DM K between the ages of 45 and 55 are called menopausal bleeding.
Etiology and pathogenesis. Climacteric bleeding is based on a violation of the strict cyclical nature of gonadotropin secretion, the interrelationship of FSH and LH and, as a result, follicular maturation processes, which leads to anovulatory ovarian dysfunction. In the ovaries, the persistence of the follicle is more often observed and, very rarely, atresia. Anovulation helps reduce the activity of gonadotropin receptors in the ovaries. As a result, hyperestrogenia is established on the background of hypoprogesteronemia. Excessive proliferation and the absence of secretory transformation of the uterine mucosa lead to endometrial hyperplasia of varying severity. Uterine bleeding due to incomplete and prolonged detachment of the hyperplastic endometrium.
Hyperestrogenic uterine bleeding is also observed in hormone-active ovarian tumors (tech-, more rarely, granulosa-cell). These tumors often occur in perimenopausal age (see Chapter 16, Ovarian Diseases).
Clinical symptoms. As a rule, patients complain of excessive bleeding from the genital tract after a delay of menstruation from 8-10 days to 4-6 weeks. Deterioration, weakness, irritability, headache are observed only during bleeding. In about 30% of patients with menopausal bleeding, menopausal syndrome is also observed.
Diagnostics. The main condition for the effective treatment of DM By the peri-menopausal period, as well as the reproductive period, is an accurate diagnosis of the cause of the bleeding, i.e. exclusion of organic diseases.
DM premenopausal period often recur and are accompanied by neuroendocrine disorders. A general examination gives an idea of the state of the internal organs, possible endocrine disorders, and metabolic changes.
During a gynecological examination, attention should be paid to the conformity of the woman’s age and changes in the genitals, and to eliminate the organic pathology of the genitals. Among reliable and informative methods for the detection of intrauterine pathology are ultrasound, hysteroscopy and separate diagnostic curettage of the uterine mucosa, followed by histological examination of the scraping. In the absence of a hysteroscope and suspected submucosal node or internal endometriosis, hysterography or HSG should be recommended. To clarify the state of the central nervous system is carried out echo and EEG, REG, make a survey image of the skull and the Turkish saddle, examine the color field of view. According to the indications prescribed consultation neurologist. It is advisable to conduct an ultrasound of the thyroid gland, hormonal studies, to determine the level of platelets.
Treatment begins with separate diagnostic curettage of the uterine mucosa under the control of hysteroscopy, which allows you to stop the bleeding and obtain data on the histological structure of the endometrium.
Treatment of climacteric bleeding should be comprehensive. In order to restore normal functioning of the central nervous system, it is necessary to eliminate negative emotions, physical and mental fatigue. Psychotherapy, physiotherapy, tranquilizers, homeopathic medicines (menopause *, menopause *, remsA) make it possible to normalize the activity of the central nervous system.
Since DCC leads to anemization of patients, in acute and chronic anemia, the use of iron preparations (totem *, venofer *), as well as vitamin therapy (preparations of group B vitamins, vitamin K – for the regulation of protein metabolism, ascorbic acid and vitamin P – for strengthening capillaries) are necessary. endometrium, vitamin E – to improve the function of the hypothalamic-pituitary region).
Hormone therapy is aimed at preventing bleeding. For this purpose, synthetic gestagens (didrogesterone, norethisterone) are most often used.
Progestins consistently lead to inhibition of proliferative activity, secretory transformation of the endometrium and cause atrophic changes in the epithelium. The dose and sequence of gestagen use depend on the patient’s age and the nature of the endometrial pathological changes. Patients younger than 47 years old can be prescribed therapy according to a regimen with preservation of regular menstrual cycles: progestogens in the 2nd phase of the cycle – from the 16th to the 25th day of the cycle or from the 5th to the 25th day of the cycle. Treatment of patients older than 48 years is aimed at suppressing ovarian function.
Combined therapy includes the correction of metabolic and endocrine disorders, primarily obesity, through strict adherence to appropriate diet and treatment of hypertension.
Recurrences of climacteric bleeding after hormone therapy are more often the result of undiagnosed organic pathology or an improperly selected drug or its dose, as well as an individual reaction to it. With recurrent uterine bleeding, contraindications to hormone therapy and the absence of data confirming malignant pathology, ablation of the endometrium (laser, thermal or electrosurgical) is possible. These treatments are aimed at preventing the restoration of the endometrium by destroying its basal layer and glands.