menstruation for more than seven days or less than three.

Adolescence and weight problems

Why was there a delay in menstruation or a cycle failure? There can be many reasons. During adolescence, the cycle often fails. This problem is quite common among girls. Since their hormonal levels are just beginning to be established. If more than two years have passed since the first menstruation, and the problems continue, then you should definitely go to the gynecologist.

Another reason for the failure of menstruation is severe weight loss (or, conversely, obesity). The body perceives fasting and extreme dieting as a sign that hard times have come. Therefore, it turns on natural defenses, resulting in a delay in menstruation. Rapid weight gain also negatively affects the body. As a result, the cycle may be disrupted.

Acclimatization

What other known causes of menstruation failure? Acclimatization. The cause of the failure is air travel, moving to another time zone. Stress for the body is a sudden change in climate. Usually the cycle is restored after the body gets used to new living conditions.

Hormonal imbalance

Every girl knows this phenomenon) - this is one of the main signs of problems with hormonal levels. This may be caused by problems in the pituitary gland, as well as the hypothalamus. In this case, you should contact an endocrinologist, he will conduct an examination, prescribe the necessary examinations, based on the results of which he will make a diagnosis.

Stress

A common cause of missed periods is stress. It often leads to cycle disruption. During stress, it produces excessive amounts of prolactin. Excess of it inhibits ovulation, resulting in delay. In this case, doctors recommend getting enough sleep and spending more time in the fresh air. A gynecologist may prescribe a sedative if your period fails due to stress. It can be valerian, Cyclodinone tablets and others.

Diseases and hormonal contraceptives

Diseases of the female organs also lead to disruption of menstruation. Often the cause of this is pathology of the cervix, inflammation of the uterus itself or the appendages. Another reason for the failure of menstruation is cysts and polyps. All such problems can be treated surgically.

Taking hormonal contraceptives or refusing them leads to disruption of the monthly cycle. In this matter, you should consult a doctor. You may need to take a break from taking oral contraceptives.

Pregnancy, lactation

Failure of menstruation after childbirth is also a fairly common occurrence. A similar problem after the baby is born and during breastfeeding is the norm. When lactation stops, the cycle should resume.

If severe pain occurs, consult a doctor immediately. Since the cause of this phenomenon can be an ectopic pregnancy. If it is not detected in time, it can lead to death due to painful shock and large blood loss when the fallopian tubes rupture.

Premenopause and abortion

Missed periods after 40 are not uncommon. A similar phenomenon may be a harbinger of menopause.

Abortions, regardless of whether they are spontaneous or forced, have a bad effect on the condition of the uterus and cause a delay in menstruation. Sometimes they even cause infertility.

Other reasons

Why is there a delay in menstruation? Also, the cause of this phenomenon may be diseases of the adrenal glands, thyroid gland or infectious diseases. In addition, bad habits (using drugs, alcohol, smoking), taking medications, vitamin deficiency and vaginal injuries lead to cycle failure.

When to see a doctor?

Under no circumstances should you delay visiting a specialist if:

Two years have passed since the beginning of menstruation, and the cycle has not yet established itself;
there is pain during ovulation. This symptom most likely indicates ovarian rupture;
There is copious bleeding. Normally, a girl loses no more than 250 ml of blood during menstruation. If it is more, then this is already a sign of hormonal imbalance. It must be treated with drug therapy;
there are regular cycle irregularities (its duration is less than three days or, conversely, exceeds seven days);
There is spotting before and after menstruation. This symptom indicates endometriosis.

Diagnostics

How is a patient with menstrual irregularities diagnosed? First, a survey and gynecological examination are carried out, during which all smears are taken. Also, the patient, if the diagnosis is not made, needs to undergo an ultrasound of the pelvic organs and an MRI. In addition, blood is donated for hormones. To clarify the diagnosis, the patient is prescribed hysteroscopy, as well as blood and urine tests.

Thanks to all these methods, it is possible to determine the reason why the cycle went wrong. Once the diagnosis is made, appropriate therapy is prescribed.

Treatment

First of all, the disease that led to the failure of the monthly cycle is treated. As preventive measures, doctors usually recommend to patients:

eat right;
eat foods rich in iron and protein three to four times a week;
sleep at least eight hours a day;
quit smoking and other bad habits;
take vitamins.

When teenage girls experience problems with their cycles, doctors often use vitamin therapy. The patient is prescribed to take ascorbic and folic acid.

For anemia, women are prescribed iron supplements.

If, in addition to the fact that a girl’s cycle is disrupted, she is diagnosed with infertility, then drugs such as Pergonal and Choriogonin are prescribed to stimulate the development of follicles.

When a patient has severe bleeding, but a bleeding disorder has been ruled out, doctors may prescribe hemostatic drugs. ε-aminocaproic acid is also prescribed.

Even with heavy bleeding, plasma infusion is performed. Sometimes even an infusion of donor blood is practiced.

The last resort for severe bleeding is surgery.

Hormonal drugs and antibiotics are also prescribed.

Failure of the monthly cycle. Possible complications

Remember that your health depends only on you! Therefore, you should not take lightly the fact that disturbances in the monthly cycle occur. Since such problems can lead to infertility. Frequent ones cause disability and fatigue.

Late detection of the pathology that caused the failure of menstruation can lead to very serious problems and death. Although this could have been avoided if he had consulted a doctor in time. Treatment should be carried out under the supervision of a qualified physician.

A little conclusion

Now you know for what reasons there can be failures in the cycle. As you can see, there are many of them. They can be quite serious. Therefore, if you have problems with your menstrual cycle, immediately contact your gynecologist.

At some point in her life, cycle disturbances probably occurred in every woman. Irregular menstruation , which many ladies are accustomed to considering as something ordinary, are actually a signal of problems with women's health.

What is NMC in gynecology? This is a disrupted menstrual cycle that happens to women at different periods of their lives.

Irregular menstruation – delays or a shorter cycle indicate disturbances in the woman’s physical or mental state. The monthly cycle is a kind of biological clock of the body. A disruption in their rhythm should alert you and cause you to consult a doctor so that diseases can be identified in a timely manner. Below we will talk about why the menstrual cycle fails and what a woman should do in such a situation.

What is the menstrual cycle

It is important to clearly know what the menstrual cycle is in women and what normal menstrual function should be.

Menarche , that is, the first menstruation in girls occurs between the ages of 12 and 14 years. At what age girls start menstruating depends on where they live. The further south a teenager lives, the earlier menarche occurs. It is important for parents to monitor when girls begin menstruation in order to understand whether the body is developing normally.

Between the ages of 45 and 55, the menstrual period ends. This period is usually called premenopausal.

During menstruation, the functional layer of the uterine mucosa is rejected as a consequence of a decrease in production in the body. A woman's monthly cycle is divided into three phases.

1 phase , follicular, characterized by the production, under the influence of which they mature follicles . From all the follicles, a dominant follicle is subsequently released, from which a mature egg is later released.
2 phase The menstrual cycle is the shortest phase, which lasts approximately 1 day. At this time, the follicle ruptures and the egg is released from it. It is important to understand, when talking about what distinguishes the second phase of the menstrual cycle, that this is the time when the egg is ready for fertilization. This is the fertile phase when conception can occur.
3 phase , luteal – the period when synthesis begins progesterone corpus luteum, which arose at the site of a ruptured follicle. Progesterone prepares the endometrium for subsequent implantation of a fertilized egg. But if conception never occurs, the corpus luteum gradually dies, progesterone production decreases, and the endometrium is gradually rejected, that is, menstruation begins.

If there is a deficiency of progesterone, estrogen production is activated again, and the cycle repeats again. For ease of perception, a diagram of the phases by day is useful, where all the phases of the cycle are indicated and what these phases are called.

Thus, the menstrual cycle is a cyclical change that occurs over a certain period of time. The duration of a normal cycle should be from 21 to 35 days. If there is a deviation in a certain direction for 3-5 days, this cannot be considered a pathology. However, if more significant changes are noted, then the woman should be wary of why the menstrual cycle is shortening or becoming longer.

If a woman has a normal menstrual cycle, how many days her period lasts is a purely individual indicator. The normal duration of menstruation is from three to seven days. It is important to take into account, paying attention to the duration, that this condition should not be a very difficult period for a woman. After all, an important characteristic is not only the normal duration, but also the fact that menstruation should not cause very strong discomfort. During this period, about 100-140 ml of blood is lost. If there is heavy blood loss or a woman notices that the retention rate is violated, it is important to immediately contact a gynecologist.

The cycle is regulated at 5 levels.

The first level is the cerebral cortex	If your menstrual cycle is out of whack, the reasons may be related to emotions, stress, and worries.
Second level - hypothalamus	It contains a synthesis of releasing factors affecting the third level.
Third level - pituitary gland	Produces follicle-stimulating and luteinizing hormones or gonadotropic hormones that affect the fourth level.
Level four – ovaries	Under the influence of pituitary hormones, depending on the phase of the cycle, the synthesis of estrogen or progesterone occurs.
Fifth level – female genital organs	Changes in the endometrium occur in the uterus, the epithelium in the vagina is renewed, peristalsis is noted in the fallopian tubes, which facilitates the meeting of sperm and egg.

In fact, the causes of irregular menstruation are very diverse and there are many of them. Conventionally, the causes of menstrual irregularities can be divided into three groups:

First - these are external factors that affect the normal cycle. That is, etiological factors influence the cerebral cortex. A woman may note that the cycle has decreased or, conversely, it is longer, if she has suddenly changed the climate, was in a state of prolonged stress, “sat down” on a strict diet, etc.
Second – a consequence of pathological conditions affecting not only the reproductive system, but also the body as a whole. Thus, the reasons for the disruption of the menstrual cycle after 40 years are often associated with the onset of menopause. However, it is possible that the reasons for the failure of the menstrual cycle after 40 years are due to the presence of health problems in a middle-aged woman.
Third – influence of medications. Often the answer to the question of why the menstrual cycle fails is treatment with a number of drugs. A delay or other failure is possible both after starting certain medications and after stopping them. We are talking about hormonal contraceptives, anticoagulants, antiplatelet agents, glucocorticoids, etc.

Factors associated with pathological conditions

Ovarian pathologies — we are talking about a disruption of the connection between the ovaries and ovarian cancer, drug stimulation of ovulation, insufficiency of the second phase of the cycle. Also, irregular periods associated with ovarian pathology can be a consequence of negative occupational exposures, radiation, vibration, and chemical influences. The reasons for an irregular menstrual cycle may be associated with surgical interventions performed on the ovaries, injuries to the genitourinary organs, etc.
Disturbed interaction between the hypothalamus and pituitary gland - an irregular cycle may be associated with too active or insufficient release of gonadotropic hormones and releasing factors. Cycle disturbances are sometimes the result of a tumor of the pituitary gland or brain, hemorrhage in the pituitary gland, or necrosis.
- if a woman develops endometriosis, both genital and extragenital, the hormonal nature of this disease leads to an imbalance of hormones.
Blood clotting disorder - hemophilia, other genetic pathologies.
Curettage of the uterus – the endometrium is damaged if curettage is performed after termination of pregnancy or for the purpose of treatment. As a result, complications may develop - inflammatory processes of the uterus and appendages. Irregular periods after childbirth are also observed.
Liver and gallbladder diseases .
The appearance of hormone-dependent tumors – oncological processes in the uterus, adrenal glands, mammary gland, thyroid gland.
in chronic form – the formation of a full-fledged endometrium does not occur.
Polyps of the uterine mucosa .
Sudden “jumps” in body weight – both weight loss and provokes irregular periods in adolescents and adult women, since adipose tissue produces estrogens.
Infectious diseases – may have a negative effect on the ovaries. Moreover, both infections that were suffered in childhood (for example, or), and sexually transmitted infections can provoke a failure of menstruation.
Presence of uterine abnormalities – septum in the uterus, sexual infantilism, etc.
Endocrine pathology – often associated with it are the causes of irregular periods after 40 years.
Pathology of the uterus – tumors, hyperplasia.
Mental illness – epilepsy, etc.
Having bad habits .
, hypovitaminosis .
Chromosomal abnormalities.

A gynecologist will tell you what to do in case of a particular health problem and how to normalize your cycle. You should definitely visit him if your periods are “off.”

How can a cycle disorder manifest itself?

Amenorrhea – no periods for six months or more. At primary amenorrhea violations are noted from the moment when girls begin menstruation; in the secondary case, the disturbances appeared after a certain period of normal cycles.
Oligomenorrhea — menstruation appears once every few months (3-4). After 45 years, such manifestations may be associated with.
Opsomenorrhea – scanty periods, lasting no more than 1-2 days.
Polymenorrhea – prolonged menstruation (more than 7 days) during a normal cycle.
Hyperpolymenorrhea – there is heavy discharge, but the cycle is normal.
Menorrhagia – heavy and prolonged menstruation (more than 10 days).
Metrorrhagia – irregular appearance of bloody discharge, sometimes it can appear in the middle of the cycle.
Proyomenorrhea - Frequent menstruation, in which the cycle is less than three weeks.
Algomenorrhea – very painful periods, during which the woman becomes unable to work. Algomenorrhea can also be primary or secondary.
- this is the name for any cycle disorders in which there is pain during menstruation and unpleasant vegetative disorders: unstable mood, vomiting and nausea, etc.

The cause of frequent periods, as well as other disorders described above, can be associated with a wide variety of pathologies. A woman should be alerted to any violations. For example, very frequent periods after 40 years of age may indicate the development of serious diseases.

Cycle disturbances are often observed in adolescents when menstruation begins. This phenomenon is due to physiological reasons. In girls, hormonal levels are developing, and both the reasons for a short menstrual cycle and the reasons for delays are associated with this. In adolescents, the duration of the cycle may be different each time.

The formation process can last for 1-2 years. But the girl must clearly know how to count the duration of the menstrual cycle in order to track how many days the cycle lasts and whether it is gradually developing. This is important not only for those who are already sexually active, but also for girls who need to know the duration of their cycle both for hygiene purposes and to monitor their health status. The mother must definitely explain to her daughter how to correctly count the menstrual cycle. An example of such a calculation is also important for a teenager.

There are the following pathological factors that influence the regularity of menstruation in adolescents:

infections of the brain and membranes;
traumatic brain injuries;
frequent colds;
sexual infections;
sclerocystic ovaries.

The formation of the monthly cycle is also negatively affected by the fact that young girls practice strict diets, as a result of which not only excessive weight loss is noted, but also hypovitaminosis and menstrual irregularities.

Interestingly, the regularity of menstruation is influenced by the personality traits of adolescents.

Doctors identify several other important factors that can affect the formation of the cycle:

early onset of sexual activity, promiscuity;
abnormalities in the development of the reproductive system;
presence of bad habits.

Due to a disrupted menstrual cycle, a teenage girl may experience the so-called juvenile uterine bleeding . This condition is characterized by prolonged periods. As a rule, long and heavy periods last more than a week. This leads to anemia and serious deterioration of the teenager’s condition. As a rule, the causes of long periods are associated with either mental stress or infections.

Disrupted cycle during premenopause

Treatment of menstruation disorders in adolescents

If a teenage girl has a disturbed menstrual cycle, and the condition is complicated by juvenile bleeding, two-stage therapy is carried out.

With prolonged severe bleeding, when the girl is worried about weakness, dizziness, and at the same time her level is low (up to 70 g/l), the doctor decides to perform curettage. Next, a histological examination of the scraping is carried out.

Provided that the hemoglobin level is from 80 to 100 g/l, hormonal tablets are prescribed (,).

Also, if necessary, antianemic therapy is carried out (blood transfusion, red blood cell transfusion, infucol, reopolyglucin). Iron supplements are also prescribed as part of the treatment regimen.

The teenager is prescribed hormonal drugs for a period of no more than three months. Treatment of anemia lasts until hemoglobin levels rise to normal.

Treatment of cycle disorders in women of childbearing age

Treatment of menstrual irregularities in this case is similar to the treatment regimen for such disorders in adolescents. Both at the age of twenty, and treatment of menstrual irregularities at the age of 40 with bleeding is carried out by curettage. It is carried out for both diagnostic and therapeutic purposes.

It is important to replenish the volume of circulating blood, for which colloidal solutions are used. Antianemic treatment and symptomatic hemostasis are also practiced. Provided that curettage does not work, the doctor may decide to hysterectomy or ablation (burning out) the endometrium.

It is also important to properly treat those concomitant diseases that could provoke a cycle disorder. So, for hypertension, it is important to take prescribed medications and limit salty and liquid intake. If you have liver pathology, you should follow a proper diet and take hepatoprotectors.

Some women also practice treatment with folk remedies. However, such methods must be practiced very carefully, since without consulting a doctor there is a risk of missing a serious pathology. And even irregular menstruation after 45 years of age, perceived by a woman as the beginning of menopause, is a reason to consult a doctor.

Since cycle disruptions may be the cause, women of childbearing age are prescribed, if necessary. Khoriogonin And Pergonal – medications to stimulate the development of active follicles. In order to stimulate ovulation, it should be taken.

Bleeding during menopause

If there is bleeding during menopause, the patient must be prescribed curettage of the uterine cavity. After all, bleeding may indicate serious pathologies, in particular the development atypical hyperplasia or endometrial adenocarcinoma . Sometimes the doctor may decide to perform hysterectomy .

Sometimes a patient during menopause is prescribed gestagen medications: Depo-Provera , , 17-OPK .

During treatment, antiestrogenic drugs may also be prescribed - Danazol , Gestrinone , 17a-ethynyl testosterone .

Conclusions

If menstruation is disrupted, the question of how to restore the menstrual cycle must be addressed immediately by a woman of any age. Those who are interested in how to restore the menstrual cycle using folk remedies should remember that such manifestations are just a symptom of the underlying disease, which must be treated correctly, according to the regimen prescribed by a specialist.

To eliminate such problems, it is not always necessary to take hormonal pills to restore menstruation. Sometimes a woman for whom the question of how to restore the menstrual cycle without hormones is relevant, even changing her daily routine and eating habits helps. For example, weight normalization helps obese women. And for those who practice very strict diets, it is enough to increase the calorie intake and overcome the exhaustion of the body. In any case, if there are “problems” with the cycle, it is important for both young girls and women during menopause to consult a gynecologist who will tell you how to proceed.

Failure of the menstrual cycle is a common reason for women to visit a gynecologist. In case of such complaints, the doctor must find out the patient’s medical history, prescribe an examination to identify possible concomitant pathologies, including tests for certain hormones, and, if necessary, refer her for a consultation with other specialized specialists, for example, an endocrinologist.

The fact is that the reasons for the failure of the menstrual cycle are varied and are not always associated with a specific disease; in addition, the absence of menstruation can be caused by a whole range of problems. We will look at only some of these problems, some of the most common.

Puberty

After the first menstruation (menarche), a girl may experience symptoms of irregular menstruation, and this is normal. It takes approximately 2 years for the menstrual cycle to become regular without delays. Previously, delays of 2 months were allowed. It should be understood that pregnancy in teenage girls, even with irregular bleeding, is not excluded.

Severe bleeding requires a mandatory visit to the doctor when 1 sanitary pad lasts for 2 hours or even less. This kind of bleeding is not uncommon in young girls, but can be dangerous to health and lead to iron deficiency anemia.

Lactation and hyperprolactinemia

Another period of a woman’s life when bleeding can be delayed is during breastfeeding. Failure of the menstrual cycle after childbirth is diagnosed by gynecologists very often. The cycle can be fully restored only after completion of lactation, that is, even 2-3 years after birth. And at the same time, the duration of the cycle may change, as well as the amount of discharge. During lactation, the hormone prolactin, which is necessary for the formation of breast milk in a woman, interferes with the establishment of a regular cycle. Meanwhile, even in the absence of menstruation in a young mother, there is a possibility of pregnancy.

Prolactin can be elevated outside of pregnancy and lactation. A persistent increase in prolactin, which almost always leads to infertility, is most often caused by a pituitary microadenoma, a benign tumor in the brain. To normalize the level of prolactin, as well as stop the growth of the tumor, special medications are prescribed (Bromocriptine, Parlodel, etc.). To make an accurate diagnosis, the doctor must prescribe a blood test for big-prolactin (macroprolatin) and an MRI in case of elevated values.

Climax

The period when a woman’s reproductive functions fade away occurs with a noticeable change in hormonal levels, and this is another reason why the menstrual cycle fails over the age of 30 (in the case of early menopause, this is not the norm).

Dramatic weight loss

The thinness that is now popular can lead not only to menstrual irregularities, but also to the complete disappearance of menstruation and infertility - as a result of a sharp decrease in the production of the hormone estrogen, which is produced in adipose tissue. In addition, losing weight for a woman up to 45 kg and below leads to severe damage to all internal organs. A woman loses her beauty, youth, the opportunity to have children and overall health. This is all very serious.

Stress

Many processes in the body depend on the state of our nervous system. Stress can accelerate aging, affects hormonal levels, and provokes graying of hair. Often, nervous shock in women leads to the disappearance of menstruation. But most often this is reversible.

Thyroid diseases

What to do if your menstrual cycle is permanent? You need to visit an endocrinologist to rule out thyroid diseases. The doctor examines the patient, prescribes an ultrasound of the thyroid gland and blood tests for hormones. Thyrotoxicosis and hypothyroidism are often causes of menstrual irregularities. Drug treatment is required. In some situations, medications are taken throughout life.

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