Dysfunctional uterine bleeding (DMK) is acyclic uterine bleeding that occurs due to functional disorders in the hypothalamic-pituitary-ovarian system and not associated with obvious anatomical (organic) changes in the female genitals, systemic diseases or complications of pregnancy.
Dysfunctional uterine bleeding of juvenile (12-18 years), reproductive (18-45 years) and menopausal (45-55 years) age periods are distinguished. Uterine bleeding is one of the most frequent hormonal pathologies of the female genital.
Juvenile dysfunctional uterine bleeding is usually caused by the lack of formation of the cyclic function of the hypothalamus-pituitary-ovary-uterus. In childbearing age, inflammatory processes of the reproductive system, diseases of the endocrine glands, abortion, stress, etc., are common causes of ovarian dysfunction and uterine bleeding, while menopausal causes dysregulation of the menstrual cycle due to the extinction of hormonal function.
There are ovulatory and anovulatory uterine bleeding, the latter being about 80%.
The clinical picture of uterine bleeding at any age is characterized by prolonged bleeding that appears after a significant delay in menstruation and is accompanied by signs of anemia: pallor, dizziness, weakness, headaches, fatigue, a decrease in blood pressure.
- Studying of the general and gynecologic anamnesis.
- General objective examination.
- Gynecological examination.
- Laboratory diagnosis:
а) Complete blood count (to determine the degree of anemia of the woman) and urine;
б) Blood test for the group and Rh factor;
в) Blood test for RW, HBs, HIV;
д) Biochemical blood analysis with the determination of serum iron level.
- Hormonal studies: determining the dynamics of levels of FSH, LH, estrogen, progesterone.
- Additional examination methods to exclude fibromatous nodes, endometriosis, endometrium polyps (carried out in the absence of bleeding): ultrasound (assessment of the thickness of the endometrium, myometrium structure allows to identify myxomatosis and foci of adenomatosis, visualize the ovaries with an assessment of their size and structure), uterosalpingography (with water soluble) contrast solutions after 5-6 days after curettage), hysteroscopy (for the detection of intrauterine pathology).
- Tests of functional diagnostics (carried out in the absence of bleeding or after it stops):
а) Measurement of basal temperature;
б) Hormonal colpocytology;
в) The study of the phenomenon of mucus arborization, the symptom of the “pupil”;
е) Determining the level of sex hormones in the blood and urine.
- Determination of the presence of chorionic gonadotropin in the urine (pregnancy test).
- Diagnostic curettage of the cervical canal and the walls of the uterus, followed by histological examination;
- Consultations of related specialists (endocrinologist, hematologist, neuropathologist).
- Hemostatic drugs – hemostatics.
- Hormonal hemostasis.
- Antianemic drugs.
- Restorative therapy.