Menstrual irregularities and their treatment

In order to understand the concept of menstrual irregularity, it is necessary to give brief information about the normal menstrual pattern and physiology.
Menstrual bleeding usually begins between the ages of 9-16. If the girl still has not menstruated when she reaches the age of 15, she should definitely be evaluated by a gynecologist. The period from the first day of one period to the first day of another period (1 cycle) should be between 25-35 days. Bleeding lasts 2-7 and the average blood loss is around 40 ml (3-4 pet/day) in one menstrual period. Bleeding greater than 80 ml is considered excessive. menstrual cycles; It happens regularly every month in a woman of childbearing age, except during pregnancy and breastfeeding, and ends with menopause.
In women with regular menstrual cycles, approximately 13-14 days of the period. The increase in the LH hormone secreted from the pituitary region in the brain, the mature follicle cracks and the egg inside is released. (ovulation-ovulation) results in. The period that lasts about 13-15 days before ovulation” follicular – proliferative period“, if around 14 days after ovulation ” luteal – secretory period” is called.

Menstrual bleeding outside the normal pattern; excessive, frequent or irregular intervals is called irregular menstrual bleeding. The majority of these bleedings, such as 75%, are caused by hormonal irregularity. (dysfunctional)while the rest are caused by female genital organs, that is organic Truck. Bleeding before puberty and after menopause absolutely requires immediate investigation. If we list the causes of abnormal non-hormonal bleeding: trauma in the genitals, bleeding-coagulation disorders, vulva and vaginal cancers, uterine lining (endometritis), tube (salpingitis) or cervix (cervicitis) inflammation, polyps in the cervix or in the lining of the uterus, fibroids, Chronic systemic diseases such as adenomyosis, endometrial hyperplasia, cervix-cervical cancer, cervical intraepithelial neoplasia-CIN, endometrium-intrauterine membrane cancer and uterine-uterine sarcoma, thyroid diseases and chronic liver (cirrhosis, etc.-especially the metabolism of estrogen hormone is impaired) diseases, Blood disorders such as Von-Willebrand disease with factor 8 deficiency, leukemia, idiopathic thrombocytopenic purpura (ITP).

Abnormal bleeding after the age of 40 is mostly not caused by hormones, but is related to organic reasons. It should be kept in mind that the use of birth control methods such as spirals, birth control pills or monthly birth control injections used in young reproductive age can cause irregular vaginal bleeding. In addition, in pregnancy; Conditions such as miscarriage, ectopic pregnancy, molar-grape pregnancy can also cause abnormal bleeding.

DIAGNOSIS

Vagina, cervix and uterus, ovaries are evaluated. With ultrasonography, it is investigated whether there is a gynecological mass in the pelvic-lower abdomen (myoma, ovarian-ovarian cyst or cancer, etc.). If no specific cause has been determined after the age of 40, it can be removed from the inner lining of the uterus. endometrial biopsy should be done. Thus, pre-cancerous or cancerous lesions of the intrauterine lining can be detected. Depends on the situation; It may be necessary to perform hysteroscopy, in which the inside of the uterus is evaluated (saline infusion sonography-SIS) accompanied by ultrasonography. A pregnancy test is done to rule out pregnancy. The amount of bleeding and whether there is a problem with coagulation should be evaluated with a complete blood count and coagulation tests. TSH hormone is checked for hypothyroidism. Most of the PCOS and pregnancy complications can be ruled out with the history and physical examination.

If an organic cause of bleeding cannot be determined as a result of the research, menstrual irregularity is accepted as hormonal (dysfunctional bleeding) and regularity is tried to be achieved with hormonal drugs.

Dysfunctional Uterine Bleeding

The most common cause is anovulation (not ovulating). Sometimes abnormal bleeding may occur during ovulatory-ovulation cycles. Bleeding due to ovulation disorder is often; It is seen in the period after menarche (first menstruation) and before menopause. In both periods; The prolonged effect of the hormone estrogen and the absence of ovulation result in the absence of the hormone progesterone. If this situation lasts for many years, the risks of endometrial -intrauterine membrane hyperplasia-thickening and endometrial cancer and uterine sarcoma increase.

TREATMENT

Dilatation and curettage-D & C (Expanding the cervix and scraping the lining of the uterus); It is one of the most effective methods in treatment as it both stops bleeding and enables tissue samples to be sent for pathological diagnosis. But in virgins and low-risk patients, cessation of bleeding with hormonal therapy can be attempted without curettage. Oral high dose estrogen hormoneAfter administration, administration of the hormone progesterone can be tried. high dose birth control pills After oral contraceptives are given 3-4 times a day, this treatment can be done by reducing the dose and continuing. If the patient’s bleeding has led to anemia, blood transfusion may be required.
Why is it anovulation, that is, not ovulating; most effective treatment progesterone hormone is to be given. If birth control is desired, oral contraceptives-birth control pills can be given for long-term treatment. If the patient wants to be pregnant; clomiphene, gonadotropin-After ovulation treatment with ovulation needles vaccination or IVFcan be done.

nonsteroidal anti-inflammatory pain medicationIt has been shown to reduce blood loss in excessive bleeding during ovulation.
If all the mentioned treatments fail; destruction of the endometrium by hysteroscopy (ablation)or abdominal-abdominal or vaginal removal of the uterus- hysterectomymay be required.

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