Health after childbirth
Dysfunction of the ovaries
Liliya Rasaeva obstetrician-gynecologist doctor, cms, gynecological hospital №11
Many women who have this pathology do not immediately realize that their health is in danger. Often they believe that a slight delay in menstruation or, conversely, frequent menstruation, an irregular menstrual cycle is an individual feature of their body. Nevertheless, in the normal menstrual cycle, there are strict parameters: the duration of menstruation is 3-7 days; interval between menstruations 21-35 days; blood loss during menstruation 50-100 ml. It is important to know that any deviation from this norm is a sign of dysfunction of the ovaries. The reproductive system functions normally only if the entire body is healthy. The first thing that is disrupted in women with serious diseases is menstrual and childbearing functions. Therefore, dysfunction of the ovaries is most often a signal of a beginning illness. If you do not pay attention to it in time, then a slight disruption of the function of the ovaries and the menstrual cycle can lead to serious consequences.
Causes and Symptoms
Dysfunction of the ovaries — это общее понятие, под которым понимают нарушение гормональной функции яичников. Эта патология проявляется либо задержкой месячных свыше 35 дней с последующим кровотечением длительностью более 7 дней, либо нерегулярными частыми менструациями, следующими друг за другом через разные промежутки времени (менее чем 21 день). Такие кровотечения называют дисфункциональными маточными кровотечениями (ДМК).
The reasons for this violation are quite diverse:
- internal defects in the ovary itself (congenital and acquired);
- concomitant endocrine diseases (thyroid, adrenal, pituitary, hypothalamus);
- stresses, neuroses;
- diseases of the genital organs (adenomyosis, ovarian tumors, uterine myoma, endometriosis, cervical cancer, uterine bodies);
- disruption of the location of the intrauterine device, abortion (medical abortion, spontaneous abortion);
- influence of a number of natural and physical factors (climate change, excessive solar radiation, radiation damage).
In addition to DMC, women with ovarian dysfunction may be bothered by pains in the lower abdomen before bleeding or during it, most often of a trailing nature. However, sometimes the pain is acute, spreads all over the stomach, gives back. With dysfunction of the ovaries, premenstrual syndrome is often strongly pronounced: lethargy, apathy, tearfulness or, on the contrary, irritability. If bleeding is profuse and prolonged, signs of anemia (reduction of the amount of hemoglobin and erythrocytes in the blood) are added to these symptoms - the pallor of the skin and visible mucous membranes appears, the heart rate increases, headache, dizziness, weakness, drowsiness, and loss of appetite.
Any violations of the menstrual cycle - an occasion for immediate medical attention. Sometimes dysfunction of the ovaries can be the first sign of asymptomatic serious diseases. Examination will exclude conditions requiring immediate surgical intervention: ectopic pregnancy, tumor diseases. The origin of DMC is always a violation of the formation and secretion of hormones that regulate the hormonal function of the ovaries. These hormones are produced by the pituitary gland 1 and are called follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL). For each phase of the menstrual cycle is characterized by a special ratio of the content of these hormones. This is a necessary condition for the maturation of the follicle, ovulation and the onset of pregnancy. If the hormonal function of the ovaries is disturbed, this ratio varies. With the initial manifestations of ovarian dysfunction, the process of ovulation is most often disturbed - it does not occur. This violation is called anovulation (from Latin, a - absence). Therefore, uterine bleeding for ovarian dysfunction is acyclic, i.e. the menstrual cycle is not respected and does not go through all of its phases. DMK indefinitely terminate on their own, however they are often renewed without proper treatment. Acyclic uterine bleeding can be frequent (with an interval of less than 21 days), sparse (with an interval of more than 35 days), blood loss with them may be greater than normal (over 100 ml). But in the future, almost always develops amenorrhea - i.e. menstruation is absent for 6 months or more. With ovarian dysfunction in childbearing age, the estrogen content in the body is almost always increased. This is a risk factor for the development of diseases such as uterine fibroids, endometriosis, malignant breast tumors, and mastopathy.
To identify the causes of dysfunctional uterine bleeding, the following methods can be used: Examination by a gynecologist. Ultrasound of the pelvic organs, if necessary - other internal organs (thyroid gland, adrenal glands). Examination for the presence of sexually transmitted infections (candidiasis, mycoplasmosis, ureaplasmosis, trichomoniasis, chlamydia, etc.), microscopy, seeding on the flora of the genital tract, PCR. Investigation of the hormonal profile (levels of FSH, LH, PRL, estrogens, progesterone, if necessary - determination of the level of hormones of the thyroid gland, adrenal glands). For these examinations, blood from the vein and urine is taken for analysis. Investigation of the pituitary gland: radiography of the skull, computed tomography, magnetic resonance imaging. Research of the state of the brain - electroencephalography. Investigation of the state of the inner layer of the uterus - endometrium: hysteroscopy (examination of the uterine cavity with a special apparatus) with separate diagnostic curettage 1. Scraping is carried out from the cervical canal and the uterine cavity. Histological examination of the scrapes obtained (microscopic examination). The volume and order of examination in each individual case is determined by the doctor. Women with chronic disorders of ovarian function should visit the gynecologist more often (regular checkups once every 3-4 months), because they have a high risk of developing other diseases of the reproductive system.
The first stage of treatment is always stop bleeding. For this purpose, often carry out therapeutic-diagnostic separate curettage. Along with scraping, hysteroscopy is performed - this makes it possible to verify the removal of the entire mucous membrane of the uterus and to identify comorbid diseases: adenomyosis, fibroids, polyps, etc. Scraping from the uterine cavity is examined and, when a concomitant disease is identified, appropriate treatment is prescribed. Next, prevent the recurrence of bleeding. For this, it is necessary to restore the normal menstrual cycle. From the 16th to the 26th day inclusive, after scraping, progesterone preparations are prescribed (with DMK its level is significantly lowered). It can be Dyufaston, Morozhestan, Norcolut. After their application within 7 days, menstruation begins. The first day of menstruation is regarded as the beginning of the cycle. If pregnancy is planned, then for the normalization of the menstrual cycle it is necessary to stimulate ovulation (in fact, in most cases it is not). For this purpose, tools such as clomiphene, prophase, pergonal, hummigon - hormonal drugs that restore the ovulatory menstrual cycle, i.e. stimulating ovulation. They are taken from the 5th to the 9th day of the menstrual cycle inclusive. During the reception of any of these drugs, a woman undergoes ultrasound: the frequency of ultrasound is determined by the doctor - he observes the rate and degree of maturation of the follicle. When the follicle reaches the required value (18 mm), and the thickness of the endometrium becomes 8-10 mm, hCG-chorionic gonadotropin is administered in the dose necessary for ovulation. Chorionic gonadotropin - a hormone that stimulates the transition of the menstrual cycle in the second - luteal - phase. As a rule, stimulation of ovulation is carried out during 3 menstrual cycles. After that, for another three menstrual cycles it is recommended to use only progesterone preparations also from the 16th to the 26th day of the menstrual cycle. Control the onset of ovulation by measuring the basal temperature (in the rectum), the size of the follicle and measuring the thickness of the endometrium with ultrasound (performed once a month, the day is determined by the doctor). When restoring a normal menstrual cycle, a woman can become pregnant and have a baby. If pregnancy is not planned, combined oral contraceptives (COCs) are prescribed - the drug is selected by the doctor individually for each woman. These drugs normalize the menstrual cycle, prevent such consequences of dysfunction, like uterine cancer, ovarian cancer, mastopathy. The content of hormones in these drugs is low (there are even microdosed drugs), they do not affect the weight change, against the background of their intake, the manifestations of premenstrual syndrome stop. Unwanted pregnancy with proper administration of COC is not possible. It should be emphasized that women who have ever had ovarian dysfunction are contraindicated in such a contraceptive method as an intrauterine device.