Lectures of menorrhagia

2021-03-18 12:00 AM

In the past, it was thought that hyper estrogen due to the existence of follicles (long-acting, not ruptured, no oocytes) made the uterine lining overproduce the cyst.

Menorrhagia

Is a bleeding from the uterus with a cycle, lasting for more than 7 days? Hemorrhage is a non-cyclical bleeding phenomenon that lasts for more than 7 days. That is the classic concept, considering the phenomenon of periodic bleeding from the uterus out is menstruation. Up to now, the concept of redness has been kept, although there are many cases of non-periodic bleeding that is still bleeding in nature, the bleeding mechanism is like menstrual bleeding, that is due to rupture of the uterine lining under the influence. of deprivation of female genitals, estrogen or both estrogen and progesterone. This irregular menstrual phenomenon is common in women around the premenopausal age. People often divide hemorrhagic menorrhagia in a young age, at the age of sexual activity and in the premenopausal age, the reason is that each period has its own characteristics.

Young menorrhagia (metropathia juvenilis). It is often called puberty menorrhagia because it is common during puberty, the mechanism of menstrual bleeding, bleeding is prolonged, blood is abundant and fresh, or is repetitive.

Reason

In the past, it was thought that hyper estrogen due to the existence of follicles (long active follicles, not rupture, not ejaculating) make the uterine lining overcapacity. Today, it is found that estrogen can be normal, although it can also be high. Basically, because FSH and LH are inadequate to stimulate the ovaries, caused by disturbances in activities of the hypothalamus, immature activity, insufficient regulation Gn - RH. Usually, the luteal phase is poor or ovulatory, with no luteum phase. Progesterone protects the hypothalamus system - the pituitary is not working properly. Of course, there are many other events that affect the structure of this area itself, the effects of acute and chronic diseases, hematological changes, nervous stress, etc.

Symptom

Prolonged menstruation, usually fresh blood, occurs after a long period (delayed period), sometimes leading to anemia. Physical examination sometimes brings inaccurate signs such as an enlarged and soft uterus, an open neck from the cervix, making the physician think of the threat of miscarriage, especially after a long menstrual cycle appears to be delayed.

Treatment

The first step is to rule out malignant whole labels and then to question hemostasis treatment, with:

Hormone curettage

6-7 days of injection, 20-25mg of progesterone per day, or equivalent dose of progestin. You can add estrogen such as Mikrofollin, Lynoral, 0.05mg per day. The blood will stop, stop the drug for 2-3 days, the bleeding will return, the uterine lining will be completely removed. So called curettage with drugs, curettage with hormones. The timing and amount of blood when the bleeding returns is similar to that of a normal person's period.

Prevent menorrhagia in the following menstrual cycle

For the menstrual cycle, it is possible to give estrogen along with progestin as a combined oral contraceptive. It is also possible to give progestin alone in the second half of the cycle, but this method is not guaranteed to work because it is difficult to predict how many days the next cycle will take to predict the start date of the second half. for medicine.

Ovulation stimulants such as citral clomiphene can be given for 5 consecutive days, from day 3 of the menstrual cycle, 1-2 tablets per day. This treatment is aimed at making the menstrual cycle with oocyte, luteum, endogenous progesterone present and the uterine lining will collapse more succinctly during menstruation days. Results can reach up to 50% of cases.

With the above treatment, in combination with hemostatic drugs, it is usually not necessary to curl the uterus with a tool. In some very rare cases, treatment with all medical methods does not show results before the curettage with instruments. To stop bleeding quickly in cases of acute bleeding, one can use a sulfate complex estrogen (Permarin brand name) dissolved in water, sometimes after only 15 minutes to stop bleeding. But after hemostasis must continue with hormonal maintenance therapy to avoid the blood rushing again when stopping the drug.

Using birth control pills to prevent young menstrual bleeding in the following cycles should be given for 3 consecutive months. Then stop the medication and wait for a response to the rebound effect. If during the period without medication, menstruation returns to normal, then stop using it. If menstruation is chaotic, menorrhagia still occurs, continue treatment for more than 3 months. Note that every month to take the drug for 3 weeks, can only use the drug in the last 10 days of each cycle, each day 1-2 pills of birth control. This method proved very convenient and gave good results. First of all, the hypothalamus is not inhibited in the first half of the menstrual cycle, can exercise activity, but is not completely inhibited as in the month-long method. Furthermore, patients can come to the physician more slowly, after menstruation has cleared,

Prognosis

Babies with hemorrhagic menorrhagia in their youth have a higher rate of secondary amenorrhea. Therefore, careful monitoring is required for a long time, although there may be no clinical abnormalities. In particular, it is necessary to treat menorrhagia very early, to avoid prolonged blood loss, leading to impairment of the hypothalamus - the pituitary does not recover in the already inactive situation.