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Dysfunctional uterine bleeding: diagnosis
Last reviewed: 23.04.2024
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The diagnosis of "dysfunctional uterine bleeding" is a "diagnosis of exclusion." In the period of puberty, in the first place, it is necessary to exclude blood diseases, accompanied by disorders of coagulating and anti-coagulating blood systems; diseases of the cardiovascular system; diseases of the hepatobiliary system; tuberculosis; pathology of the thyroid and adrenal glands.
In the reproductive age, uterine bleeding can be a manifestation of impaired uterine and ectopic pregnancy, inflammatory lesions of the female genital area in gonorrhea and tuberculosis, endometriosis, fibroids, ovarian hormone-active tumors, cervical cancers and, rarely, the uterus body.
In the pre-menopausal period, dysfunctional uterine bleeding must be differentiated from benign and malignant tumors of the uterus and appendages.
In addition, it is necessary to exclude pathological conditions that are clinically manifested by bleeding from the vagina: urethral polyps, colpitis, vaginal tumors.
The main diagnostic method so far remains separate scraping of the walls of the cervical canal and the uterine cavity with subsequent histological examination of the removed tissue. This manipulation simultaneously serves a healing purpose, since with its help you can quickly stop bleeding. Endometrial scraping is usually performed under the control of hysteroscopy, which significantly increases its diagnostic value, provides complete removal of the endometrium, helps to identify polyposis of endometrium and submucous nodes of uterine myoma.
Histological examination of the distant endometrium helps to clarify the pathogenetic variant of dysfunctional uterine bleeding. Endometrium, which is in a state of proliferation, glandular and glandular-cystic hyperplasia, indicates anovulation, the active form of glandular hyperplasia of the endometrium corresponds to the state of acute estrogenia, and the resting form of glandular hyperplasia is chronic estrogen. Atypical hyperplasia of the endometrium is not a rare finding in anovulatory bleeding, especially in premenopausal women.
Uneven and inadequate secretory transformation of mucosal tissues indicates bleeding due to deficiency of the yellow body. With the persistence of the yellow body, the structure of the endometrium resembles the structure of the mucosa observed during early pregnancy.
As additional diagnostic methods that help to exclude the organic nature of bleeding, in addition to the hysteroscopy mentioned above, in practical gynecology hysterography, gas genicography, ultrasound, laparoscopy is used.
Hysterography using water-soluble contrast agents, conducted on the 5th-7th day after endometrial scraping, helps to detect not only the submucous form of uterine myoma, but also internal endometriosis. Gas genicography can detect the presence of ovarian tumors, the hormonal activity of which can provoke uterine bleeding.
Extremely informative method of ultrasound scanning, which allows to identify the nodes of uterine fibroids, ovarian tumors. The pathology of the endometrium can be determined by studying the middle uterine echo (M-echo). This method makes it possible to detect endometrial hyperplasia, glandular and glandular fibrotic polyps, adenocarcinoma, submucous myoma of the uterus.
The auxiliary diagnostic methods include laparoscopy, which can detect an ovarian tumor, sclerocystosis of the ovaries, the presence or absence of a mature follicle and yellow body.
Finding their place in gynecology and such methods of examination as tests of functional diagnostics (measuring basal temperature, determining the cervical number, colpocytology), immunological methods for determining pregnancy, colposcopy, bacterioscopic and bacteriological studies of the cervical canal and vaginal discharge.
In girls and young women a coagulogram is necessarily determined, in adult women, as a first step, it is possible to restrict control over the number of platelets, blood coagulability and prothrombin complex.
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