Juvenile uterine bleeding is considered to be a fairly common disruption of the reproductive system during puberty. Many girls face this problem, and therefore it is important to know about the underlying causes and symptoms of the disorder. Indeed, in the absence of qualified medical care, ailment can lead to dangerous and unpleasant consequences, including infertility.
So why do dysfunctional bleeding appear? What forms of pathology exist? What is the process of diagnosis and is it always possible to notice the presence of the disease yourself? What treatment methods can young patients expect? Are there methods of prevention and popular treatment? Which doctor to contact? Answers to these questions interest many girls.
What are juvenile bleeding?
Uterine bleeding during adolescence is a fairly common problem. According to statistics, about 20-30% of girls face in one form or another of this pathology. It should immediately be noted that the appearance of bleeding from the uterus is in no way connected with organic lesions of the reproductive organs. The main factors in this case is hormonal imbalance.
Puberty in girls is different. Moreover, it is difficult to even establish exact age limits for puberty, since for some girls it begins at 8 years old, for others - at 11. Normally, active development of the reproductive system does not begin until 8 years old and must be fully completed by the age of sixteen. On the other hand, variations are also possible here - for example, the first menstruations often appear in a girl of 18 years.
The girl's body goes through a series of major changes. At the same time, the development process involves not only the uterus and ovaries, but also the brain areas that regulate the production of female sex hormones. It is during this period of hormonal instability that pubertal uterine bleedings are observed, which often coincide in time with the onset of ovulation. So what to do in such cases? Which specialists to contact?
Juvenile uterine bleeding in adolescents: causes
Naturally, first of all patients, as well as their parents, are interested in the causes of the development of pathology. Juvenile uterine bleeding is most often caused by the non-synchronous functioning of the ovaries and the hypothalamic-pituitary system. This part of the brain is a kind of "control center". It produces neurohormones that control the work of all the endocrine glands, including the organs of the reproductive system. Against the background of desynchronization, folliculogenesis processes are disturbed, which leads to a change in the normal menstrual function.
When the relationship between the brain and the ovaries is disturbed, hyperestagenia often develops (a sharp increase in the level of estrogen in the blood). This, in turn, leads to endometrial hyperplasia of the uterus. Often, against the background of such failures, the formation of cysts in the organs of the reproductive system is observed.
Since functional uterine bleeding in juvenile age is associated with hormone instability, several risk factors can be identified. For example, constant stress, nervous overstrain, emotional exhaustion affects the release of hormones, and therefore may well trigger bleeding.
According to statistics, many adolescent girls face a similar problem after suffering infectious diseases, including colds, rubella, chicken pox, flu, mumps, etc. The risk factors include chronic inflammatory diseases that gradually deplete the body’s reserves, for example, tonsillitis
Pathology can be provoked by intense physical exertion, regular workouts (especially for girls who are professionally involved in sports). Proper nutrition is also important, because the diet should contain all the minerals and vitamins. Often bleeding begins after a strong hypothermia of the body.
The causes of bleeding include blood clotting disorders, but this condition is associated not only with the uterus - blood loss is possible in almost any organ, and it is very difficult to stop it.
It is proved that there is a certain genetic predisposition. It was noticed that if the mother had a problematic pregnancy, gestosis, anomalies of the reproductive system, or the same juvenile uterine bleeding during adolescence, then the chances of the development of the disease in her daughters are much higher.
Forms of pathologies
Depending on the characteristics of changes in the hormonal background, juvenile uterine bleeding can be of two types:
- Hyperstroe pathologies, which, by the way, are observed most often. They occur on the background of increased levels of estrogen and are accompanied by abundant, prolonged secretions from the genital tract. As a rule, such bleeding occurs after a slight delay of menstruation (from 1 to 3 months).
- Rarely, patients are diagnosed with hopoestrogenic forms that develop on the background of estrogen deficiency. As a rule, bleeding begins after a long delay in menstruation (from 2 to 8 months). The secretions are not too abundant and often quickly disappear by themselves.
What symptoms are accompanied by pathology?
Unfortunately, quite often teenage girls cannot distinguish bleeding from menstruation. By the way, the first episodes of pathology often fall on the first menstruation. However, they may continue for several years after the onset of ovulation.
Bleeding is rarely accompanied by severe pain. However, an increased amount of secretion can be noted. Often, bleeding lasts for several days in a row (8 or more) - this is a cause for concern. Pathology can occur not only during menstruation, but also between them. In addition, the cycle time is reduced - it is less than 21 days.
Against the background of persistent blood loss, anemia develops. Girls complain of weakness, chronic fatigue, decreased performance, learning difficulties, fatigue, constant dizziness. The skin becomes pale.
Symptoms of juvenile uterine bleeding
- Intermenstrual bleeding from the genital tract that occurs between menstruation - metrorrhagia.
- Irregular prolonged uterine bleeding, usually occurring after menstruation, menometrorrhagia.
- Regular long (more than 7 days) and heavy (more than 100 ml) uterine bleeding (menstruation) - menorrhagia, hypermenorrhea.
- Regular uterine bleeding (menstruation) with an interval of less than 21 days - polymenorrhea.
- General malaise, weakness, dizziness, headache.
- Hyperestrogenic - on the background of elevated levels of estrogen in the blood (with the persistence of follicles in the ovaries). Spotting from the genital tract, abundant, prolonged, usually occurring after a slight delay of menstruation (1-3 months).
- Hypoestrogenic - against the background of a low level of estrogen in the blood (with follicle atresia in the ovaries). The bloody discharge from the genital tract, as a rule, is not abundant, arising after a delay of menstruation for 2-8 months.
A gynecologist will help in the treatment of the disease
- Analysis of the history of the disease and complaints (when (how long) bleeding from the genital tract, their duration, intensity, etc.) appeared.
- Analysis of menstrual function (duration and regularity of the menstrual cycle, profusion and pain of menstruation, when there was the first and last menstruation, etc.).
- Analysis of the history of life (illness in childhood, features of the course of pregnancy and childbirth in the mother of the girl, etc.).
- Gynecological examination.
- Ultrasound diagnosis of the pelvic organs.
- Determination of the level of hormones in the blood (FSH, LH, estradiol, progesterone, prolactin, testosterone, 17-OH-progesterone, DGA-S, TSH, T3, T4).
- The study of blood coagulation (coagulogram).
- Consultation gynecologist-endocrinologist, endocrinologist.
Treatment of juvenile uterine bleeding
- Symptomatic treatment - stop bleeding:
- uterine contractions (uterotonic),
- hemostatic drugs,
- drugs that strengthen the walls of blood vessels,
- surgical method (curettage of the uterus).
- Hormonal therapy is determined depending on the form of juvenile uterine bleeding:
- taking drugs containing only estrogen (estrogen),
- taking drugs containing estrogen and progesterone (estrogen-gestogenny drugs),
- taking drugs containing progesterone analogue (gestagennye drugs).
- Physiotherapy treatment (hydrotherapy, overtonal frequency currents in combination with copper electrophoresis, sulphide waters, mud therapy, etc.).
- Restorative therapy (taking vitamins of various groups, exercise therapy, etc.).
Prevention of juvenile uterine bleeding
- Timely and adequate treatment of infectious and inflammatory diseases (chronic tonsillitis, bronchitis, tonsillitis, etc.).
- Fetal protection in the antenatal period (intrauterine) - regular monitoring of a pregnant woman with an obstetrician-gynecologist, compliance with medical recommendations, timely correction (correction) of complications or abnormalities during pregnancy.
- Compliance with a healthy lifestyle (avoiding bad habits, proper nutrition with the exception of unreasonable diets, regular exercise, hardening, etc.).
- Exclusion of excessive physical and psycho-emotional stress, respect for sleep and wakefulness.
- Maintaining a menstrual calendar.
- Regular visits to the gynecologist 1 time per year.
Causes of violations
The main reason is a violation of the hypothalamic-pituitary system. Hormonal failure triggers a single-phase ovarian cycle with delayed menstruation and further bleeding. Most often, dysfunctional uterine bleeding of puberty occurs during the first two years after menarche.
There is no direct connection between this pathology and the development of other secondary sexual characteristics. In general, puberty girls passes without violations. In more than a third of patients, the disease may be complicated by the appearance of acne and oily seborrhea.
The appearance of uterine bleeding in older girls is noted with early menarche (7-12 years). It is diagnosed in more than 60% of patients. With the late appearance of the first menstrual periods (after 15-16 years), this pathology rarely occurs - no more than 2% of cases.
The main causes of the pathological condition in adolescents:
- pathology of blood clotting system,
- the formation of ovarian tumors of hormonal origin,
- acute and chronic infectious diseases (ARVI, pneumonia, chronic tonsillitis, chicken pox, rubella),
- diseases of the endocrine system (pancreas, adrenal glands),
- genital tuberculosis,
- malignant neoplasms of the body and cervix,
- living in adverse conditions, excessive physical and psychological stress,
- poor nutrition that does not provide the body with essential vitamins and trace elements.
Chronic tonsillitis with regular periods of exacerbation is recognized as the most significant provoking factor. There is a definite connection between the disease in girls and how pregnancy proceeded in her mother. Late toxicosis, chronic intrauterine hypoxia of the fetus, premature aging or detachment of the placenta, asphyxia of the child at birth could be provoking factors.
Symptoms of the disease
For many girls, the regular monthly cycle does not recover immediately after menarche, but only for half a year — two years. Menstruation can take place with a delay of two to three months, and sometimes half a year. Uterine bleeding often occurs after a delay of menstruation up to 2 weeks or one and a half months.
In some cases, dysfunctional bleeding may occur a week or two after menarche or occur in the intermenstrual period. The main symptoms of pathology include:
- copious (more than 100 ml per day) and prolonged (more than 7 days) bleeding,
- discharge occurring 2-3 days after the end of menstruation,
- menstruation, which are repeated at intervals of less than 21 days,
- dizziness, drowsiness, nausea as a result of anemia,
- pallor of the skin, dry mouth,
- pathological desire to eat inedible foods (such as chalk),
- depression, irritability, fast physical fatigue.
Very often, a girl and even her more experienced mother can not identify the violation and regard it as usual periods. The girl can continue to lead her habitual way of life, thereby postponing treatment, which should start immediately, and aggravate the problem. It should be remembered that any abundant discharge, and even with clots, require close attention. Monthly are considered abundant when the pad or tampon has to be changed at least every hour.
Since the pathology can be caused by various reasons, in addition to the mandatory examination by the pediatric gynecologist, consultation of an endocrinologist, a neuropathologist, an oncologist is necessary.
Treatment of folk remedies
Traditional medicine known for many herbs, infusions and decoctions of which have a hemostatic effect. However, they can not completely replace drug treatment. Herbal decoctions and infusions can be used as an additional treatment method.
Among the most effective plants should be highlighted:
- Pomegranate - contains acetic and malic acids, tannin, vitamins K and C, strengthens the walls of blood vessels, increases blood viscosity,
- water pepper - tannin, organic acids, vitamin K in the composition stabilize the activity of the smooth muscles of the uterus, increase blood clotting,
- shepherd's purse - contains alkaloids, organic acids, vitamin C, tannin, riboflavin, which help reduce blood excretion,
- nettle - the most famous plant to stop bleeding, regulates the menstrual cycle, nourishes the body with vitamins K, C, A, B.
For the preparation of decoctions, the grass of plants is crushed, poured boiling water and kept in a water bath for 15-20 minutes. After filtering, take several times a day. The duration of administration and dosage should be clarified with a doctor.
Prevention of bleeding
Since juvenile bleeding occurs mainly with hormonal disorders, there are no specific preventive measures. However, following certain recommendations will help reduce the risk of their occurrence:
- Timely treatment of infectious and viral diseases, especially those that become chronic (tonsillitis, bronchitis, ARVI).
- Regular observation of pregnant women by an obstetrician-gynecologist, starting from early gestational periods in order to identify and correct early and late toxicosis, edema of pregnant women, intrauterine fetal developmental disorders, premature birth, fetal hypoxia.
- Adherence to a teenage girl principles of proper nutrition - eating foods rich in vitamins, the exclusion of fast food, the avoidance of "diets" that involve prolonged starvation.
- Maintaining a menstrual calendar, which will help pay attention to deviations when they first appear.
- Receiving sedative drugs in order to strengthen the blood vessels and the nervous system (as prescribed by a doctor).
- Refusal of bad habits, adherence to the day, a good sleep, regular exercise, sports.
- Notification girls about the dangers of early sexual intercourse.
Separately, it should be said about the need to visit a pediatric gynecologist. Many mothers consider it superfluous until the girl becomes sexually active. Visiting a pediatric gynecologist for prophylactic purposes, especially after the onset of menstruation, should be just as normal as visiting other doctors.
What complications are possible?
Immediately it should be noted that girls 18 years and more, as a rule, no longer suffer from such pathologies, since the hormonal background can be leveled with the help of properly administered therapy. But with the wrong treatment or its absence, the consequences can be dangerous.
Massive blood loss is dangerous in itself. Moreover, recurrent bleeding leads to the development of anemia. In turn, this disease is fraught with oxygen starvation and depletion of the body. It is also possible the development of persistent hormonal disorders that provoke a variety of problems, including the formation of cysts and tumors in the tissues of the ovary, as well as infertility.
Modern diagnostic methods
Of course, the diagnostic process should include several stages.First, the teen gynecologist will try to collect a full history. It is important to know when the discharge appeared, whether there were provocative factors, whether the patient's mother was suffering from gynecological diseases, whether the girl had any infectious diseases, etc.
Next, a standard gynecological examination is performed, and then an ultrasound examination of the pelvic organs - this makes it possible to assess the condition of the ovaries, detect the presence of cysts or other neoplasms, check whether there is an inflammatory process, etc. In order to examine the internal genitals more closely, sometimes held hysteroscopy.
Since girls' juvenile uterine bleeding is associated with hormonal imbalances, the blood test for hormones is an essential part of the diagnosis. In particular, they check the levels of progesterone, FSH, estradiol, LH, testosterone and thyroid hormones. When violations are detected, the patient is sometimes referred for consultation to an endocrinologist.
Depending on the data obtained in the process of diagnostics, a blood clotting test may be additionally performed. Only after receiving all the necessary data, the doctor can make an effective treatment regimen.
Drug treatment: drugs to stop uterine bleeding
The treatment of such a pathology largely depends on its severity, as well as the cause of development. If juvenile uterine bleeding in one way or another associated with physical or emotional stress, they need to be eliminated - sometimes even this is enough to ensure that episodes of the disease do not recur.
Unfortunately, in most cases the condition of the patients is more severe, and the bleeding requires hospitalization. The first task in this case is to stop blood loss. To start, girls are prescribed hemostatic drugs, in particular, Vikasol, Ditsinon, as well as aminocaproic acid and ascorutin. Oxytocin, which causes contractions of the uterus and helps to stop bleeding, is also necessary. Glucose solution is injected intravenously.
If the above treatment regimen does not have the desired effect, the patient is prescribed hormonal estrogen-gestation drugs, in particular, Marvel, Rigevidon, Mersilon. Such drugs in most cases help to stop blood loss during the day, after which their dose is gradually reduced. Nevertheless, the course of taking pills lasts 21 days. Such therapy helps not only eliminate bleeding, but also gradually normalizes the normal menstrual cycle, which is important, especially if the pathology is associated with a serious hormonal imbalance.
In addition, the patient is prescribed vitamin complexes, iron supplements, vessel-strengthening drugs - this helps to eliminate anemia and restore the balance of minerals and nutrients in the body. In case of severe anemia, not only iron, but also folic acid, vitamins C and B12 are necessary. Massive blood loss is an indication for erythrocyte mass transfusion and frozen plasma. Needed and physiotherapy. Comprehensive treatment should also include feasible physical exertion, a healthy diet, the correct mode of work and rest.
If bleeding occurs on the background of stressful situations or is associated with a mental factor, then consultation with a psychotherapist is mandatory. Sometimes you need to take sedatives and other drugs.
Surgical treatment: when is it necessary?
In some cases, such a pathology requires surgical intervention. Hysteroscopy is performed with diagnostic curettage of the uterus. This procedure is usually performed under general anesthesia, but it is also possible with the use of local anesthesia. If possible, the doctor retains the hymen. The tissues obtained during curettage are then sent to the laboratory for further research.
Surgical intervention is required for long-term massive bleeding that cannot be established by conservative means. But even after curettage, the patient requires treatment with medications, including hormones. It is worth noting that in case of bleeding disorders, the operation should never be performed.
Are there effective prevention methods?
It's no secret that sometimes it is much easier to prevent the development of a disease than to undergo treatment and fight complications. Modern medicine recommends preventive maintenance therapy to prevent new bleeding.
From the fifth to the fifteenth day of the menstrual cycle, patients are prescribed vitamin E, folic acid and glutamic acid, as well as an intravenous solution of vitamin B. From the 16th to the 26th day of the cycle, the treatment regimen looks different - the girls take ascorbic acid and vitamins of groups B. Such treatment is carried out within three months after the cessation of bleeding and, according to reviews, gives really good results.
If the bleeding was stopped with the help of hormonal drugs, the patient is shown to take small doses of progestins, in particular “Logest”, “Novinet”, “Silest” and some other drugs. Estrogen-progestin medications are prescribed to girls who have been cureable, followed by hormonal arrest of bleeding.
Naturally, during the rehabilitation period, general health procedures are of great importance. The important point is proper nutrition. You need to ensure that the body gets enough vitamins and minerals. Twice a year, prophylactic vitamin supplementation is recommended.
All this will not only prevent the appearance of bleeding in the future, but will also help to normalize the menstrual cycle, to adjust the work of the reproductive system.
Positive physical conditions will affect positively the state of health (their intensity should increase gradually), swimming, walks in the fresh air, rest by the sea, active tourism, sanatorium-and-spa treatment.
Juvenile uterine bleeding is a bleeding that is outwardly similar to menstrual bleeding. not having a specific cycle (that is, those that do not arise on a regular basis) and are not tied to the processes of ovulation.
Allotment very abundant (more than 100 ml. of blood per day), their duration, as a rule, is not less than 1 week, bleeding occurs with a different interval (sometimes less than 21 days, in other cases - more than several months). In the discharge can be found characteristic blood clots.
The first signs of pathology can occur in girls aged 9-13 years. If no action is taken at this time, the situation will worsen.
In particular, in pubertywhen a girl has a menstrual cycle, uterine bleeding can lead to a serious violation of it (menstruation lasts from 2 weeks to several months). All this adversely affects the reproductive function of the female body.
Classification and forms
According to the volume of blood loss and dependence on the menstrual cycle, uterine bleeding in adolescents can be divided into the following types:
- Menorrhagia. Bleeding does not lead to irregularities and changes in the menstrual cycle. At the same time, the volume of blood secreted is very significant (over 80 ml. Per day, the duration is about 7 days).
Metrorrhagia. Allocations have a rather scanty volume, which is not observed.
- Polymenorrhea. There are irregularities in the menstrual cycle when it is less than 21 days.
Recommendations for the treatment of vulvovaginitis in girls can be found on our website.
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Dysfunctional uterine bleeding of the juvenile period is a process that develops in a certain sequence. There are the following stages of development this phenomenon:
- Violations of the secretory function of the hypothalamus.
- Changes in the amount of hormones secreted by the pituitary gland.
- The level of the hormone secreted by the ovaries decreases.
- The level of estrogen decreases, which contributes to the disruption of the maturation process of the egg follicles (they are rejected before they reach full maturity).
- As a result of lowering the level of progesterone, the process of ovulation is disrupted, which now happens irregularly.
- Deformation of the mucous membrane occurs, which lines the uterus from the inside.
- The elements of the mucous membrane, together with the immature follicles, are excreted from the body in the form of bleeding.
Main symptoms uterine bleeding in a girl are:
- copious bloody discharge of about 100 ml. per day,
- the duration of the bleeding period is 7 days or more,
- if there are more scarce bleeding, their duration is about 2 weeks,
- a decrease in the duration of the menstrual cycle, the duration of which is not more than 21 days,
- spotting in the period between menstruation,
- violation of blood coagulation,
- deterioration of general well-being, in particular, weakness, frequent dizziness,
- decrease in blood pressure,
- increased fatigue
- propensity to develop depression, depressed emotional state,
- blanching of the skin,
- constant thirst.
These symptoms not always manifested fully.
The main signs of uterine bleeding are copious discharge, the presence of discharge between periods, changes in the menstrual cycle.
The development of uterine bleeding in girls can lead various negative factors such as:
- Changes in hormonal levels in the body, associated, for example, with the achievement of a period of puberty, taking hormone-containing drugs.
Infectious diseases in acute or chronic form of the course.
- Improper nutrition, in particular, the use of products, poor in vitamins and minerals, hypovitaminosis.
- Psychological trauma.
- Prolonged physical or intellectual fatigue.
- Changes in the blood vessels (capillaries) in the tissues of the uterus, in particular, their expansion, leading to stagnation of blood in the uterus.
- Deformation of certain areas of the mucous membrane of the organ.
Complications and consequences
Juvenile uterine bleeding, especially if they are plentiful and long lasting, often lead to a drop in the level of hemoglobin in the blood, and, consequently, to the development of anemia.
Anemia, in turn, contributes to the deterioration of the general well-being of the girl, weakness, increased fatigue, dizziness.
The most dangerous complications of uterine bleeding is a change in the uterine lining.
As a result of such changes, precancerous conditions often occur in this area, development and malignant tumors of the uterus.
With a significant deterioration in the condition of the girl, need to give her first aid. And for this:
- It is important to reassure the girl, to protect her from emotional experiences.
- On the lower abdomen is recommended to put a heating pad with ice.
- Provide plenty of drink (add a small amount of sugar and lemon juice to the water).
- To improve your well-being, you can give your child a Dicinone pill, a vitamin C drug.
It is important to remember that if after all these actions the attack has passed, the child still needs to be shown to the doctor as the methods mentioned above can only eliminate the symptoms of the disease, but not its cause.
Further, depending on the symptoms of the ailment and their severity, medication therapy is prescribed, which includes the following drugs:
- Means that increase the tone of the uterus (Oxytocin).
- Preparations for blood thickening (Vikasol, Ditsinon).
- Means for strengthening the vascular walls (Askorutin).
- Drugs that increase hemoglobin (Maltofer, Venofer).
- Sedative drugs with severe anxiety (tincture of valerian, motherwort).
- Hormonal agents (prescribed to girls over the age of 13 years, if there is a pronounced deformation of the tissues of the uterine mucosa).
In case of severe bleeding, which pose a threat to the health and life of the girl, surgical methods of treatment are used, such as curettage, cryodestruction of the uterine mucosa.
The main ways to establish the presence of the disease and identify its extent, methods of first aid, the sequence of stages of treatment, a list of drugs, indications for hospitalization and surgical treatment are spelled out in special documents, developed by specialists in the field of pediatric gynecology.
Diagnosis and treatment of pubertal abnormal uterine bleeding - clinical guidelines.
Juvenile bleeding: classification
All juvenile bleeding is divided into anovulatory and ovulatory. The first type of pathology is characterized by cycle failures, large blood loss, loss of appetite, drowsiness and weakness. You can recognize it by the clinical picture of the flow on a gynecological examination, during ultrasound and other laboratory tests.
Ovular bleeding in its manifestations are similar to the usual monthly discharge in women. Their distinctive feature is the duration, there are also scanty discharge for the entire month and too short or too long periods between periods.
Juvenile bleeding: symptoms
The main symptom of juvenile bleeding is blood discharge from the genitals that occurs after a delay of menstruation for a period of 2 weeks to 2 months. For many girls, this phenomenon is repeated. Bleeding is usually profuse and is accompanied by weakness, dizziness and other signs of anemia. In some cases, with such a violation, moderate intensity bleeding is observed, but there are no signs of blood loss, such juvenile bleeding can last up to two weeks or more.
Juvenile bleeding: treatment
Therapy of bleeding data involves two stages, the first of which stops the bleeding, and the second - the prevention of recurrence of the pathology. The choice of the appropriate treatment for juvenile bleeding depends on the condition of the patient.
In severe cases (with severe anemia, pallor of the skin and decrease in hemoglobin to a level of 80 g / l and below), if the bleeding continues, surgical treatment is indicated. It consists in carrying out curettage of the uterus with the removal of the mucous membrane and the subsequent laboratory examination of part of the scraping. To avoid damage to the hymen doctors use baby vaginal mirrors. Among other things, the patient is prescribed vitamins B and ascorbic acid, as well as iron supplements. Nutrition in the recovery period should be increased calorie.
If the patient's condition is regarded as moderate or satisfactory, then conservative treatment is carried out. It includes hormonal and vitamin-containing drugs.
With timely initiated full-fledged treatment, the prognosis for the development of the disease is favorable. If the necessary measures are not taken on time, the development of infertility is possible.
Prevention of juvenile bleeding
Preventive measures for juvenile bleeding are aimed at the formation of a regular cycle in a woman. To do this, you can use hormonal drugs such as oral contraceptives. In preventing the appearance of juvenile bleeding, acupuncture is used, which stimulates ovulation and increases the regularity of the cycle. Of particular importance is the maintenance of general body health: sanitation of the oral cavity and other possible foci of infection, proper nutrition, physical activity, vitamin therapy, hardening, and so on.
Causes of bleeding
The main cause of bleeding in girls is a disorder of the ligament of the pituitary-hypothalamus-ovaries. Processes occur in it that lead to changes in the production of FSH and LH. Their essence is irregularity in the selection of follicles. In each cycle should be formed dominant, but it is absent. Нарушается объем прогестерона, так как не приходится ждать появления его источника — желтого тела. Матка делается мишенью лишь для эстрогенов.
As a consequence of violations of the ovaries may appear cysts, follicular (in most cases) or corpus luteum. Endometrium lacks the chance of timely replacement, that is, the menstrual function suffers negative changes. Therefore, juvenile uterine bleeding is usually detected after the delay of menstruation for a time from 1.5 to 6 months. But they also happen after 2 - 3 weeks after menstruation. The lining of the uterus grows excessively as a result of the hyperplastic process. And leaving the body content is characterized by an increased volume or duration of elimination, and sometimes both signs.
The circumstances contributing to such disorders are:
- acute and chronic infections (tonsillitis, pneumonia, flu),
- deficiency and excess of vitamins, minerals,
- strong emotional experiences
- excessive physical exertion
- hereditary features of development,
- problems with the thyroid, pancreas,
- blood pathology,
- liver disease.
Signs of pathology
Juvenile hemorrhages in adolescent girls are considered as such if they are detected between menarche and up to 2 years after it. His signs:
- copious discharge of blood from the genital tract,
- their existence over 7 days,
- detection of moderate bleeding, but for more than 15 days,
- deterioration of blood clotting, and, as a result, increase in the volume of uterus contents being expelled,
- dizziness, fatigue, drowsiness, nausea, as a result of high loss of biological fluid,
- pallor of skin, dry mouth.
Problem Identification Methods
Juvenile dysfunctional uterine bleeding requires identifying the perpetrators of their occurrence, as well as differentiation from incomplete spontaneous abortion. Examinations are carried out before the discharge stops and after, the complex consists of:
- questioning and examining the patient,
- various blood tests, from which you need to know the number of platelets, APTTV, other features of coagulation, biochemistry,
- hormone tests (FSH, LH, progesterone, estrogens, prolactin, cortisol, thyroid substances, testosterone),
- Ultrasonography of the uterus and ovaries to assess the condition of the mucous membrane of the gonads (for those with intimate life, the examination is performed intravaginally).
Dysfunctional uterine bleeding of the juvenile period will require consideration of the physical development of the girl, secondary sexual characteristics. After stopping the discharge, a wide examination of the patient’s condition is carried out, bearing in mind the probable perpetrators of the problem:
- X-ray skull with projection of the Turkish saddle,
- echo and electroencephalography,
- CT scan of the brain assuming the presence of a pituitary tumor,
- echography of adrenal glands and thyroid,
- ultrasound again to see in the dynamics of the lining of the uterus and ovaries.
What doctor should the patient go to
Uterine juvenile bleeding at 12 years of age can be the result of not only hormonal imbalance caused by a transitional stage in life. They are manifestations of a different ailment, and not the pathology itself. In particular, uterine bleeding is detected in coagulation of the Vergolf disease, inflammation of the internal genital organs, tuberculosis, and a tumor. Therefore, a mandatory consultation with a gynecologist may not be enough to have all the information. In some cases, the patient will need to be examined:
- a neurologist,
The first 3 specialists will be needed for all girls who are concerned about juvenile bleeding.
Hormones against bleeding
Hormonal hemostasis in juvenile bleeding is indicated if it is not possible to achieve the effect of a different treatment. It involves taking estrogen-progestin drugs to equalize its own balance of substances. The choice is made from the drugs "Rigevidon", "Non-Ovlon", "Mersilon", "Marvelon", which they drink 3-4 tablets per day every 6-8 hours. This allows you to get rid of bleeding on the first day of using one of the remedies. After the dosage is reduced by half a tablet every 2 days, if the problem goes away. When in this way only 1 piece is needed for a single use, the drug is not stopped to drink. The general course should last 21 days. After discontinuation of the medication, there will be a small discharge with blood that will not last longer than the usual period.
Hormonal hemostasis for blood clotting disorders is performed using artificial gestagens, sometimes combining them with glucocorticosteroids. How to take duphaston with juvenile bleeding: it is prescribed 10 mg twice a day. Treatment should last 7 days. Progestins are shown in the case when the level of estrogen in functional diagnostic tests is elevated or moderate. In addition to Duphaston, Norkolut is also used.
We recommend reading the article on menstrual irregularities. From it you will learn about the deviation from the norm, the causes of pathology, diseases that lead to disruption of the cycle, treatment.
Prevention of the appearance of pathology
Stopping the discharge control of juvenile bleeding should not be limited. Prevention is required, which is a whole system of measures:
- Observance of a correct way of life, nutrition, emotional stability. Also shown moderate exercise, fresh air.
- Girls up to 15 years of vitamin therapy on the days of the cycle. From the 5th to the 15th, folic and glutamic acids and B6 are needed. Ascorbic acid and B1 are shown from the 16th day of the cycle. Vitamin E is taken all month. Therapy lasts 3 cycles.
- Girls 16 - 17 years old will need gestagens. This is all the same "Duphaston", appointed from the 5th day of the cycle on the tablet (course 21 days). Another scheme - from the 16th day of the cycle on 2 doses (course of 10 days).
Juvenile bleeding, ICB 10, puts No. 93 “Other abnormal bleeding from the uterus and vagina.” But the problem may be much wider. Therefore, a thorough examination of the problem by professionals and the fight against bleeding, spotting is very important, they should not be written off solely on the game of hormones. Gynecological well-being is largely laid in childhood.
Treatment of uterine bleeding of reproductive age is determined after obtaining the results of histological analysis. If a relapse occurs, non-hormonal and hormonal hemostasis is performed. Next, you must comply with measures to correct the identified dysfunction, with the help of hormonal treatment. It is necessary to regulate the menstrual function.
In the period of menopause
Treatment of uterine bleeding in menopause is aimed at suppressing hormonal function and menstruation, in other words, menopause is provoked. Bleeding can only be stopped surgically - curettage and hysteroscopy or surgical removal of the uterus.
- As a preventive measure of juvenile uterine bleeding, proper nutrition is recommended, with elevated levels of iron in foods. General hardening of the body, rehabilitation of chronic infectious foci, as well as the use of progestin preparations are carried out.
- As prophylaxis of uterine bleeding of reproductive age, the treatment of associated diseases is necessarily carried out, the neuro-psychological state is normalized with the help of vitamins and sedatives. But with the wrong choice of treatment, uterine bleeding can occur again.
Prevention of dysfunctional uterine bleeding should be carried out even in the period of intrauterine development. Further, as the organism develops, measures should be taken to strengthen the body, for example, hardening. Diseases, including the sexual sphere, must be promptly treated. In case of uterine bleeding, it is necessary to take measures to restore the menstrual cycle, for this purpose, the appointment of hormonal contraceptives. Oral contraceptives reduce the likelihood of unplanned pregnancy and as a result of abortion. In addition, drugs allow the body to lead to hormonal balance. It is also recommended to regularly visit a gynecologist, at least 2 times a year and more often.
Causes of juvenile uterine bleeding
Juvenile uterine bleeding has a polyetiological nature and occurs under the influence of many internal and external factors. The main reason is the imperfection of the regulation of the reproductive system in the period of formation of the menstrual cycle. Factors affecting still in the antenatal period can predispose to unstable functioning. We are talking about the pathologies of pregnancy and childbirth of the mother of the girl, especially intrauterine hypoxia, since oxygen deficiency is destructive for the brain and may later manifest a violation of the hormonal functions of the pituitary gland. Thus, hormonal disorders in juvenile uterine bleeding are often caused by dysfunction in the central part of the regulation.
Against the background of the existing predisposition of a girl of puberty, they are often subject to emotional stress. The trigger for the development of juvenile uterine bleeding can serve as a conflict in the family or with peers, school failure, problems in relationships with the opposite sex and much more. Stress leads to impaired production of follicle-stimulating (FSH) and luteinizing hormone (LH) more often with an excess of the first of them. As a result, ovulation does not occur, hyperestrogenia takes place for a long time, which is the main cause of increased proliferation of the endometrium without its timely rejection. The uterus mucosa is often undergoing abnormal changes with the formation of polyps and cysts. Areas of ischemia and necrosis appear, subsequently the endometrium is rejected with the development of juvenile uterine bleeding.
Classification of juvenile uterine bleeding
Dysfunctional bleeding puberty are divided depending on the degree of blood loss and its connection with the phase of the menstrual cycle. There are also differences due to the concentration of estrogen in the blood. The following clinical options for juvenile uterine bleeding are possible:
- Menorrhagia. The rhythm of menstruation is preserved, blood loss exceeds 80 ml with a duration of more than 7 days.
- Polymenorrhea. The cycle is also saved, is regular and short (less than 21 days).
- Metrorrhagia - acyclic uterine bleeding, which is often preceded by cycles with scarce bleeding (oligomenorrhea).
Very important in determining the medical tactics is the correlation of the types of juvenile uterine bleeding with the concentration of estrogen in the patient's blood. There are three types of bleeding: hypoestrogenic, normoestrogenic and hyperestrogenic. Hypoestrogenic type occurs in girls with underdeveloped secondary sexual characteristics with accelerated development of intelligence (acceleration). The norm estrogen type suggests harmonious physical development, but the size of the uterus remains below the age norm. Hyperestrogenic juvenile uterine bleeding occurs in physically developed girls, often with some psychological immaturity.
Symptoms of juvenile uterine bleeding
The typical age of onset is 13–16 years old, there may be cases of earlier or late onset of symptoms. Both the girl and her parents can contact the doctor. The main complaint is blood loss, subjectively exceeding the volume of a normal menstruation. Juvenile uterine bleeding is often acyclic and occurs against the background of a previous menstrual delay. The duration of bleeding is usually 3-4 weeks, but statistics show that the duration of blood loss can vary from 10 to 90 days. Approximately 10-15% of cases of bleeding are accompanied by pain in the lower abdomen.
With prolonged juvenile uterine bleeding, paleness and dryness of the skin, an increase in the pulse are observed, which indicates the development of post-hemorrhagic anemia. The latter is also manifested by general weakness and dizziness. The features of the physical development of the girl and her personal characteristics attract attention. Some of them are described above, in general, there is increased anxiety, often the mood is lowered, perhaps a subdepressive state. The development of secondary sexual characteristics in juvenile uterine bleeding may correspond to the age norm or lag behind it.
Treatment of juvenile uterine bleeding
As a rule, treatment is carried out on an outpatient basis. The indications for hospitalization are juvenile uterine bleeding, not amenable to medical correction, or profuse uterine bleeding. To stop bleeding, uterotonics and hemostatic agents are first used, while vitamin therapy and correction of anemia are performed. If treatment is ineffective, hormone therapy with monophasic COC in low doses is prescribed, the number of courses is determined individually. If blood loss persists, despite the measures described above, the issue of hysteroscopy, that is, diagnostic curettage of the uterus, is resolved. As a rule, in this case, the cause of juvenile uterine bleeding becomes glandular-cystic deformity of the endometrium.
An obligatory stage of therapy is the prevention of recurrent juvenile uterine bleeding. It is recommended to maintain a normal weight, if necessary, appropriate diet is prescribed, since an excess or deficit of body weight is to some extent responsible for the regulation of the menstrual cycle. Dispensary observation is carried out once a month until the cycle is stabilized; echography is performed at least once in 6-12 months. In general, a number of specialists are involved in the treatment of juvenile uterine bleeding, including a pediatrician, an endocrinologist, a hematologist, a neurologist, and an oculist. Psychological counseling is recommended.
Prognosis and prevention of juvenile uterine bleeding
The prognosis largely depends on the cause of the development of bleeding and the success of therapy. Unfortunately, very often the cycle has to be regulated by hormones, which has a number of negative consequences for the girl. In addition, it does not eliminate the primary cause of the resulting disorders, that is, the central internal regulation remains impaired. In the future, gynecological pathology is noted in most girls, primary infertility is diagnosed in more than half of the cases. Prevention is possible partly in the antenatal period. A favorable family environment also reduces the risk of juvenile uterine bleeding.
What is Juvenile Uterine Bleeding?
Dysfunctional uterine bleeding in the pubertal (juvenile) period is called juvenile uterine bleeding (UMC). Their frequency is 20% or more of all gynecological diseases of childhood. UMCs are associated with the immaturity of the hypothalamic-pituitary system, in particular with the unsteady cychoral (hourly) rhythm of lyulberin secretion. This leads to a violation of the proportions of FSH and LH secreted by the pituitary gland, more often to a single-phase ovarian cycle or a deficiency of the luteal phase. Due to the dysfunction of the entire reproductive function regulating system, endometrial hyperplasia develops.
What triggers juvenile uterine bleeding
At the heart of dysfunctional uterine bleeding is the desynchronization of the functioning of the hypothalamic-pituitary-ovarian system. As a result, the relationship between the secreted releasing hormones FSH and LH changes, folliculogenesis and menstrual function are disturbed. Several atretic follicles mature in the ovary, or one persists, but the dominant follicle is absent and, consequently, the corpus luteum is not formed. When several follicles mature in the body, “relative hyperestrogenism” is observed, i.e. There is little estrogen, but the corpus luteum is absent, so the uterus is influenced only by estrogen. With the persistence of the follicle, the level of estrogen is higher than normal (absolute hyperestrogenism), but even so, the uterus is only under the influence of estrogens. Often in the ovaries follicular cysts are formed (82.6%), less often yellow body cysts (17.4%). Regardless of the onerous or absolute hyperestrogenism, the uterine mucosa does not reject in time (on menstruation days) and undergoes hyperplastic transformation — glandular cystic hyperplasia develops. In the mucosa there is no secretion phase, its excessive proliferation leads to malnutrition and rejection. However, the rejection may be accompanied by heavy bleeding or stretch in time.
When recurrent UMC possible atypical hyperplasia.
UMC often occur with atretic follicles and are observed in the first 2 years after menarche. Sometimes dysfunctional uterine bleeding in the juvenile period are also motivated by the persistence of the follicle.
Mental and physical stresses, overwork, unfavorable living conditions, hypovitaminosis, dysfunction of the thyroid gland and / or the adrenal cortex contribute to the violation of the hormonal regulation of sexual development with UMK. Большое значение в развитии ЮМК имеют как острые, так и хронические инфекционные заболевания (корь, коклюш, ветряная оспа, эпидемический паротит, краснуха, ОРВИ и особенно частые ангины, хронический тонзиллит). Кроме того, могут иметь значение осложнения у матери во время беременности, родов, инфекционные заболевания родителей, искусственное вскармливание.
Симптомы Ювенильных маточные кровотечения
The clinical picture is the appearance of blood discharge from the genital tract after a delay of menstruation for periods ranging from 14-16 days to 1.5-6 months. Such menstrual irregularities sometimes appear immediately after menarche, sometimes during the first 2 years. In a third of girls, they can be repeated. Bleeding can be profuse and lead to anemia, weakness, dizziness. If such bleeding continues for several days, a second violation of the blood coagulation system of the type of DIC may occur for a second time and then the bleeding will further increase. In some patients, the bleeding may be moderate, not accompanied by anemia, but last 10-15 days or more.
UMKs do not depend on the compliance of the calendar and bone age, as well as on the development of secondary sexual characteristics.
Treatment of juvenile uterine bleeding
Treatment of juvenile uterine bleeding is carried out in 2 stages. At the 1st stage, hemostasis is performed, at the 2nd stage - therapy aimed at preventing recurrence of bleeding and regulation of the menstrual cycle.
When choosing the method of hemostasis, it is necessary to take into account the general condition of the patient and the amount of blood loss. Patients whose anemization is not very pronounced (hemoglobin is more than 100 g / l, hematocrit is more than 30%), and according to the ultrasound there are no signs of endometrial hyperplasia, symptomatic hemostatic therapy is performed. Uterine-reducing agents are prescribed - oxytocin, 5 IU intravenously, 5% glucose solution or 0.3-0.5 ml intramuscularly 3-4 times a day, hemostatic preparations - dicinone, vikasol, 2 ml intramuscularly, as well as 1 pill 3 times a day, aminocaproic acid, 1 tablet 3 times a day or 100 ml intravenous drip. A good hemostatic effect is given by the combination of the indicated therapy with physiotherapy — sinusoidal modulated currents to the region of the cervical sympathetic ganglia, 2 procedures per day for 3-5 days, as well as acupuncture or electroacupuncture.
With the ineffectiveness of symptomatic hemostatic therapy, hormonal hemostasis is performed with synthetic progestins. Estrogen-progestin drugs (non-ovlon, rigevidon, marvelon, mercilon) is prescribed 3-4 times a day, 1 tablet to complete hemostasis. Bleeding stops, as a rule, within 1 day. Then the dose is gradually reduced (1/2 tablet in 2 days with no blood discharge), bringing the dose to 1 tablet per day, after which the treatment is continued for 16-18 days so that the course is 21 days. Menstrual-like discharge after discontinuation of estrogen-gestagens are moderate and ends within 5-6 days.
With prolonged and heavy bleeding, when there are symptoms of anemia and hypovolemia, weakness, dizziness, hemoglobin level below 70 g / l and hematocrit below 20% shows surgical hemostasis - separate diagnostic curettage under the control of hysteroscopy with careful histological examination of scrapings. In order to avoid breaks, the hymen is crushed with a 0.25% solution of novocaine with 64 U of lidase. Patients with impaired blood coagulation, separate diagnostic curettage is not carried out. Hemostasis is performed only with synthetic progestins, if necessary in combination with glucocorticosteroids.
Simultaneously with conservative or surgical treatment, it is necessary to conduct a full anti-anemic therapy: iron preparations (maltofer, oral phenuls, venofer intravenously), vitamin B12 intramuscularly at 200 μg / day with folic acid 0.001 g 2-3 times a day inside, vitamin B6 inside by 0.005 g 3 times a day or intramuscularly in a dose of 1 mg of a 5% solution 1 time a day, vitamin C intramuscularly 1 ml of a 5% solution once a day, vitamin P (rutin) in a dose of 0.02 g 3 times a day orally. In the extreme case (hemoglobin level is below 80 g / l, hematocrit is below 25%), blood components are poured - fresh frozen plasma and red blood cell mass.
Prevention of Juvenile Uterine Bleeding
In order to prevent recurrence of bleeding after complete hemostasis on the background of symptomatic and hemostatic treatment, it is advisable to carry out cyclic vitamin therapy: during 3 months from the 5th to the 15th day of the cycle, folic acid is prescribed 1 tablet 3 times a day, glutamic acid 1 tablet 3 once a day, vitamin B6 5% solution 1 ml intramuscularly, vitamin E 300 mg every other day, and from the 16th to the 26th day of the cycle - ascorbic acid 0.05 g 2-3 times a day, vitamin B , 5% solution of 1 ml intramuscularly. For the regulation of menstrual function, endonasal electrophoresis of lithium, vitamin B, novocaine, and electrosleep is also used. Prevention of bleeding after hormonal hemostasis consists in taking low-dose synthetic progestins (novinet, divin, logest, silest) 1 tablet starting from the 1st or 5th day of the cycle (within 21 days) or gestagens - norkolut 5 mg or dufastone on 10-20 mg per day from the 11th to the 25th day for 2-3 months, followed by cyclic vitamin therapy. Patients with endometrial hyperplastic processes after curettage, as well as after hormonal hemostasis, should be prevented from relapsing. For this purpose, estrogen-progestin preparations are prescribed or pure gestagens (depending on changes in the ovary - atresia or persistence of the follicle). Of great importance are measures of general recovery, hardening, good nutrition, sanitation of foci of infection.
Proper and timely treatment and prevention of relapses of UMC contribute to the cyclical functioning of all parts of the reproductive system.