Menstrual function

Menstrual function is one of the specific functions of the female body, which also includes reproductive, secretory, sexual.

Violations of menstrual function occur in 30-40% of women. Their consequences lead not only to the disruption of the health and working capacity of women, the violation of the comfort of her life, but also cause significant social and economic damage. Since the specific functions of women are due to hormonal processes in the body - the study of the laws of menstrual function and its disorders, the methods of diagnosis and treatment of the latter is the basis of gynecological endocrinology.

Menstrual function - a clinical manifestation of the cyclic processes of the monthly preparation of the female body for pregnancy. Includes a set of endocrine-exchange (change in body weight, muscle strength, the work of the most important organs and systems), vascular (vascular tone, pulse rate and blood pressure level, fluid retention), mental changes (irritability, memory loss, insomnia) in the body of a woman during the menstrual cycle. This is a complex process that determines the possibility of conception, the correct formation of the fetus, the bearing of pregnancy.

External manifestation of menstrual function is menstruation (monthly, regul - lat.) - regularly appearing bloody discharge from the genital tract, caused by the rejection of the functional layer of the endometrium. The period from the beginning to the beginning of the next menstruation is called the menstrual cycle.

The totality of hormonal changes in the system of regulation of sexual (reproductive) function throughout the cycle is called the hormonal cycle. It should be emphasized that if the menstrual function is disturbed, the hormonal and menstrual cycles may not coincide in duration, which should be taken into account when examining patients.

In its development, a woman undergoes several periods, during which the formation, flowering and extinction of menstrual function takes place:

• Perinatal - including intrauterine and 168 h after delivery. During this period, the formation and formation of the female reproductive system determined by the specific karyotype of 46XX takes place. At the time of birth, the system of regulation of the reproductive system, the hormone regulators and target organs of the reproductive system functioning in it are completely formed.
• Pre-pubertal (newborn and childhood) - takes up to 10 years (before the puberty period). During this period, the slow maturation of the system of regulation of specific functions of the female body, including menstrual.
• Pubertal (puberty) - takes a period of 10 to 16-18 years. It is characterized by the development and maturation of the organism, which occurs under the influence of increased production of hormones. An important moment of his is the first menstruation - menarche, which testifies to the entry of girls into a qualitatively new stage of sexual development and the inclusion of a system of regulation of sexual function. However, the arrival of the menarche does not mean the onset of puberty, since for 1-2 years the menstrual period is still anovyutory, and it is more correct to call them menstrual like secretions.

Factors determining the formation of menstrual function include: socio-economic and material-living conditions of life, the nature of nutrition, severe or long-lasting physical illnesses, infections, intoxications, sports.

• Reproductive - the main, biologically conditioned period of the heyday of the specific functions of the female body. It lasts about 30 years - from 16-18 to 45-49 years.
• The climacteric is the period of gradual extinction of specific functions. At present, in connection with the increase in life expectancy it takes up to a third of it - from 46 to 65 years.
• Senile (senile) - the age period beginning with 65 years.

[1], [2], [3], [4], [5], [6], [7], [8], [9],

Regulation of specific functions of the female body

Neurohormonal (neurohumoral) regulation of specific functions of the female body (including menstrual) is carried out by the feedback mechanism between the central (cerebral cortex, hypothalamus, pituitary) and peripheral (ovary) links of the regulatory system and target organs (uterus and appendages, vagina , mammary glands) of the reproductive system. The main hormone regulator of the feedback system is estradiol E2), produced by the ovaries.

The transition of the nerve impulse in the system of regulation into the hormonal factor is realized at the level of the hypothalamus. There are 2 groups of hypothalamic hormones: liberins (releasing hormones), stimulating the synthesis and release of tropic hormones from the corresponding peripheral glands from the pituitary cells, and statins (inhibins) that inhibit the production of adequate tropic hormones. For the reproductive system, 2 liberins are important: lyuliberin (LH-releasing hormone, LH-RG, Gn-RG), stimulating simultaneous production of gonadotrophs of the anterior hypophysis of LH and FSH, and tiroleiberin, which is a physiological stimulator not only of TSH, but also of the third gonadotropic a hormone - prolactin. The secretion of LH-RG by the nuclei of the hypothalamus occurs in a pulsating mode with a frequency of release into the bloodstream approximately 1 time per hour (cirroral rhythm of secretion). The role of statins of the hypothalamus is performed by biogenic amines such as dopamine and serotonin. According to modern concepts, dopamine is a physiological hormone-inhibitor of prolactin secretion. Its deficiency leads to a rupture of the synaptic connections of the neurons of the hypothalamus and an increase in the level of prolactin in the serum. Excess prolactin leads to the formation of such a common pathology, as hyperprolactinemic insufficiency of the ovaries (up to 30% of regulatory disorders of menstrual function).

Gonadotropic hormones produced by the cells of the anterior lobe of the pituitary (adenohypophysis) include luteinizing (LH), follicle-stimulating hormone (FSH) and prolactin (PRL).

Under the influence of gonadotropic hormones in the pituitary gland, a consistent synthesis of sex steroid hormones occurs in the ovaries: androgens (testosterone and androstenedione) are formed from cholesterol, and in turn, by means of a number of biochemical transformations, estrogens (estrone-E1, estroliol-E2 and estriol-E3 ) and gestagens (progesterone and 17beta-oxyirogesterone). The role of the regulator of the feedback mechanism in the reproductive system is played by estradiol, the receptors of which are present in all its departments.

For most of the cycle, the secretion of LH and FSH is relatively constant (basal or tonic secretion). Under the influence of the latter, the growth of production of estrogens (secreted by the granulosa of the ripening follicle) during the 1st phase of the cycle provides proliferative processes in the endometrium of the uterus and the mucous membrane of the vagina. The threshold level of estrogen by the feedback mechanism stimulates the predovulatory release of LH-RG and gonadotropins, which provide the mechanism of ovulation (the exit of a mature egg from the dominant follicle) in the middle of the cycle (14-16th day of the cycle). The growth of progesterone production at the end of the 1 st phase of the menstrual cycle potentiates the effect of estrogens in the feedback mechanism. Formed in place of the follicle, the yellow body produces gestagens and estrogens that support secretory transformations in the endometrium during the 2nd phase of the cycle. The phase of the heyday of the yellow body (19-21 days) with the maximum production of ovarian hormones reflects the readiness of the endometrium to implant a fertilized egg. In the absence of pregnancy, there comes a regression (luteolysis) of the yellow body. The fall in the production of its hormones causes a second, smaller in amplitude, release of gonadotropins at the end of the 2 nd phase of the cycle, including the mechanism of menstruation. The third gonadotropic hormone, prolactin, not only participates in the formation of a pre-ovulatory peak, but also supports the implantation of a fertilized egg into the uterine lining during pregnancy. A reflection of this is the increase in the level of its products within the framework of basal secretion at the end of the 2nd phase (25-27th day of the cycle).