At what age do girls bleed? Drug treatment: drugs to stop uterine bleeding

Juvenile (pubertal) uterine bleeding is dysfunctional bleeding in girls during puberty (from menarche to 18 years of age).

ICD-10: N92.2

general information

JMC are one of the most common and severe forms of disorders of the reproductive system during puberty, and their frequency in the structure of gynecological pathology of children and adolescents, according to various researchers, ranges from 8-10 to 25%. JMC are a risk factor for the development of disorders of menstrual and generative functions, hormonally caused pathology in reproductive age. Among the reasons for hospitalization in the Ukrainian Center for Gynecology of Children and Adolescents "Okhmatdyt" UMK occupy a leading place and account for 35% of all diseases.
True UMC include dysfunctional uterine bleeding that occurs during the formation of menstrual function, i.e. bleeding, which is based on disorders hormonal levels, in which there is no initial organic diseases genital area (tumors, infantilism, malformations and systemic diseases). They usually appear two to three years after the formation of menstrual function.

Etiology
In the development of dysfunctional JMCs, the leading role belongs to the infectious-toxic effect on the structures of the pituitary gland and hypothalamus that have not yet reached functional maturity, which regulate ovarian function. A particularly unfavorable effect of infection is observed in chronic tonsillitis. In addition, predisposing causes of JMC include:
unfavorable course of the antenatal period;
chronic somatic diseases;
spicy and chronic forms stress;
unfavorable living conditions;
intoxication;
hypo- and vitamin deficiencies;
pathological conditions of the endocrine glands (thyroid glands, adrenal glands), hypothalamic syndrome.

Pathogenesis
During puberty, JMB are, as a rule, acyclic bleeding, often of the type of follicular atresia, less often of the type of persistence of follicles. In both cases, hyperestrogenism occurs (in the first - relative, in the second - absolute), which leads to endometrial hyperplasia with subsequent bleeding. Hyperplastic processes endometrium may be expressed in glandular cystic hyperplasia, endometrial polyp, adenomyosis.

Clinical picture

Main symptoms of JMC:
prolonged (more than 7-8 days) bloody discharge from the genital tract;
bleeding, the interval between which is less than 21 days;
blood loss more than 100-120 ml/day;
The severity of the disease is determined by:
nature of blood loss (intensity, duration);
degree of secondary posthemorrhagic anemia.
Typical complaints with JMC are weakness, lack of appetite, fatigue, headache, pallor of the skin and mucous membranes, tachycardia. In addition, irregular, more or less heavy bleeding from the vagina occurs, which can lead to the development of anemia, including severe. This is the main danger of juvenile bleeding.

Diagnostics

Diagnosis is based on typical clinical picture. The examination is carried out in the presence of the mother or relative.
Physical research methods
Questioning – onset, duration of bleeding and its features; menarche; features of menstrual function; pre-treatment; features of the course of pregnancy and childbirth in the patient’s mother.
General examination – anemia, degree of development of secondary sexual characteristics (mammary sex, armpit, pubic hair), the presence of hyperandrogenism.
Deep palpation abdomen - detection of tumors.
Examination of the external genitalia - degree of development, presence of anomalies, nature of bleeding, absence of injuries to the genitals.
Rectoabdominal examination - to assess the condition of the internal genital organs.
Speculum and bimanual examination gynecological examination(for sexually active girls) – determination of the condition of the internal genital organs.
Laboratory research methods
Required:
determination of blood group and Rh factor;
general blood test - presence of signs of anemia;
general urine analysis;
biochemical parameters blood - determination of the level of serum iron, bilirubin, liver enzymes;
detailed coagulogram.
If indicated:
determination of the level of hormones in the blood and urine - FSH, LH, prolactin, estrogens, progesterone, cortisol, 17-KS - in daily urine;
hormonal colpocytology.
Instrumental research methods
Required:
Ultrasound transabdominal, preferably transvaginal (for sexually active girls);
Vaginoscopy - to exclude pathology of the vagina and cervix, and their injuries.
If indicated:
diagnostic curettage;
hysteroscopy;
radiography of the skull with a projection of the sella turcica;
EEG;
CT scan for suspected pituitary tumor;
radiography of the hands (determination bone age),
Ultrasound scan of the adrenal glands and thyroid gland;
MRI of the pelvic organs.
Specialist consultations
Required:
pediatrician
If indicated:
gynecological oncologist;
endocrinologist;
hematologist.
Differential diagnosis:
spontaneous abortion;
ectopic pregnancy;
hormone-producing ovarian tumors;
RE;
vaginal pathology – trauma, foreign bodies, atrophic colpitis,
endometrial polyps,
adenomyosis,
ovarian cysts and tumors,
anomalies uterine vessels– dysplasia and arteriovenous shunts,
diseases of the blood coagulation system.

Treatment

Treatment includes two stages.
1. Stopping uterine bleeding - symptomatic hemostatic therapy (non-hormonal or hormonal hemostasis);
2. Prevention of recurrent bleeding.
Pharmacotherapy
The choice of hemostasis method is determined by the general condition of the patient and the degree of blood loss. Also, uterotonic, antianemic therapy and general therapeutic effect, which helps to increase the protective and adaptive forces of the body. However, it should be borne in mind that the symptomatic treatment method does not always have the desired effect, which necessitates the prescription of hormone therapy. Thus, in the event of bleeding and severe anemia (hemoglobin 100 g/ml and below, hematocrit 25% and below), the presence of endometrial hyperplasia (M-echo more than 10 mm), hormonal hemostasis is carried out, which is effective (unlike non-hormonal methods of stopping bleeding) quickly and quite effectively. Stopping bleeding with hormonal hemostasis occurs within 10-12 hours.
Currently, hormonal hemostasis in girls is carried out using both monophasic COCs and gestagenic drugs. Carrying out hormonal hemostasis only with estrogens in adolescence undesirable, since “withdrawal” bleeding is pronounced and leads to secondary anemia and depression central mechanisms regulation of menstrual function. When prescribing combined gestagen-estrogen drugs for the purpose of hemostasis, monophasic drugs are used containing a dose of ethinyl estradiol from 30 to 50 mcg (ethinyl estradiol + gestogen, ethinyl estradiol + levonorgestrel, ethinyl estradiol + norethisterone). Triphasic COCs are not recommended for stopping bleeding, since during the first two phases they contain lower doses of progestins than monophasic drugs.
In order to prevent recurrent bleeding, both combined monophasic and triphasic estrogen-gestagen drugs are prescribed. In this case, low dosage is preferable oral contraceptives(ethinyl estradiol + gestodene, ethinyl estradiol + levonorgestrel). Considering the functional immaturity of neuro endocrine system During puberty and incomplete establishment of MC in patients, courses of hormonal therapy must be prescribed at intervals of 1-3 months. During this period, general strengthening therapy, herbal medicine, cyclic vitamin therapy are carried out, and homeopathic remedies are prescribed.
Hormonal drugs are prescribed to teenage girls with the consent of their parents.

For the purpose of hemostasis it is also used non-hormonal drugs:
non-steroidal anti-inflammatory drugs - reduce the synthesis and change the balance of prostaglandins in the endometrium, inhibit the binding of the vasodilator PGE to specific receptors, increase platelet aggregation and endometrial vasospasm. The drugs reduce menstrual blood loss, as well as dysmenorrhea, headache, diarrhea associated with menstruation;
herbal remedies - infusions of nettle, water pepper.
Preventive hormone therapy(scheme No. 9) is carried out in combination with other methods pathogenetic therapy, applying:
sedatives;
iron supplements;
vitamins;
antioxidants;
homeopathic medicines;
psychotherapy;
physiotherapy (electrophoresis of cervical sympathetic nodes with novocaine No. 10, endonasal electrophoresis with vitamin B 1 No. 100).
Surgery
Therapeutic and diagnostic curettage of the walls of the uterine cavity is carried out according to the following indications:
profuse uterine bleeding, which poses a threat to the patient’s life;
severe secondary anemia (Hb 70 g/l and below, hematocrit below 25.0%);
suspicion of pathological changes in the structure of the endometrium (endometrial polyp according to pelvic ultrasound).

Performance criteria:
normalization of MC throughout the year;
lack of heavy and prolonged periods;
absence pain syndrome during menstruation;
absence pathological changes from the internal genital organs.

The most common and severe forms Disorders of the reproductive system during puberty in girls include juvenile uterine bleeding. This term refers to dysfunctional bleeding at the age of 10-18 years from the beginning of the first menstruation until adulthood.

This gynecological pathology occurs in approximately 10-20% of all girls of this age. age category. Heavy and frequent bleeding can cause a significant decrease in the level of hemoglobin in the blood, aggravate hormonal disorders, and in the future cause infertility. In addition, uterine bleeding in adolescents negatively affects the psychological state of children, causing isolation, self-doubt, fear for their health and even life.

Reasons for violations

The main reason is disturbances in the functioning of the hypothalamic-pituitary system. Hormonal disbalance provokes a single-phase ovarian cycle with a delay in menstruation and further bleeding. More often, dysfunctional uterine bleeding of puberty occurs during the first two years after.

There is no direct connection between this pathology and the development of other secondary sexual characteristics. In general, the girl’s puberty proceeds without disturbances. In more than a third of patients, the disease can be complicated by the appearance of acne and oily seborrhea.

The appearance of uterine bleeding in older girls is noted at early menarche (7-12 years). It is diagnosed in more than 60% of patients. At late appearance During the first menstruation (after 15-16 years), this pathology occurs rarely - no more than 2% of cases.

The main causes of the pathological condition in adolescents:

• pathologies of the blood coagulation system;
• formation of ovarian tumors of hormonal origin;
• acute and chronic infectious diseases(ARVI, pneumonia, chronic tonsillitis, chicken pox, rubella);
• diseases of the endocrine system (pancreas, adrenal glands);
• tuberculosis of the genital organs;
• malignant neoplasms of the body and cervix;
• living in unfavorable conditions, excessive physical and psychological stress;
• poor nutrition that does not provide the body with necessary vitamins and microelements.

The most significant provoking factor is chronic tonsillitis with regular periods of exacerbation. There is a definite connection between the disease in girls and how her mother’s pregnancy proceeded. Provoking factors could be late toxicosis, chronic intrauterine, premature aging or placental abruption, asphyxia of the child at birth.

Symptoms of the disease

Many girls have regular monthly cycle does not recover immediately after menarche, but only over six months to two years. Menstruation may be delayed by two to three months, and sometimes even six months. Uterine bleeding most often occurs after a delay of menstruation of up to 2 weeks or a month and a half.

In some cases, it may occur a week or two after menarche or occur during the intermenstrual period. The main symptoms of the pathology include:

• copious (more than 100 ml per day) and prolonged (over 7 days) bleeding;
• discharge that occurs 2-3 days after the end of menstruation;
• menstruation that recurs at intervals of less than 21 days;
• dizziness, drowsiness, nausea as a result of anemia;
• pallor skin, dry mouth;
• pathological desire to eat inedible foods (for example, chalk);
• depressed state, irritability, rapid physical fatigue.

Very often a girl and even more experienced mother cannot determine the violation and regard it as normal menstruation. The girl can continue to lead her usual lifestyle, thereby delaying treatment, which should begin immediately, and aggravating the problem. It should be remembered that any copious discharge, and even with clots, require close attention. Menstruation is considered heavy when a pad or tampon has to be changed at least every hour.

Since the pathology can be caused for various reasons, besides mandatory inspection a pediatric gynecologist, consultation with an endocrinologist, neurologist, or oncologist is necessary.

Diagnostics

For diagnosis, general and special methods violation studies. General ones include gynecological and general examination patients, examination of the condition of internal organs, analysis of physique and height-to-weight ratio, presence of secondary sexual characteristics. From the conversation, the gynecologist learns about the date of the first menstruation, the regularity of the menstrual cycle, previous diseases and general condition health.

Patients are prescribed a number of laboratory tests: general tests urine and blood, biochemical analysis blood sugar test and hormonal screening to determine hormonal levels. To clarify the diagnosis, pelvic organs are also examined.

Abnormal uterine bleeding during puberty should be differentiated from other pathological conditions which may be accompanied by bleeding, namely:

• diseases of the blood system;
• hormone-producing ovarian tumors, endometriosis, cervical cancer;
• inflammatory diseases genitals;
• injuries of the vagina and external genitalia;
• beginning abortion during pregnancy;
• polycystic ovary syndrome.

With diseases of the blood system, patients often experience nosebleeds and the appearance of hematomas on the body. Unlike inflammatory diseases of the genital organs, dysfunctional uterine bleeding is rarely accompanied by cramping pain in the lower abdomen. If a tumor is suspected of various nature, their presence will be determined after ultrasound and other specific diagnostic methods.

Treatment

With heavy bleeding and feeling unwell girls need to be called ambulance. Before her arrival, the child is put to bed, given complete rest and an ice pack is applied to the stomach. The patient should be given a lot of sweet drinks, preferably tea. Even if the bleeding was stopped on its own, this should not be a reason for complacency, since such pathologies are prone to relapse.

The main goal of therapy is the complete cessation of discharge and normalization of the menstrual cycle in the future. When choosing methods and drugs for treatment, the intensity of bleeding, the severity of anemia, data laboratory tests, general physical and sexual development patients.

To treat and stop discharge in adolescents, they are carried out in exceptional cases. They are indicated only when the pathology threatens the patient’s life. In other cases, they are limited to drug therapy.

Drugs used for uterine bleeding in adolescents

If the girl’s general condition is satisfactory and there are no signs of severe anemia, treatment can be carried out at home using hemostatic agents, sedatives and vitamins.

If the patient's condition is severe and there are all signs of anemia (low hemoglobin, dizziness, pale skin), hospitalization is necessary.

To stop bleeding and normalize the menstrual cycle, the following drugs are prescribed:

• uterine contractants - Oxytocin, Ergotal, water pepper extract;
• hemostatic drugs - Vikasol, Tranexam, Ascorutin, Dicinone, Aminocaproic acid;
• combined - Rugulon, Non-ovlon, Janine;
• sedatives– bromine or valerian preparations, motherwort tincture, Seduxen, Tazepam;
• drugs to regulate the menstrual cycle - Utrozhestan, Duphaston, which are taken from the 16th to the 25th day of the cycle;
• vitamins – group B, including folic acid, C, E, K.

At elevated level girls are prescribed Turinal, Norkolut for three cycles with a three-month break with further repetition of the drug regimen. At reduced level sex hormones are prescribed in a cyclic manner. Hormone therapy is not the main method of preventing new bleeding.

How helper methods Treatments include physiotherapy - electrophoresis with novocaine or vitamin B1 and acupuncture. The second procedure is prescribed for blood loss without the threat of anemia, in the absence of pronounced hormonal imbalance.

If bleeding is caused by diseases of the endocrine system, appropriate specific treatment and iodine preparations.

With the aim of sedative effect and normalization of excitation and inhibition processes central structures brain can be prescribed Nootropil, Veroshpiron, Asparkam, Glycine. Complex treatment and measures to restore the menstrual cycle include exercise physical therapy and psychocorrective sessions with a psychologist.

Clinical recommendations for uterine bleeding during puberty include adherence to bed rest During treatment, apply cold to the lower abdomen, drink plenty of fluids to replenish fluid loss by the body. It is forbidden to apply warm heating pad, take a hot bath, douche, or take hemostatic agents without consulting a doctor.

Eliminating symptoms is important iron deficiency anemia, which is most often a complication of uterine bleeding. For treatment, iron preparations such as Ferrum Lek, Maltofer, Hematogen, Totema, Sorbifer Durules are prescribed. The drugs are taken in tablet form; injections are more effective. In the future, the girl must follow a diet that includes foods rich in iron: red meat, liver, poultry, seafood, spinach, beans, pomegranates, brown rice, dried fruits, peanut butter.

After discharge from the hospital, the girl must be registered with pediatric gynecologist.

Treatment with folk remedies

Traditional medicine knows many herbs, infusions and decoctions of which have a hemostatic effect. However, they cannot completely replace drug treatment. Herbal decoctions and infusions can be used as an additional treatment method.

Among the most effective plants should be highlighted:

• knotweed - contains acetic and malic acids, tannin, vitamins K and C, strengthens the walls of blood vessels, increases blood viscosity;
• water pepper - tannin, organic acids, vitamin K in the composition stabilize the activity of the smooth muscles of the uterus, increase blood clotting;
• shepherd's purse - contains alkaloids, organic acids, vitamin C, tannin, riboflavin, which help reduce blood secretions;
• nettle is the most famous plant for stopping bleeding, regulates menstrual cycle, saturates the body with vitamins K, C, A, B.

To prepare decoctions, plant herbs are crushed, poured with boiling water and kept in a water bath for 15-20 minutes. After straining, take several times a day. The duration of use and dosage should be checked with your doctor.

Prevention of bleeding

Since juvenile bleeding occurs mainly when hormonal disorders, there are no specific preventive measures. However, following certain recommendations will help reduce the risk of their occurrence:

1. Timely treatment of infectious and viral diseases, especially those that become chronic (tonsillitis, bronchitis, ARVI).
2. Regular observation of pregnant women by an obstetrician-gynecologist, starting from early dates gestation in order to identify and correct early and late gestation, edema of pregnant women, intrauterine disorders of fetal development, premature birth, fetal hypoxia.
3. Adolescent girl's adherence to principles proper nutrition– eating foods rich in vitamins, excluding fast food, avoiding “diets” that involve prolonged fasting.
4. Maintaining a menstrual calendar, which will help you pay attention to deviations when they first appear.
5. Taking sedative medications to strengthen blood vessels and nervous system(as prescribed by a doctor).
6. Refusal bad habits, adherence to daily routine, good sleep, regular physical exercise, playing sports.
7. Notifying girls about the dangers of early sexual intercourse.

Separately, it should be said about the need to visit a pediatric gynecologist. Many mothers consider this unnecessary until the girl becomes sexually active. A visit to a pediatric gynecologist for preventive purposes, especially after the onset of menstruation, should become the same norm as visits to other doctors.

Juvenile bleeding is a group of menstrual cycle disorders of a dysfunctional nature during puberty, not associated with organic pathologies. Dysfunctional juvenile bleeding appears during the period of formation of the hormonal function of the ovaries; their causes can appear long before the onset of menstruation, or occur after the first menstruation.

Ovaries as hormonal gland begin to form during active puberty (puberty). The age norm of puberty has wide acceptable limits, but its physiological boundaries are between the ages of 8 and 16 years. In this age interval, the ovaries “mature”, but the pace of their development is often individual, so the first menstruation () does not come at the same age for all girls. During puberty, successive structural and functional changes occur not only in the tissues of the ovaries, the most significant of them are also present in the brain - in the centers that regulate ovarian function. The pituitary gland and hypothalamus, together with the ovaries, form the main link of the reproductive system, therefore the maturation of the ovaries and these centers is always symmetrical.

So, how and when is the menstrual cycle formed, and what are its generally accepted normal parameters?

Puberty starts at the age of 8 and ends (in healthy girls) by the age of 16. After its completion, the ovaries are able to function as a hormonal female gland, and the girl’s external features take on an “adult” tint. During this time period, growth zones in tubular bones, the body is actively growing in length, and muscle and adipose tissue are distributed in such a way that the girl’s figure becomes “feminine”.

The processes of puberty occur gradually, which allows the entire puberty to be divided into several important stages:

— Preparatory, prepubertal period. Starts at 8-9 years of age. The girl’s body begins to synthesize estrogens for the first time. They are produced sporadically and chaotically, and their level is too low to maintain full hormonal function of the ovaries.

The “growth spurts” of the body begin, the first external signs gender: the contour of the hips is rounded, a “female” pelvis is formed. The mucous membrane lining the genital tract also begins to actively change: it loses single-layer structure due to the appearance of a layer of intermediate cells.

- The beginning of puberty, or puberty itself. He has owned it for several years. In the first half (10-13 years), the pituitary gland indirectly (through the secretion of FSH and LH) stimulates the onset of hormonal activity of the ovaries. Ovarian hormones, in turn, provoke the development of mammary glands, hair growth female type"on the body and changes in the composition of the microflora in the vaginal mucosa (lactobacteria appear). At the end of this period, intensive body growth is completed.

The culmination of the first phase of puberty is the first menstruation (menarche).

— The final phase of puberty. The first menstruation is not identical to the full hormonal function of the ovaries. Hormones are still synthesized without a clearly established rhythm, and their levels are still not sufficient to ensure ovulation. By the age of 16, when the second phase of puberty ends, the ovaries begin to work in a cyclical rhythm, and the concentration of FSH and LH can stimulate full ovulation. Complete hormonal support for the end of puberty ensures the completion of the development of the female phenotype.

— Frequent bleeding with an interval of less than 21 days.

- Too much blood loss. It is usually noted when bleeding coincides with menstruation.

- Intermenstrual bleeding.

Often, bleeding has a clear connection with some provoking factor: stress, hypothermia, excessive physical activity, and others. As a rule, such bleeding does not tend to recur if it is external cause is eliminated.

The severity of bleeding is determined by a list of consequences. Prolonged and/or heavy bleeding provokes and negatively affects the body of girls.

Sometimes distinguish normal menstruation bleeding is not easy. For a reliable diagnosis, it is necessary to exclude all possible reasons non-functional: blood diseases, genital malformations and others. Diagnostics includes:

1. Study of medical history, which may indicate the presence of chronic and/or congenital pathologies, including extragenital ones.

In a conversation with a girl, you need to determine psychological characteristics, find out her attitude to the changes happening to her. Unfortunately, young patients entering puberty do not always have trusting relationships in the family, and therefore cannot openly communicate on intimate topics with loved ones.

2. Inspection. Girls puberty with juvenile bleeding often have external signs of impaired sexual development. During an external examination, it is important to correlate the patient’s age and the severity of signs of puberty (breast development, body hair growth, etc.).

A gynecological examination is also carried out, but is less informative compared to laboratory and instrumental diagnostics.

3. Laboratory research:

— detailed analysis blood with mandatory determination of all coagulation factors. It is also important to determine the degree of anemia (hemoglobin);

— phase-by-phase determination of the concentration of leading hormones: FSH, LH, progesterone, estradiol, prolactin, hormones thyroid gland and adrenal glands;

4. Instrumental diagnostics.

Overestimate its importance for the production correct diagnosis impossible. Ultrasound scanning allows you to study the structures of the pelvic cavity and compare what you see with the recognized norm.

Juvenile bleeding in girls and adolescents

As we approach the end of puberty, the connections regulating the menstrual cycle improve, the ovaries “mature”, ovulatory cycles anovulation begins to dominate, and the likelihood of dysfunctional uterine bleeding decreases.

In adolescence, which ends at 18 years of age, menstrual dysfunction is also possible, but it also has other, organic causes.

The presence of ovulation implies potential, therefore, often in the absence of necessary contraception, girls have their first abortions precisely at this age. Interrupt unwanted pregnancy against the background of the formation of hormonal function provokes serious violations and leads to uterine bleeding. In addition, any, even the most “safe” abortion provokes local inflammatory process, which also negatively affects menstrual function.

An infectious and inflammatory process poses a serious threat to the ovaries. The infection can penetrate the appendages from the genital tract, and then damage the follicular apparatus of the ovaries, which will provoke hormonal dysfunction. Uncontrolled sexual intercourse increases the likelihood of such a scenario.

It is possible to reliably find out what the origin of dysfunctional bleeding in a teenage girl is only after an adequate examination.

Treatment of juvenile bleeding

Therapy for juvenile dysfunctional bleeding is largely determined by its cause and clinical picture. Sometimes, to eliminate menstrual dysfunction, it is enough to eliminate the external provoking factor, for example, emotional or physical stress.

If the bleeding is not accompanied by severe anemia, and the girl’s health remains satisfactory, treatment is carried out without hospitalization. Typically, juvenile hemorrhage is controlled simultaneously and diagnostic search its reasons. Hemostatic and vascular-strengthening drugs are used, vitamin complexes, sedatives. Once the cause of bleeding is determined, treatment is aimed at eliminating it.

Unfortunately, juvenile bleeding in girls is often different severe course and require hospitalization. The primary task of specialists is to stop bleeding in the shortest possible period. Conventional hemostatic therapy for large blood loss is often ineffective, but hormonal drugs based on gestagens (Duphaston, Utrozhestan) or containing a combination of gestagens and estrogens (so-called COCs) successfully cope with this task.

After the bleeding is eliminated, therapy does not end. To prevent bleeding episodes from returning, it is necessary to restore normal hormonal function, that is, to recreate ovulatory cycles using hormonal drugs. Combined estrogen-gestagen agents (Logest, Mercilon, Marvelon and analogs), “pure” gestagens such as Duphaston, are used. Adolescents (girls over 16 years of age) with recurrent uterine bleeding are allowed to prescribe ovulation-stimulating drugs such as Clomiphene. Universal schemes hormonal treatment does not exist in such situations. Selecting what you need hormonal drug can only be done by a specialist, based on individual laboratory data.

Hormones are very effective as emergency therapy; when combined with non-hormonal hemostatic agents, bleeding stops within a few hours.

Hormonal therapy is never prescribed as monotherapy. Treatment of juvenile bleeding can be completely successful only if several types of therapy and physical treatment are combined. It is necessary to select for patients correct mode physical activity, include in food essential vitamins. An important part therapeutic measures is psychotherapy.

Sometimes related specialists are involved in the treatment of girls and adolescents with uterine bleeding due to extragenital pathology: therapists, endocrinologists, neurologists.

Among the methods of treating dysfunctional uterine bleeding in adolescents, there is also surgical hemostasis (curettage of the uterine cavity). It is rarely used when bleeding is life-threatening. The procedure is carried out using special instruments that allow you to preserve the hymen and not injure the uterus.

Most young patients respond very favorably to the treatment. As a rule, a full menstrual cycle (with ovulation) forms in them during the first year after therapy.

Prevention of juvenile uterine bleeding

After successful treatment of an episode of uterine bleeding, girls need dynamic monitoring. To avoid a relapse, measures aimed at restoring normal connections in the “hypothalamus-pituitary-ovarian” system and bringing the patient’s lifestyle into an acceptable direction for her age help.

- constantly lead menstrual calendar to keep track menstrual function and note its features;

- adjust your diet and balance physical activity;

- avoid stress and emotional fatigue;

- promptly eliminate infectious and viral diseases;

- refrain from early intimate relationships.

Juvenile bleeding is classified as a group of dysfunctional uterine bleeding, which means that such a diagnosis is a diagnosis of exclusion, i.e. First, examinations are carried out for the most common diagnoses of uterine bleeding.
It is believed that the cause of juvenile bleeding is an imbalance in the regulation of the menstrual cycle at the hypothalamic-pituitary level, which, moreover, is immature in adolescents. At the same time, girls' cycles are usually anovulatory. It is believed that up to 20% of dysfunctional uterine bleeding occurs during adolescence. Irregular menstrual cycles occur in 20% of adolescents over a 5-year period.

In adolescents, menstruation can be heavy, especially against the background of anovulation, which is often accompanied by endometrial hyperplasia. Very often such heavy menstruation occur against the background of stress, physical activity, fasting, weight loss and obesity, as well as against the background of thyroid disease. As I mentioned above, juvenile hemorrhage is a diagnosis of exclusion and is therefore extremely rare. It is necessary to take into account the fact that menstrual irregularities can occur for numerous reasons. Therefore, such a diagnosis is made against the background of excluding all these causes. In other words, this is bleeding for no reason against the background of complete normality of all laboratory parameters, without a burdened history of the past and present.

Juvenile bleeding is treated only if anemia occurs. It is by the level of hemoglobin that the degree of juvenile bleeding is determined: weak (more than 110 g/l), moderate (90-110) and severe (less than 90 g/l). Weak degree bleeding does not require treatment.

With moderate juvenile bleeding appoint hormonal contraceptives or cyclic progestins. No curettage of the uterine cavity is performed. Additionally, iron supplements may be prescribed, although most often they are not required.

Severe juvenile bleeding requires restoration of blood volume, so treatment is carried out in a hospital. Treatment is carried out with estrogens with the addition of progestins (in tablet forms). Curettage is not performed in adolescents, even with severe bleeding. There is hormonal hemostasis, which is always sufficient to stop bleeding. Antiprostaglandins and antifibrinolytics are used less frequently. Iron supplements in such cases are advisable.

If drug treatment is not effective, very in rare cases Curettage of the uterine cavity or hysteroscopy is performed. Also surgery carried out in situations where a teenager’s life is in danger.

There is NO way to prevent juvenile hemorrhage. It is important to understand that bleeding in adolescents occurs for a specific reason, i.e. are not juvenile. This means that you need to find this cause and eliminate or reduce it. Understanding the processes of formation of menstrual cycles depends on the competence of the doctor, i.e. his level of knowledge of modern gynecology. Eliminating stress and normalizing weight are often the only necessary measure to regulate menstrual cycles.

JUMK (juvenile uterine bleeding) is blood loss of an inorganic nature that occurs in puberty. Juvenile bleeding most often occurs due to a delay in menstruation due to disruption of the interaction of the ovaries with endocrine glands. In this case, the volume of discharge exceeds the norm during menstruation, and in the absence of treatment, symptoms such as pale skin, dizziness, chronic fatigue, feeling of weakness, etc.

Causes

JMC have a polyetiological origin and appear as a result of many factors, both external and internal. The most common cause of juvenile bleeding in girls is disruption of the reproductive system during the formation of the menstrual cycle. As a result of this disorder, the concentration of estrogen and progesterone changes, which causes uterine bleeding. Factors that provoke the appearance of juvenile uterine bleeding:

• blood diseases (including von Willebrand-Diana disease);
• heredity;
• excessive physical activity;
• strong emotional experiences and regular stress (problems at school, quarrels with parents or peers, etc.);
• vitamin imbalance in the body;
• chronic and acute infectious pathologies;
• disruption of the endocrine system;
• liver dysfunction.

JMC also depend on the physiology of a teenage girl. IN medical field There are three types of violations:

• hyperestrogenic: most often observed in children with psychological immaturity and excessive physiological and sexual development;
• normoestrogenic: occurs in young girls and adolescents with normal development and an underdeveloped uterus;
• hypoestrogenic: this type of disorder is encountered by young girls with a well-developed psyche, whose secondary sexual characteristics are poorly developed.

Classification and forms

According to the degree of blood loss, there are three types of juvenile uterine bleeding in adolescents:

• metrorrhagia - develops against the background of the absence of scanty menstrual flow and is not cyclical;
• menorrhagia - with this type of bleeding, the menstrual cycle is not disrupted, but blood loss lasts longer than 7 days and exceeds 80 ml/day;
• polymenorrhea - the menstrual cycle persists, but lasts no longer than 3 weeks.

Experts have found that children whose mothers suffered from JMC most often experience infectious diseases during pregnancy.

Clinical manifestations

JMCs occur between the first menstruation and the next two years. Signs of violation:

• increased or decreased arterial pressure;
• systematic dizziness;
• constant feeling thirst;
• pale skin;
• increased fatigue and feeling tired;
• sudden mood swings;
• bleeding is observed between menstruation;
• the cycle lasts less than 3 weeks;
• discharge lasts longer than 15 days;
• heavy blood loss continues for more than a week.

If you suspect JMC, you should pay attention to the duration, volume and cyclicity bloody discharge. If you feel unwell or have any abnormalities, you should seek help from a specialist.

Diagnostics

Sometimes it is extremely difficult to distinguish menstrual flow from UMC, and only a doctor can accurately diagnose the problem. Basic diagnostic methods:

• interviewing the patient to identify the presence of congenital or chronic pathologies;
• study of anamnesis;
• visual inspection, with which you can identify deviations in puberty (the size of the mammary glands, the presence of vegetation on the pubis and in the axillary recesses);
• blood test for hormones to determine the level of estradiol, prolactin, progesterone, FSH and LH;

After stopping the bleeding, you need to additionally undergo:

• echography of the adrenal glands and thyroid gland;
• secondary ultrasound examination of the pelvic organs;
• electroencephalogram;
• X-ray of the skull;
• CT scan of the brain;
• echoencephalogram.

To confirm/exclude the diagnosis, you should consult an oncologist, neurologist, endocrinologist and hematologist.

Treatment

At heavy bleeding you should call an ambulance. Additionally, the following measures need to be taken:

• the teenager needs to take horizontal position;
• Place an ice pack wrapped in a soft towel on the lower abdomen for 10-15 minutes;
• the child needs to be provided with plenty of fluids in the form of sweetened tea or water;
• It is advisable to give the girl 1 tablet or capsule of vitamin C.

You should consult a doctor even if the bleeding stops on its own. Timely diagnosis and treatment of pathology will avoid negative consequences.

For juvenile bleeding in teenage girls, treatment is carried out in two stages.

To begin with, the doctor sets himself the task of stopping the bleeding. If the pathology is severe, then classical means to stop bleeding may be ineffective. In such situations, hormonal therapy is prescribed by taking gestagens and estrogens.

If the bleeding can be stopped, then medications are prescribed to stabilize the menstrual cycle. In this case, drugs are selected depending on the causes of the disorder and the characteristics of the patient’s body.

In addition, female patients may be prescribed vitamin complexes, physiotherapeutic procedures and a special schedule of physical activity. At this stage, the physician also pays attention to psychological condition patients. Sometimes repeated JMC are observed after stress.

If bleeding poses a threat to life, then in this case it is prescribed surgery, in which the uterine cavity is scraped out. After this, a drug treatment regimen is selected.

Average term therapy - 12 months. During this period, the menstrual cycle is established, and irregularities no longer occur.

Complications and consequences

JMC in girls can cause the development of anemia and associated complications. In severe cases, anemia affects many systems and internal organs, which poses a threat not only to health. but also for the life of a teenage girl.

Untimely and improper exfoliation of endometrial tissue can lead to inflammation of the uterus, which can lead to the development of tumors, endometriosis and cysts, which can cause infertility.

Therefore, in case of any deviations, you should consult a doctor.

Prevention

The state of the reproductive and reproductive systems of girls is formed in early age. After the birth of a child, parents need not only to constantly monitor his hygiene, but also to accustom him to healthy image life and daily routine. Balanced diet, saturated useful microelements and vitamins, regular walks outside and moderate physical activity- all this will allow the child to develop correctly and prevent many gynecological pathologies.

In addition, to prevent juvenile uterine bleeding in girls, viral and infectious diseases should be promptly treated and regularly visited by a gynecologist.

A mother should definitely inform her daughter about the importance of menstruation. It is also advisable for her to monitor this process until the end of puberty.

Your child should be seen for the first time at the gynecologist during their first period.

Then to gynecological consultation should be applied every six months until adulthood.

The baby's body weight also affects the menstrual cycle. It is necessary to ensure that the child is not overweight or underweight. If necessary, you can additionally consult with a nutritionist on this issue. The specialist will select a nutrition plan for the teenager, help get rid of weight problems and prevent the recurrence of juvenile bleeding in the future.

In addition, mothers should discuss issues with their daughters that explain the dangers and consequences of early sexual intercourse.

Puberty is individual for each child, so you should not self-medicate and try to solve the problem of JMC on your own. It's better to contact medical specialist, who identifies the deviation and prescribes adequate therapy