Dysfunctional uterine bleeding

Uterine bleeding in the puberty period (juvenile uterine bleeding, dysfunctional uterine bleeding, profuse menstruation in the pubertal period) are bloody discharges from the uterus that are different from natural menstruation, which arise during the first 3 years after menarche as a result of mismatching the activity of the organs of the reproductive system.

ICD-10 code

N92.2 Abundant menstruation in the puberty period.

Epidemiology of dysfunctional uterine bleeding

Dysfunctional uterine bleeding pubertal period (MKPP) in the structure of gynecological diseases of children and adolescents ranges from 10.0 to 37.3%. Over 50% of all adolescent girls' complaints to the gynecologist are uterine bleeding from the puberty period. Almost 95% of all vaginal bleeding in the puberty period is due to uterine bleeding in the pubertal period. Most uterine bleeding occurs in adolescent girls during the first 3 years after the menarche.

[1], [2], [3], [4], [5]

What causes dysfunctional uterine bleeding?

Dysfunctional uterine bleeding of the pubertal period is a multifactorial disease that arises as a result of excessive or unbalanced interaction of random factors and individual reactivity of the organism. As the risk factors for uterine bleeding in the pubertal period, one can most often mention acute psychogenies or prolonged psychological stresses, an unfavorable ecological situation in the place of residence, hypovitaminosis, alimentary deficiency, obesity, weight loss, etc. The leading and most likely provocative role belongs to various kinds of psychological stress, acute psychological trauma and constant readiness for stress reactions (up to 70%). These unfavorable factors are more correctly regarded not as causal, but as provoking bleeding phenomena.

What are the symptoms of dysfunctional uterine bleeding?

Symptoms of dysfunctional uterine bleeding in the pubertal period are very heterogeneous. Certain typical symptoms depend on whether at what level (central or peripheral) there were violations of the agreed activity (self-regulation).

If it is impossible to recognize the type of uterine bleeding of the pubertal period (hypo-, normo- or hyperestrogenic), in the absence of correlation between clinical and laboratory data, one can speak of atypical forms of uterine bleeding in the pubertal period.

How is dysfunctional uterine bleeding diagnosed?

Dysfunctional uterine bleeding of the pubertal period is diagnosed on the basis of clinical criteria:

• the duration of blood vaginal discharge from the vagina is less than 2 days or more than 7 days against a background of shortening (less than 21-24 days) or lengthening (more than 35 days) of the menstrual cycle;
• blood loss more than 80 ml or subjectively more pronounced compared with usual menstruation;
• presence of intermenstrual or postcoital blood secretions;
• absence of structural pathology of the endometrium;
• confirmation of anovulatory menstrual cycle during the period of uterine bleeding (progesterone level in venous blood on the 21-25th day of the menstrual cycle is less than 9.5 nmol / l, monophasic basal temperature, absence of preovulatory follicle according to echography).
  

Screening of dysfunctional uterine bleeding

It is advisable to conduct screening of the disease with the help of psychological testing among healthy patients, especially those who study at a high educational level (gymnasiums, lyceums, professional classes, institutes, universities), especially honors pupils. In the risk group for the development of pubertal uterine bleeding, adolescent girls with deviations in physical and sexual development, early menarche, and profuse menarche periods should be included.

How are dysfunctional uterine bleeding treated?

Dysfunctional uterine bleeding puberty period are treated in several stages. In patients with uterine bleeding at the first stage of treatment, it is advisable to use inhibitors of the transition of plasminogen to plasmin (tranexamic or aminocaproic acid). The intensity of bleeding is reduced due to a decrease in the fibrinolytic activity of the blood plasma. Tranexamic acid is administered orally at a dose of 4-5 g during the first hour of therapy, then 1 g every hour until the bleeding stops completely. Possible intravenous administration of 4-5 g of the drug during the first hour, then drip introduction of 1 g per hour for 8 hours. The total daily dose should not exceed 30 g. At high doses, the risk of developing the syndrome of intravascular coagulation increases, and with the simultaneous use of estrogens the probability of thromboembolic complications is high. It is possible to use the drug at a dose of 1 g 4 times a day from the 1st to the 4th day of menstruation, which reduces the volume of blood loss by 50%.

How is dysfunctional uterine bleeding prevented?

Patients with uterine bleeding in the pubertal period need constant dynamic observation 1 time per month until the menstrual cycle stabilizes, then it is possible to limit the frequency of the follow-up examination to 1 time in 3-6 months. Ultrasound of pelvic organs should be performed at least once every 6-12 months. Electroencephalography - after 3-6 months. All patients should be trained in the rules for managing the menstrual calendar and assessing the intensity of bleeding, which will help evaluate the effectiveness of the treatment.

Patients should be informed of the advisability of correcting and maintaining the optimal body weight (both in deficit and overweight), normalizing the work and rest regime.

What prognosis are dysfunctional uterine bleeding?

Most adolescent girls respond favorably to the drug treatment of dysfunctional uterine bleeding, and within the first year they develop full-fledged ovulatory menstrual cycles and normal menstruation. Dysfunctional uterine bleeding has a different prognosis, which depends on the presence of the pathology of the hemostatic system or systemic chronic diseases depends on the degree of compensation for existing disorders. Girls who are overweight and who have recurrent puberty uterine bleeding at the age of 15-19 should be included in the risk group for the development of endometrial cancer.