Change in the menstrual cycle causes. Causes that can cause a failure in the cycle of menstruation and the main clinical forms of disorders

In an adult healthy woman, the menstrual cycle should be regular. Irregularity, a change in the number of days of the cycle, or its complete cessation outside the period of pregnancy are reasons for visiting a doctor.

How to calculate the monthly cycle in women

The cycle is counted from the first day of menstruation to the first day of the next. On average, the ovarian-menstrual cycle lasts 25-35 days. To track the regularity of the cycle, it is necessary to mark dates on the calendar for at least three months. And it is better to mark the dates constantly - this will help track any changes in the cycle in a timely manner.

It is necessary to monitor the regularity of the cycle for:

health care. Any changes may indicate disease.
pregnancy planning. This will help calculate the day of ovulation.
personal feeling of comfort. This will help you plan vacations, workouts in advance, as well as stock up on feminine hygiene products.

Symptoms of menstrual irregularity

an increase or opsomenorrhea - the duration of the cycle is more than 35 days;
reduction or proyomenorrhea - the cycle lasts less than three weeks;
cessation of menstruation or amenorrhea;
cycle instability;
the duration of menstruation is more than seven and less than three days;
too much or too little discharge.

Any problems, delays and other changes in the cycle or discharge should alert and become a reason for contacting a gynecologist.

Dangers of menstrual cycle failure

Any changes in the cycle - the duration, color and abundance of secretions, should be taken very seriously. If the changes in the cycle are more than 5 days, consult a doctor. Behind the diagnosis can be such serious diseases as tumors of the brain, ovaries, uterus, ectopic pregnancy, tuberculosis and other hormonal problems.

Causes of menstrual cycle failure

diseases of the pelvic organs;
hormonal disorders;
infectious diseases;
diabetes;
benign and malignant tumors;
pregnancy;
childbirth or abortion;
taking antibiotics or other medications;
stress;
sudden weight loss or weight gain;
acclimatization;
chronic fatigue;
change in the rhythm of life;
lack of vitamins.

It is considered normal to change the cycle within 3-5 days. A longer delay, instability, cessation of menstruation is a reason to undergo an examination in gynecology.

Failure of the menstrual cycle

At each age, failures of the menstrual cycle are associated with different reasons.

In adolescence

The first menstruation begins in girls at the age of 12-13. During the first year, the cycle may be irregular, but during this period there must be at least 8 cycles. If menstruation does not start after the age of 14 or the cycle does not become regular within a year, you should consult a doctor.

During menopause

This period occurs in 45-50 years. During premenopause, the production of the female sex hormone estrogen begins to decrease. This process takes two to ten years. Menopause is the period when the last menstruation passes. If after that there is no menstruation for a year, this means the cessation of the ovaries and the onset of the postmenopausal period. There are serious changes in the body.

After pregnancy and childbirth

After giving birth, a woman may need time to recover. There is no specific time period during which menstruation should begin again. On average, up to five months. The first months of the cycle may be irregular. It should be noted that in the postpartum period, women may experience permenstrual syndrome, as well as some changes during menstruation. For example, to disappear pain, if they were before.

When breastfeeding

The lactation period affects the female body. This is due to the production of the hormone prolactin, which is responsible for the secretion of breast milk. It suppresses the work of the ovaries, throwing the forces of the female body to feed the child. Therefore, menstruation may not occur until the end of breastfeeding.

After taking antibiotics

Menstruation is not a reason to delay antibiotic treatment if necessary. However, after this, some changes are possible: slight changes in the dates of the cycle, the amount and shade of the discharge. As a rule, antibiotics themselves do not cause changes. To a greater extent, the cycle is affected by dysbacteriosis, malnutrition during illness, stress, and inflammatory processes.

After taking birth control

Modern oral contraceptives are popular not only as a highly effective method of protection against unwanted pregnancy. With the help of such hormonal drugs, you can improve the condition of the skin, get rid of excess weight and stabilize the cycle. When choosing drugs, you must consult a doctor so as not to harm the body.

While taking oral contraceptives, the ovaries rest. Menstruation is the result of the action of medications. The first 1-2 months the body is rebuilt, so the cycle may be unstable.
After the drug is discontinued, the body returns to its previous state, and this restructuring may also take time. The ovaries begin to function again after rest, so the first couple of months the cycle can be unstable.

After sports

Playing sports can also introduce instability into the normal cycle. There are several reasons:

high load on the body - especially on the pelvic muscles;
chronic fatigue;
decrease in the percentage of adipose tissue;
taking steroid drugs.

The cycle can change for a couple of days - this is considered the norm. For more serious changes, visit your doctor's office immediately.

After the stress

Stress has a huge impact on the state of the body. After the difficulties experienced, women quite often experience a delay in the cycle. In this case, not only failures are observed, but also a change in the number of allocations.

Stressful situations for the body can also be considered the restructuring of the body of a woman in adolescence and premenopausal age. During these periods, cycle instability can also be observed.

Treatment of menstrual irregularity

The cycle change itself is not a disease, but only a symptom. The main task will be the diagnosis and treatment of the disease that led to the failure of the cycle.

For diagnosis, the following types of examinations can be carried out:

examination by a gynecologist;
taking smears;
general blood analysis;
blood biochemistry;
hormone analysis;
scraping from the cervix;
Ultrasound of the pelvic organs;
blood clotting analysis;
Analysis of urine;
hysteroscopy;
biopsy.

The information obtained will help determine the cause of cycle violations.

Next, you need to cure the underlying disease that caused the violation of the cycle. For this, surgery, antibiotics, hormonal drugs, physiotherapy, psychotherapist consultations and more can be used - depends on the nature of the disease.

Preparations for recovery

To restore the hormonal background of the female body, additional medication may be required. They are prescribed depending on the cause of the violations. With an increased amount of testosterone - preparations "Janine", "Diana -35". With violations of the production of progesterone - "Duphaston", "Progesterone", "Utrozhestan". In case of violations of estrogen production - "Estradiol" or analogues.

Do not choose the drug yourself, so as not to be mistaken. It's better to see a doctor.

Traditional medicine

It is possible to maintain the health of the body during treatment not only with the help of drugs. Diet and lifestyle also play an important role. It will be useful:

adhere to proper nutrition, consume a large amount of protein;
taking vitamins and iodine;
tea with herbs - wormwood - 1-6 days of the cycle, sage - 6-15 days, goose cinquefoil - 16-25 days;
moderate physical activity.

However, remember that these methods are not a treatment, but complement the main course of treatment, if there are no contraindications.

Therefore, if your monthly cycle has gone astray, do not self-medicate, but be sure to seek help from a gynecologist. Only a doctor will correctly determine the cause that provoked the failure of the menstruation cycle and prescribe the correct treatment.

How to calculate the monthly cycle and determine the failure

The length of time from the onset of menstruation to the next - this is the cycle of menstruation. Ovulation is the process of release of an egg ready for fertilization into the fallopian tube. She divides the cycle into two phases: follicular (the process of maturation of the follicle) and luteal (the period from ovulation to the onset of menstruation). In girls who have a 28-day cycle of menstruation, ovulation, as a rule, occurs on the 14th day from their onset. After ovulation, the level of estrogen in the female body drops, but bleeding does not occur, since the corpus luteum controls the production of hormones. Strong fluctuations in the level of estrogen in one direction or another at the time of ovulation can cause uterine bleeding between periods, before and after them.

A normal monthly cycle lasts 21-37 days, usually a cycle is 28 days. The duration of menstruation is usually 3-7 days. If the monthly cycle has gone astray by 1-3 days, this is not considered a pathology. But if menstruation does not occur even 7 days after the desired period, you should consult a doctor for advice.

How to calculate the monthly cycle? The time interval between 1 day of the onset of menstruation and 1-1 days of the next is the duration of the cycle. In order not to be mistaken, it is better to use a calendar where you can mark the start and end times of menstruation.

In addition, there are currently quite a few computer programs that help in the calculations. With their help, you can calculate the time of ovulation and even track the onset of premenstrual syndrome (PMS).

You can most accurately calculate the monthly cycle using basal temperature charts. The temperature in the first days after menstruation is kept within 37 ° C, after which it drops sharply to 36.6 ° C, and the next day it rises sharply to 37.5 ° C and stays within these limits until the end of the cycle. And then a day or two before menstruation decreases. If the temperature does not drop, pregnancy has occurred. In the case when it does not change during the entire cycle, ovulation does not occur.

Symptoms that signal a violation of the menstrual cycle:

an increase in the time interval between menstruation;
shortening of the monthly cycle (cycle less than 21 days);
scanty or vice versa abundant menstruation;
lack of menstruation;
spotting and/or bleeding.

Also, a negative symptom is the duration of menstruation less than three or longer than seven days.

The cycle of menstruation has gone astray: causes

1. Adolescence. In young girls, the failure of the monthly cycle is a fairly common phenomenon, since the hormonal background is still being established. If two years have passed since the appearance of the first menstruation, and the cycle has not returned to normal, you should consult a gynecologist.

2. Severe weight loss or obesity . Extreme diets, starvation and malnutrition are seen by the body as a sign that hard times have come and pregnancy is not desirable. Therefore, it turns on natural protection, causing a delay in menstruation. Too fast weight gain is also bad for the body and leads to menstrual irregularities.

3. Acclimatization . Moving, air travel to another time zone, holidays in hot countries often cause the monthly cycle to fail. A sharp change in climate is a certain stress. Usually, the menstrual cycle during acclimatization returns to normal when the body gets used to new conditions.

4. Stress and physical overload. These factors quite often lead to a violation of the monthly cycle. When stressed, the body produces an excessive amount of the hormone prolactin. Its excess inhibits ovulation, and menstruation occurs with a delay. In this case, it is worth getting enough sleep, spending more time in the fresh air, and, on the recommendation of a doctor, start taking sedatives.

5. Hormonal disorders . crash monthly cycle can be caused by problems in the work of the pituitary gland and hypothalamus. In this case, the necessary treatment will be selected by the endocrinologist.

6. Diseases of the female genital organs . A possible cause is often the pathology of the cervix, inflammation of the uterus and its appendages, polyps and cysts. In most cases, such gynecological problems are treated surgically.

7. Hormonal contraceptives . Taking birth control pills or not taking them can cause your monthly cycle to go wrong. In this case, you need to consult a gynecologist and take a break from taking oral contraceptives.

8. Pregnancy and lactation . The absence of menstruation during pregnancy and breastfeeding is normal. After the cessation of lactation, the normal monthly cycle is restored. In the presence of severe pain in the lower abdomen, an urgent need to consult a doctor, since the cause may be an ectopic pregnancy, the untimely determination of which can even lead to death due to pain shock and significant blood loss when the fallopian tube ruptures.

9. Preclimax. At the age of 40-45 years, a failure of the menstrual cycle can be a harbinger of menopause.

10. Forced or spontaneous abortions also have a bad effect on the condition of the uterus, cause delays in menstruation, and often cause infertility.

Also, the reasons for the failure of the cycle of menstruation can be diseases of the thyroid gland and adrenal glands, infectious diseases, the presence of bad habits (smoking, alcohol, drugs), taking certain medications, vaginal injuries, vitamin deficiency in the body.

Diagnosis of menstrual cycle disorders

Diagnostics consists of the following steps:

questioning the patient;
gynecological examination;
taking all smears;
Ultrasound of the abdominal cavity or small pelvis;
determination of the level of hormones in the blood;
MRI (detailed examination of the patient for the presence of pathological changes in tissues and neoplasms);
hysteroscopy;
urine and blood tests.

The combination of these methods makes it possible to identify the causes that caused the monthly cycle to go astray and eliminate them.

Treatment of menstrual irregularities

The main thing is the treatment of the underlying disease, which caused the failure of the cycle. As preventive measures, it is recommended to eat rationally: eat foods rich in protein and iron at least 3-4 times a week, give up bad habits, relax in the fresh air, sleep at least 8 hours a day, take vitamin complexes.

In case of severe bleeding, after excluding blood clotting disorders, the doctor may prescribe:

hemostatic preparations;
ε-Aminocaproic acid (to eliminate bleeding);
with heavy bleeding - an infusion of plasma to the patient, and sometimes donor blood;
surgical treatment (extreme method for severe bleeding);
hysterectomy (removal of the uterus);
hormonal drugs;
antibiotics.

Complications in case of failure of the monthly cycle

Remember, your health depends only on you! Violations of the monthly cycle should not be taken lightly, since an irregular menstrual cycle can lead to infertility, and frequent heavy intermenstrual bleeding can cause fatigue and disability. Late detection of pathologies that cause a failure of the menstrual cycle can also lead to death, although this can be quite successfully avoided by contacting a doctor in time. Treatment of menstrual disorders is possible only under the supervision of a qualified specialist.

The cycle of menstruation is the interval from one menstruation to another, what to do if the cycle has gone astray depends on the probable cause of the deviation and the duration of the delay in monthly bleeding. Such failures are a common occurrence in teenage girls, women who have entered menopause, in the first months after the birth of a child. All women should remember how to count the cycle of menstruation, mark the beginning of critical days in their calendar. After all, the first thing any gynecologist will ask during a consultation is the date of the last menstruation.

If there is no menstruation for 1 month, while pregnancy is excluded, the doctor may prescribe Duphaston to be taken for 10 days, and mestrual-like bleeding will begin to cancel it. The fact is that periodically delays occur due to a lack of the hormone progesterone. And Duphaston is just its source. It is this drug that most doctors advise on the question of how to restore a lost cycle of menstruation. And yet, with the help of this drug, many manage to conceive a child. But only if you start taking it on time, not earlier than ovulation occurs.

The cycle of the monthly norm is 28-35 days on average. But at least 21 days between the start of two periods. The duration of the cycle can change as a result of various life circumstances, health characteristics. There, a vacation in a hot country can postpone your critical days for a month. And it's not scary if the situation does not repeat itself regularly. Failure of the cycle of menstruation after birth control pills sometimes happens. In this case, it usually takes time for everything to recover. However, if even before taking the pills there was a problem with the regularity of bleeding, then the drugs are not to blame. They create, as it were, an artificial hormonal background, when a menstrual-like reaction begins on drug withdrawal. Well, since the drug is canceled every month on the same day, then menstruation begins regularly.

It is bad if after the postinor the cycle of menstruation has gone astray, this drug is an emergency contraceptive containing a large amount of the hormone. Often, taking it provokes rapid uterine bleeding, which may not coincide with the menstrual period. You need to try not to use emergency contraception, this is a strong blow to the body.

If symptoms of menstrual irregularities are observed, many doctors advise taking oral contraceptives. Of course, this is not a panacea, but an excellent "sedative" remedy for women who are not yet planning children. If the children are in the immediate plans, and delays happen regularly, and not by a week, but by a month or more, then you need to pass the hormone in certain phases of the cycle, do an ultrasound to determine ovulation, perhaps visit an endocrinologist if the gynecologist suspects the reasons why the cycle has gone astray monthly for this part. It is necessary to exclude hyperprolactinemia, thyroid insufficiency, diabetes mellitus and other serious diseases.

By nature, the woman's menstrual cycle is a very precise mechanism. Its work is influenced by many factors, from the characteristics of the endocrine system to the most complex biochemical reactions of the brain.

At the same time, as in the work of any other mechanism, failures of a different nature sometimes occur in the female cycle. Let's find out what are their features and possible causes.

Failure of the menstrual cycle - symptoms

First of all, it should be noted that the duration of the cycle is an individual feature of each woman. On average, this is 28 days, but the medical norm is from 26 to 36 days.

If, for example, your cycle always lasts 35 days, then this is not a failure, but your personal hallmark. A variant of the norm can also be called a shift in menstruation by 2-3 days, because not everyone has them at regular intervals.

Failure, in turn, is called a shift in the beginning of menstruation by 5-7 days in one direction or another. And if this began to happen systematically, then you should not postpone a visit to the gynecologist. The doctor will help you understand the reasons for this and establish a cycle. This is very important not only for those who plan to become a mother in the near future, but also for women's health in general.

What to do if the menstrual cycle fails?

First of all, you should establish the causes of the failure, and only then determine how to establish a cycle. This should be done, of course, with the help of a gynecologist. At the appointment, he will conduct a standard examination and ask questions that will help identify the origins of the problem. Additionally, it may be necessary to take tests, conduct an ultrasound of the uterus and ovaries, thyroid gland or other organs. Having determined the causes of menstrual irregularities, the doctor will prescribe the appropriate treatment.

Update: October 2018

It is difficult to meet a woman, especially at the present time, who at least once did not have a failure or violation of the menstrual cycle. Such shifts in the form of delays, both long and short, or manifested by a shortening of the cycle, are completely unsafe for the female body, because regular menstruation reflects the mental and physical state of a woman.

The menstrual cycle (many women call it in their own way, like the "menstrual cycle") plays the role of the biological clock of the body and any violations are the first bell of diseases not yet recognized. Why there is a violation of the menstrual cycle - the question is of interest not only to the fairer sex, but also to doctors.

A little about menstruation and the menstrual cycle

The first menstruation or menarche occurs in girls around 12-14 years old, and the further south the child lives, the earlier her menstruation begins. Menstruation ends at about 45 - 55 years (this period is called premenopausal).

Menstruation is the rejection or desquamation of the functional layer of the uterine mucosa in response to. That is why gynecologists like to repeat that menstruation is the bloody tears of the uterus after an unaccomplished pregnancy. To understand this definition, it is worth remembering the physiology of the menstrual cycle. As you know, the monthly cycle of a woman is divided into 3 phases:

In the first, the follicular phase, they are produced, the action of which determines the maturation of the follicles. From these follicles, the main or dominant follicle is released, subsequently from which a mature egg is released.
The second phase is the shortest (about a day), it is during this period that the main follicle ruptures, and the mature egg comes out “to freedom”, ready to meet with “gum” and fertilization.
In the third phase, luteal, the synthesis of progesterone by the corpus luteum begins, which arose at the site of the ruptured follicle. It is progesterone that causes the preparation of the endometrium for the implantation of a fertilized egg. In the event that conception does not occur, the corpus luteum slowly “dies” (regresses), progesterone production drops and rejection of the endometrium begins, that is, menstruation.
Then estrogen production picks up again and the cycle repeats.

From all that has been said, it becomes clear that the menstrual cycle is called cyclic changes that occur in the body after a strictly defined time.

The normal duration of the monthly cycle is 21 - 35 days. Deviation from the usual rhythm in one direction or another for 3-5 days is not a pathology, and longer shifts should alert the woman.

Menstruation normally lasts from three days to a week and does not cause significant discomfort to a woman.

The amount of blood lost during menstruation does not exceed 100 - 140 ml.

The regulation of the menstrual cycle occurs at 5 levels:

The first is the cerebral cortex, that is, all emotional experiences can lead to irregular periods. For example, it is known that in wartime women did not have periods, which has its own name - “wartime amenorrhea”.
The second level of regulation is the hypothalamus., in which releasing factors are synthesized that affect the next one.
The third level is the pituitary gland. In the latter, hormones are produced: follicle-stimulating and luteinizing, or gonadotropic hormones.
Under their influence in the ovaries - the fourth level estrogens or progesterone begin to be synthesized (depending on the phase of the cycle).
The fifth level of regulation is the uterus, fallopian tubes and vagina. Changes in the endometrium occur in the uterus, the fallopian tubes peristalt, helping the meeting of the egg and sperm, the epithelium is updated in the vagina.

What disrupts the menstrual cycle?

The causes of menstrual irregularities are very numerous and varied. Conventionally, they can be divided into 3 groups.

The first includes external factors, that is, the physiological impact on the cycle. In this case, we are talking about the influence of etiological factors on the first level of regulation of the menstrual cycle - the cerebral cortex:

climate change
nervous exhaustion
constant and prolonged stress
stock of character
change in diet and others.

The second includes various pathological conditions not only in the field of the reproductive system, but also in the whole body of a woman as a whole.

The third group includes the impact of drugs, both when they are taken and when they are canceled. These can be hormonal contraceptive pills (see), glucocorticoids, anticoagulants and antiplatelet agents, anticonvulsants and antidepressants, and others.

Factors due to pathological conditions:

Caused by ovarian pathology

These include impaired communication between the ovaries and the pituitary gland, ovulation induction by drugs, ovarian cancers, failure of the second phase of the cycle, occupational hazards (vibration, radiation, chemical exposure), ovarian surgery (removal of most of the ovarian tissue), trauma to the urogenital organs and formation fistulas and more.

Interaction between the hypothalamus and the anterior pituitary gland

Insufficient or excessive release of releasing factors and gonadotropic hormones, pituitary tumors, pituitary hemorrhage or necrosis, brain tumors that compress the pituitary / hypothalamus.

endometriosis

It does not matter genital or extragenital endometriosis, in any case, the disease is hormonal in nature and leads to an imbalance of hormones.

Impaired blood clotting (hemophilia, genetic pathologies).
Curettage of the uterine cavity - artificial termination of pregnancy or therapeutic and diagnostic curettage contribute to damage to the endometrium, which disrupts its growth or may be complicated by inflammation of the uterus and appendages.
Hormone-dependent tumors - uterus, adrenal glands, thyroid gland.
Diseases of the adrenal glands (tumors, injuries, etc.).
Polyps of the mucous membrane of the uterus.
Chronic endometritis - a full-fledged endometrium is not formed.
Rapid weight change - weight loss or obesity leads to a failure of the menstrual cycle, because adipose tissue produces estrogens.
Anomalies of the uterus - sexual infantilism, a septum in the uterus, a double uterus and others.
Infections - both infections in childhood (rubella, chickenpox) and sexually transmitted infections can negatively affect the ovaries.
Pathology of the uterus - this item includes tumors of the uterus and pathology of the endometrium (hyperplasia).
Mental illness (schizophrenia, epilepsy, alcoholic psychosis).
Endocrine pathology.
Chromosomal abnormalities (eg, 46XY karyotype for a female phenotype).
Arterial hypertension (see).
Bad habits (smoking, alcohol abuse).

How does a menstrual cycle disorder manifest itself?

Various shifts during the monthly cycle are defined as a violation. The monthly cycle can vary both in duration and in the nature of menstrual bleeding:

with amenorrhea, menstruation is absent for six months or more (primary amenorrhea is distinguished, when the violation of the cycle began from the moment of the onset of menstruation, and secondary amenorrhea - the disturbed cycle appeared after the period of its normal course);
oligomenorrhea - if menstruation occurs once every 3-4 months;
opsomenorrhea - short and extremely meager periods (no more than 1 - 2 days);
hyperpolymenorrhea- very heavy periods, but the duration of the cycle does not change;
Menorrhagia is prolonged and (lasting more than 10 days);
Metrorrhagia - irregular spotting, which can appear in the middle of the monthly cycle;
proyomenorrhea - the duration of the menstrual cycle is less than three weeks (that is, frequent periods);
algomenorrhea - extremely painful menstruation, leading to disability (also divided into primary and secondary);
Dysmenorrhea - any menstrual irregularities accompanied by pain during menstruation and autonomic disorders: headache, emotional lability, excessive sweating, nausea / vomiting).

Irregular periods in adolescence

In adolescent girls, menstrual irregularities are quite common. This is due to physiological reasons. That is, the hormonal background has not yet been established and the duration of both the cycle itself and menstruation can be different each time. The formation of the cycle for 1 - 2 years is considered the norm.

Pathological factors, causes of irregular periods include:

traumatic brain injury
infectious lesions of the brain and its membranes
susceptibility to colds
vegetative-vascular dystonia
obesity
sclerocystic ovaries and genital infections.

Of no small importance is the craze for girls diets, which leads not only to a significant loss of body weight, but also to hypovitaminosis and menstrual irregularities. In addition, the nature of the girl also affects the regularity of the menstrual cycle (too emotional, impulsive or aggressive).

Also in violation of the cycle play a role:

early and promiscuous sex
bad habits
malformations of the reproductive system

A disturbed menstrual cycle in girls can result in such a complication as juvenile uterine bleeding. In this case, menstruation lasts more than a week and is profuse, which leads to anemia of the child (see iron preparations for anemia). Usually, juvenile bleeding is provoked either by an infectious process or by nervous strain.

Violation of the cycle in premenopause

With menopause, which, as indicated above, occurs in the region of 45-55 years, in addition to disturbances in the menstrual cycle, vegetative-vascular disorders occur, disruptions in metabolic processes and psycho-emotional state (hot flashes, emotional lability, osteoporosis).

Disorders in the menstrual cycle in premenopause are associated with the extinction of the reproductive function, that is, the production of gonadotropins is upset at the pituitary gland, which leads to a disturbed process of maturation of follicles in the gonads, luteal insufficiency against the background of hyperestrogenism.

This causes pathological restructuring of the endometrium in both phases of the cycle, acyclic and cyclic bleeding, as endometrial hyperplasia develops. If the disorder of the menstrual cycle according to the type of rare and irregular monthly or acyclic bleeding occurred after 40 years, this most likely indicates premature ovarian exhaustion (early menopause) and requires hormone replacement therapy.

Violation of the cycle against the background of taking hormones

Often, against the background of taking contraceptive drugs (combined contraceptives or long-acting progestogens, such as Depo-Provera), they occur in the first 3 months of using hormones (see).

This is considered the norm, since the body must reconfigure hormones coming from outside and suppress the production of its own. If acyclic bleeding lasts longer than the specified period, this is due to improper selection of the drug (too high or low dose of hormones) or improper pill intake.

The same situation can cause the development of algomenorrhea. There is a high probability of massive uterine bleeding when using pills for emergency contraception, which is associated with the "elephant" content of hormones in such drugs (therefore, gynecologists recommend resorting to fire contraception no more than 1 time per year, see).

Amenorrhea is often due to the use of progestin preparations or injections of long-acting progestins. As a result, progestins are usually given to premenopausal women or women with endometriosis (when artificial menopause is needed).

In case of a menstrual cycle disorder, treatment is selected according to the reason that led to the failure of the cycle, the age of the woman / girl, clinical manifestations and the presence of concomitant pathology.

Treatment of irregular menstruation cycle in adolescence

Violation of the cycle, which is complicated by juvenile bleeding, is subject to two-stage therapy.

In the first stage, hemostasis is carried out with hormonal drugs and hemostatic agents (dicinone, vikasol, aminocaproic acid).
If the patient's bleeding is prolonged and severe and is accompanied by symptoms such as weakness, dizziness, low hemoglobin (70 g / l or less), then the girl must be scraped out. To prevent ruptures of the hymen, the latter is chipped with 0.25% novocaine. Scraping, respectively, is sent for histological examination. If hemoglobin is in the range of 80 - 100 g / l, hormonal pills are prescribed (combined low-dose contraceptives: Marvelon, Mercilon, Novinet and others).
In parallel with surgical and hormonal hemostasis, antianemic therapy is carried out (blood transfusion, erythrocyte mass, rheopolyglucin, infucol, and iron preparations are indicated: sorbifer-durules, tardiferon, and others).
Hormonal treatment lasts at least three months, and anemia therapy until hemoglobin levels rise to normal numbers (this is the second stage of treatment).
In uncomplicated cases of menstrual disorders in girls (with the formation of menstrual function), cyclic vitamin therapy is prescribed. Vitamins in case of violation are taken according to the scheme (to stimulate the production of their own hormones in the ovaries):
in the first phase, vitamins B1 and B6 or a complex of B vitamins (Pentovit), while in the second phase, vitamins A, E (“aevit”), ascorbic acid and folic acid.

Example from practice: An 11-year-old girl with juvenile bleeding was sent to the gynecological department. Diagnosis at admission: Premature sexual development. Violation of the menstrual cycle. Juvenile bleeding. Fortunately, the bleeding of the patient was not abundant, but lasted more than 10 days. Hemoglobin is reduced to 110 g/l. My colleague and I, of course, dispensed with curettage and began to stop bleeding with symptomatic hemostasis. The treatment had no effect, so it was decided to switch to hormonal hemostasis. Against the background of taking Novinet, the girl’s discharge practically disappeared by the end of the first day (the therapy was carried out according to the scheme: first 4 tablets during the day, then 3 tablets, then 2, and then one at a time until the end of the package). The girl took Novinet for another three months, no bleeding was observed either during treatment or after discontinuation of the drug. To date, the former patient is 15 years old, the menstrual cycle has been established, there were no recurrences of bleeding.

Treatment of a disturbed cycle in women of childbearing age

Treatment is basically the same as for adolescents. In the event of bleeding, regardless of its severity, such patients undergo diagnostic curettage for both therapeutic purposes (surgical hemostasis) and diagnostic purposes.

After the histological conclusion, hormone therapy is prescribed:

These can be combined oral contraceptives according to the generally accepted scheme.
In the case of an inferior luteal (second) phase, progesterone analogues are prescribed in the second half of the cycle, either 17-OPK or Norkolut.
Replenishment of the volume of circulating blood (colloidal solutions), antianemic therapy (see) and symptomatic hemostasis are mandatory.
If curettage of the uterine cavity has not brought results, the issue of ablation (burning) of the endometrium or hysterectomy is being decided.
It also shows the treatment of concomitant diseases that led to the disorder of the cycle (hypertension - restriction of salt and fluid, the appointment of antihypertensive drugs, liver pathology - adherence to therapeutic nutrition, intake, etc.).
Disruptions in the menstrual cycle can cause infertility, so for the purpose of pregnancy, pergonal and choriogonin (stimulate the development of active follicles) and clomiphene (stimulate ovulation) are prescribed.

Bleeding during menopause

If bleeding appeared in the menopause, the woman is necessarily subjected to curettage of the uterine cavity, since such bleeding may be signs of endometrial adenocarcinoma or atypical hyperplasia. In this case, the issue of hysterectomy is solved (see). After the results of histological examination:

small myomas
and/or grade 1 adenomyosis

gestagens are prescribed: 17-OPK, duphaston, Depo-prover. It is also possible to prescribe antiestrogenic drugs, such as danazol, 17a-ethynyl testosterone, gestrinone in a continuous mode.

It does not matter at what age the menstrual cycle disorder occurred, this pathology is only a consequence of some underlying disease, therefore it is necessary to identify and treat the underlying pathology, because only after the cause has been eliminated is it possible to restore the normal cycle. And, of course, it is necessary to remember about the normalization of the regime of the day and rest, good nutrition and minimization of stress. With obesity, it is often enough just to normalize the weight to restore the menstrual cycle. The same applies to malnourished women (in this case, a high-calorie diet is indicated).