Violation of the menstrual cycle

Violations of the menstrual cycle can for a long time reduce the efficiency of women, accompanied by a deterioration in the reproductive function (miscarriage, infertility), as the closest (bleeding, anemia, asthenia) and distant (endometrial, ovarian, breast cancer) consequences and complications.

Causes of menstrual irregularities

Violation of the menstrual cycle is mainly secondary, that is, it is a consequence of the genital (defeat of the system of regulation and target organs of the reproductive system) and extragenital pathology, the impact of various unfavorable factors on the system of neurohumoral regulation of the reproductive function.

The leading etiological factors of menstrual cycle disorders include:

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

Violations of the menstrual cycle may be caused by other causes:

• Imbalance of hormones. Decrease in the body of the level of progesterone is often the cause of hormonal imbalance in the body, which leads to disruption of the menstrual cycle.
• Stressful situations. Violation of the menstrual cycle, caused by stress, is often accompanied by irritability, headaches, general weakness.
• Genetic predisposition. If your grandmother or mother had problems of this kind, it is quite possible that you have inherited such a disorder.
• Shortage in the body of vitamins, minerals, exhaustion of the body, painful leanness.
• Climate change.
• Taking any medications can have an adverse event in the form of a menstrual cycle.
• Infectious diseases of the genitourinary system.
• Alcohol abuse, smoking.

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

[1], [2]

Phases of the menstrual cycle

The follicular phase

The menstrual phase includes immediately the period of menstruation, which in total can be from two to six days. The first day of menstruation is considered the beginning of the cycle. When the follicular phase comes, the menstrual discharge stops and the hormones of the "hypothalamus-pituitary" system begin to be actively synthesized. There is growth and development of the follicle, the ovaries produce estrogens that stimulate the renewal of the endometrium and prepare the uterus for the adoption of the ovum. This period lasts about fourteen days and stops when blood is released into the blood of hormones that inhibit the activity of follitropines.

Ovulatory phase

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

Luteinizing phase

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

The processes in the ovary that occur during the MC are as follows: menstruation → maturation of the follicle → ovulation → development of the yellow body → termination of the functioning of the yellow body.

Regulation of the menstrual cycle

In the regulation of the menstrual cycle, the cerebral cortex, the "hypothalamus-pituitary-ovary" system, the uterus, the vagina, the fallopian tubes take part. Before proceeding to normalization of the MC, one should visit the gynecologist and take all the necessary tests. With concomitant inflammatory processes and infectious pathologies, treatment with antibiotics, physiotherapy can be prescribed. To strengthen the immune system requires the intake of vitamin-mineral complexes, a balanced diet, a rejection of bad habits.

Malfunction of the menstrual cycle

Menstrual cycle failure is most common in adolescents in the first year or two from the moment of menstruation, in women after the puerperium (until the end of lactation), and is one of the main signs of the onset of menopause and the completion of the ability to fertilize. If the failure of the menstrual cycle is not associated with any of these causes, then such a disorder can be triggered by infectious pathologies of female genital organs, stressful situations, hormonal problems in the body.

Talking about the failure of the menstrual cycle, you should also take into account the duration and intensity of menstrual flow. So, excessively abundant secretions can signal the development of neoplasm in the uterine cavity, can also be the result of the negative impact of the intrauterine device. A sharp decrease in the amount released during monthly contents, as well as a change in the color of the discharge, may indicate the development of such a disease as endometriosis. Any abnormal spotting from the genital tract may be a sign of an ectopic pregnancy, so if there are any irregularities in the monthly cycle, it is strongly recommended that you consult with your doctor.

Delay in the menstrual cycle

If the menstruation has not occurred within five days of the expected time, it is considered to be a delay in the menstrual cycle. One of the reasons for the non-occurrence of menstruation is pregnancy, therefore the test for determining pregnancy is the first thing to do when the menstrual period is delayed. If the test is negative, you should look for the cause in the diseases that may have affected the MC and caused its delay. Among them, as gynecological diseases, and endocrine, cardiovascular system, neurological disorders, infectious pathologies, hormonal alteration, lack of vitamins, trauma, stress, overstrain, etc. In adolescence, the delay in the menstrual cycle in the first year or two from the moment of onset menstruation - a very common phenomenon, since the hormonal background at this age is still not stable enough.

[3], [4]

Symptoms of menstrual irregularities

Hypomenaprural syndrome - a violation of the menstrual cycle, which is characterized by a decrease in the volume and duration of menstruation until their cessation. It occurs both with a saved and broken cycle.

There are following forms of hypomenstrual syndrome:

• Hypomenorrhœa - scanty and short months.
• Oligomenorea - delayed menstrual periods from 2 to 4 months.
• Opsomenorrhea - delayed monthly from 4 to 6 months.
• Amenorrhea is the extreme form of the hypomenstrual syndrome, it is the absence of menstruation for 6 months. And more in the reproductive period.

Physiological amenorrhea occurs in girls before puberty, in pregnant women and breast-feeding mothers and in postmenopausal women.

Pathological amenorrhea is divided into primary, when menstrual amenorrhea does not appear in women older than 16 years, and secondary - when MC is not restored within 6 months. In a previously menstruating woman.

Different types of amenorrhea differ in their causes and in the level of lesion in the reproductive system.

Primary amenorrhea

Violation of the menstrual cycle, which is a lack of factors and mechanisms that ensure the start of menstrual function. In the study, 16-year-olds (and possibly 14-year-olds) need girls who do not develop mammary glands at this age. In girls with normal MC, the mammary gland should have an unchanged structure, the regulatory mechanisms (hypothalamic-pituitary axis) should not be violated.

Secondary amenorrhea

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

Oligomenorrhea

This disorder of the menstrual cycle occurs in women with an irregular sexual life, when there is no regular ovulation. In the reproductive period of life, the cause most often is polycystic ovary syndrome.

Menorrhagia

Copious blood loss.

Dysmenorrhea

Painful menstruation. 50% of women in the UK complain about painful menstruation, 12% on very painful.

Primary dysmenorrhea - painful menstruation in the absence of an organic cause. This disorder of the menstrual cycle occurs after the onset of the ovarian cycle shortly after menarche; pains are cramped in nature, irradiate into 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. To reduce the production of prostaglandins and as a result of pain leads reception of inhibitors of prostaglandins, for example mefenamic acid, at a dose of 500 mg every 8 hours inside. Pain can be removed by suppressing ovulation by taking combined contraceptives (dysmenorrhea may be the cause of the appointment of contraceptives). The pain decreases somewhat after the delivery of the cervical canal, but surgical stretching can cause cervical failure and is not currently used as a treatment.

Secondary dysmenorrhea is caused by the pathology of the pelvic organs, for example endometriosis, chronic sepsis; occurs at a later age. It is more constant, observed throughout the period and is often combined with a deep disparity. The best way to treat is to treat the underlying disease. With the use of vitrimo-matic contraceptives (IUDs), dysmenorrhea becomes worse.

[5], [6], [7], [8], [9],

Intermenstrual bleeding

A disorder in the menstrual cycle that occurs in response to the production of estrogens in the middle of the cycle. Other reasons: cervical polyp, ectropion, carcinoma; vaginitis; hormonal contraceptives (topically); IUD; complications of pregnancy.

Bleeding after coition

Causes: trauma of the cervix, polyps, cervical cancer; vaginitis of different etiology.

[10], [11], [12], [13], [14]

Bleeding after menopause

Violation of the menstrual cycle, which occurs 6 months after the last menstruation. The cause, until proven otherwise, is considered carcinoma endometrium. Other reasons: vaginitis (often atrophic); foreign bodies, for example pessaries; cancer of the cervix or vulva; polyps of the endometrium or cervix; abolition of estrogens (with hormone replacement therapy for ovarian tumor). The patient can confuse the bleeding from the vagina and from the rectum.

[15], [16], [17], [18]

Pain syndrome with a saved cycle

Painful syndrome with the saved cycle - cyclic pains observed in the time of ovulation, 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 with hormonal medication stimulation of the ovaries, which in some cases requires emergency care.

Types of menstrual dysfunction

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

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

Violations of the menstrual cycle are divided into the following groups:

• Algodismenorea, or painful periods, is more common than other disorders, can occur at any age and occurs in about half of women. With algodismorrhoea, soreness during menstruation is combined with headache, general weakness, nausea, and sometimes vomiting. The pain syndrome usually lasts from a few hours to two days.
• Dysmenorrhea. Such a violation is characterized by the instability of MC - the monthly can both significantly delay, and begin earlier than the expected time.
• Oligomenorrhea is a violation of the menstrual cycle, which is characterized by a reduction in the duration of menstruation to two or less days. Menstrual discharge, as a rule, is meager, the duration of the intermenstrual period can be more than thirty-five days.
• Amenorrhea is the absence of menstruation for several cycles.

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

Drug Group	A drug
Gestagens	Progesterone, 17-hydroxyproteterone capronate (17-OPK), utero, dufaston, norethystron, norcolut, acetomepregenol, organometrium
Estrogens	Estradiol dipropionate, ethinyl estradiol (mikrofolin), estradiol (estraderm-TTS, climara), estriol, conjugated estrogens
Oral contraceptives	Non-oblong, antevine, trikwilar
Antiandrogens	Danazol, cyproterone acetate (Diane-35)
Antiestrogens	Clostilbegit (clomiphene citrate), tamoxifen
Gonadotropins	Pergonal (FSH + LH), metidine (FSH), prophase (LH), chorionic
Gonadotropin-releasing hormone agonists	Zoladex, Buserelin, Decapeptil, Decapeptal Depot
Dopamine agonists	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;
• hyperprolactinemia.
• 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).