Treatment of menstrual irregularities
Treatment of menstrual irregularities is diverse. It can be conservative, surgical or mixed. Often, the surgical stage is followed by treatment with sex hormones, which performs a secondary, corrective role. This treatment can be of a radical, pathogenetic nature, completely restoring the menstrual and reproductive function of the body, and play a palliative, substitute role, creating an artificial illusion of cyclic changes in the body.
Correction of organic disorders of the target organs of the reproductive system, as a rule, is achieved by surgical means. Hormonal therapy is used here only as an auxiliary, for example, after removal of the synechia of the uterine cavity. These patients are most often using oral contraceptives (OC) in the form of cyclic courses for 3-4 months.
Surgical removal of gonads containing male germ cells is mandatory in patients with gonadal dysgenesis with a karyotype of 46XY because of the risk of malignancy. Further treatment is carried out together with the endocrinologist.
Replacement hormone therapy (HRT) by sex hormones is prescribed at the end of the patient's growth (closing of the 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 in 3 days - 7 injections. After the appearance of menstrual-like secretions, they switch to combined therapy with estrogens and gestagens: microfotlin 1 tablet / day - 18 days, then norethisterone (norkolut), dyufaston, lutenil 2-3 tablets / day - 7 days. Since this therapy is carried out for a long time, for years, breaks for 2-3 months are allowed. After 3-4 cycles of treatment. Such treatment can be performed and OK with a high level of estrogen component - 0.05 mg of ethinyl estradiol (non-vellon), or preparations of HRT of climacteric disorders (femoston, cycloproginov, divina).
Tumors of the pituitary-hypothalamic region (selar and suprasellar) are subject to surgical removal, or subjected to radiation (proton) therapy followed by replacement therapy with sex hormones or dopamine analogues.
Replacement hormonal therapy is indicated for patients with hyperplasia and ovarian and adrenal tumors with increased production of sex steroids of different genesis, either alone or as a postoperative treatment stage, as well as postovarioectomy syndrome.
The primary difficulty in the therapy of various forms of amenorrhea is primary ovarian involvement (ovarian amenorrhea). The therapy of the genetic form (syndrome of premature ovarian exhaustion) is exclusively palliative (cyclic HRT by sex hormones). Until recently, a similar scheme was proposed for ovarian amenorrhea of autoimmune genesis (ovarian resistance syndrome). The frequency of autoimmune oophoritis is, according to various authors, from 18 to 70%. In this case, antibodies to ovarian tissue are determined not only in hypergonadotropic, but also in 30% of patients with normogonadotropic amenorrhea. At present, the use of corticosteroids is recommended for the removal of the autoimmune block: prednisolone 80-100 mg / day (dexamethasone 8-10 mg / day) for 3 days, then 20 mg / day (2 mg / day) for 2 months.
The same role can be performed by antigonadotropic drugs (gonadotropin-releasing hormone agonists), appointed for up to 8 months. In the future, with an interest in pregnancy, ovulation stimulants (clostilbegite) are prescribed. In patients with hypergonadotropic amenorrhea, the effectiveness of such therapy is extremely low. For the prevention of the syndrome of estrogen deficiency, he showed the use of ZGT preparations of climacteric disorders (femostone, cycloprogin, divin, trisequence, etc.).
Diseases of the most important endocrine glands in the body, secondary to a violation of sexual function, require treatment in the first place in the endocrinologist. Therapy with sex hormones is often not required or is of an auxiliary nature. At the same time, in a number of cases their parallel assignment allows to achieve faster and more stable compensation of the underlying disease (diabetes mellitus). On the other hand, the use of DTF in the ovaries allows, at the appropriate stage of treatment, to select the optimal dose for the recovery of menstrual and reproductive function, and compensation for the underlying disease dose of the drug for pathogenetic effects.
Therapy is lighter than amenorrhoea, the stages of the hypomenenstrual syndrome is closely related to the degree of hormone deficiency of MC. For the conservative hormonal therapy of menstrual function disorders, the following groups of drugs are used.
Violation of the menstrual cycle: treatment
When the menstrual cycle is disturbed, which is associated with hormonal imbalance and insufficiency of progesterone, cyclodinone is used. The drug is taken once a day in the morning - one tablet or forty drops once, without chewing and washing with water. The general course of treatment is 3 months. In the treatment of various disorders of the menstrual cycle, such as algodismenorea, amenorrhea, dysmenorrhea, and also with menopause, the remens drug is used. It promotes the normal functioning of the "hypothalamus-pituitary-ovarian" system and levels the hormonal balance. On the first and second day, the drug takes 10 drops or one tablet eight times a day, and from the third day - 10 drops or one tablet three times a day. Duration of treatment is three months.
Modern preparations for drug correction of menstrual function disorders
||Progesterone, 17-hydroxyproteterone capronate (17-OPK), utero, dufaston, norethystron, norcolut, acetomepregenol, organometrium
||Estradiol dipropionate, ethinyl estradiol (mikrofolin), estradiol (estraderm-TTS, climara), estriol, conjugated estrogens
||Non-oblong, antevine, trikwilar
||Danazol, cyproterone acetate (Diane-35)
||Clostilbegit (clomiphene citrate), tamoxifen
||Pergonal (FSH + LH), metidine (FSH), prophase (LH), chorionic
|Gonadotropin-releasing hormone agonists
||Zoladex, Buserelin, Decapeptil, Decapeptal Depot
||Parlodel, norprolact, dostinex
|Analogues of hormone other endocrine glands
Thyroid and antithyroid drugs, corticosteroids, anabolics, insulins
In patients with infertility of endocrine genesis, additional application of ovulation stimulants is shown.
As the first stage of treatment of patients with infertility, it is possible to design combined OC (non-ovolon, tricvilar, etc.) in order to achieve a rebound effect (withdrawal syndrome). OK apply for a conventional contraceptive scheme 2-3 months. If there is no effect, then go on to direct stimulants of ovulation.
- Antiestrogens - the mechanism of action of AE is based on a temporary blockade of receptors of LH-RG gonadotrophs, the accumulation of LH and FSH in the pituitary gland, followed by the release of their increased amounts into the bloodstream, stimulating the growth of the dominant follicle.
In the absence of the effect of treatment with clostilbugite, ovulation by gonadotropins is possible.
- Gonadotropins have a direct stimulating effect on the growth of follicles, their production of estrogens and maturation of the egg.
Violation of the menstrual cycle is not treated by gonadotropins in the following cases:
- hypersensitivity to the drug;
- ovarian cysts;
- uterine myoma and abnormalities of genital organs incompatible with pregnancy;
- dysfunctional bleeding;
- oncological diseases;
- tumors of the pituitary gland;
- Analogues Gn-RG - zoladex, buserelin, etc. - are used to simulate the natural impulse secretion of LH-RG in the body.
It should be remembered that when artificially induced, against the background of the use of stimulants of ovulation, pregnancy is required to prescribe preserving hormone therapy at its early, preplacental stage (progesterone, utero, dufaston, turinale).