Dysfunctional uterine bleeding
Dysfunctional uterine bleeding arise from violations of ovarian hormone production. They are subdivided into bleeding in the juvenile age of childbearing age and in menopause. The girls are usually associated with disturbances of function of the hypothalamus – pituitary – ovary. In women of childbearing age dysfunctional uterine bleeding more often due to inflammation of genitals in climacteric – violation of the regulation of the menstrual funktsii.V basis of pathogenesis are disturbances of ovulation (anovulation) as a result persistence and atresia of follicles. Consequently, the corpus luteum is not formed, the secretory transformation of the endometrium does not occur. Prolonged exposure to estrogen (with atresia of follicles) or their increased production (in the persistence of the follicle) lead to the proliferation of the endometrium. This is reflected in the development of polyposis or glandular-cystic hyperplasia. Under the influence of the subsequent decline of concentration of estrogen in the body hyperplastic endometrium long torn away, which is accompanied by acyclic bleeding. Bleeding continues until until the entire endometrium is not ottorgnetsya (sometimes for many days or even weeks).
Symptoms, course. The disease is characterized by alternating delay menstruation (for a few weeks) and hemorrhages. Bleeding are of varying strength and duration. Prolonged bleeding and develops hemorrhagic anemia. On gynecological examination the uterus without bleeding normal or somewhat larger than usual, sizes, and often show cystic changes in one ovary. Regardless of bleeding (phase temporary amenorrhea) great diagnostic importance of functional diagnostics tests (see Amenorrhea). Anovulyatornomu cycle with persistence of follicles typical signs of increased production of estrogens: Symptoms pupil + + + ++++; KPI 70-80%; monophase basal temperature.
The diagnosis of dysfunctional bleeding as a result of atresia of follicles put under more prolonged delay of bleeding (up to 1-2 months); monotone symptom pupil level + +, relatively low CPI (20-30%), monophase basal temperature. Histological examination of scrapings of the endometrium and that in both cases show no secretory transformation of the mucous membrane, often observed polyposis or endometrial hyperplasia. In urine low content pregnandiola – lowers 1-1,5 mg / day. The differential diagnosis is carried out with starting or incomplete abortion, ectopic pregnancy, inflammation of the uterine appendages, uterine myoma, endometriosis, uterine body cancer, uterine cervix, gormonalnoaktivnymi tumors of the ovary, blood diseases.
Treatment has two main goals: to stop bleeding and prevent rebleeding. Cessation of bleeding can be achieved by scraping the uterus and the introduction of hormones (estrogen, progesterone, combined estrogen-gestagen preparations, androgens). At menopause, when curettage of the uterus was not previously, should begin with this operation to exclude primarily cancer of the uterus. At the youthful age of endometrectomy resorted to only in extreme cases, mainly on the life conditions (severe uterine bleeding, which continues unabated under the influence of hormones). In the child-bearing age endometrectomy produce, depending on the specific situation (disease duration, the strength of bleeding, the effectiveness of hormonal homeostasis). Estrogens for hemostasis administered in large doses: sinestrol 1 ml 0,1% solution / m every 2-3 hours; ethinylestradiol by 0.1 mg every 2-3 hours hemostasis usually occurs after a day from the beginning of drug administration. After that, continue to impose estrogen for 10-15 days, but in smaller doses under the control of functional diagnostic tests (KPI, a symptom of muscle) with subsequent administration of progesterone for 8 days (10 mg daily / m). 2-3 days after the administration of progesterone occurs menstrualnopodobnaya reaction. During the following months of treatment used combined hormone therapy on the common scheme (the first 15 days – estrogen, then within 6-8 days, progesterone). Progesterone for hemostasis can be assigned only for patients without anemia, because it relaxes the muscles of the uterus and can increase bleeding. The drug injected by 10 mg daily in / m for 6-8 days. Combined estrogen-gestagen preparations appointed to haemostasis of 4-6 tablets per day until the bleeding stops. The bleeding usually stops within 24-48 hours after receiving this drug should be continued for 20 days, but 1 tablet per day. 2 days after taking the medicine comes menstrual-like reaction.
In order to prevent re-bleeding is necessary hormonal regulation of the menstrual cycle in combination with a general strengthening, anti-inflammatory drugs and other Vedas treatment of concomitant diseases. This is usually used zstrogeny 5000 – 10 000 IU daily (folliculin etc.) in the first 15 days followed by introduction of progesterone on 10mg for 6-8 days and ovulation stimulants such as klostilbegid (see Amenorrhea). Effective as combined esgrogenogestageny. Their introduction began at 5 – 6 days after diagnostic curettage of the uterus and continue for 21 days (1 tablet per day). 2-3 days comes menstrual-like reaction. Needed 5-6 courses of therapy. In menopause after diagnostic curettage and exclusion of endometrial cancer can be assigned Androgens: methyl testosterone 30 mg per day under the tongue within 30 days of testosterone propionate 1 ml 2,5% solution / m 2 once a week for 1 month. Treatment with androgens is designed to suppress ovarian function and the establishment of persistent amenorrhoea.
In addition to hormone therapy for treatment of dysfunctional uterine bleeding is widely used symptomatic therapy: Oxytocin on 0,5-1 ml (2,5-5 ED) in / mg; metilergometrin 1 ml 0,2% solution / m; pregnantol 1 ml % a solution in 1.2 / m, a water extract of pepper and 20 drops 3 times a day, etc. Assign vitamins, blood transfusion of 100 ml, physiotherapy (electric stimulation of the cervix, the collar of galvanic Sherbaku, diathermy of mammary glands). Rentgenokastratsiya practically applied.
Categories: Uncategorized
No Comments »
« Menopause. Climacteric neurosis | Home | The Nursing Profession »
