Obstetrics and gynecology. Diagnosis and treatment of menstrual disorders (most important)

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Obstetrics and gynecology. Diagnosis and treatment of menstrual disorders (most important)

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51. Diagnosis and treatment of menstrual disorders

When diagnosing pathological uterine bleeding, anamnesis data are taken into account, paying particular attention to the onset of bleeding, frequency, duration and severity, the cyclicity of these bleedings, the presence of pain, and obstetric and gynecological history. Take into account the data of objective and additional methods of examination. The task of differential diagnosis of DUB and organic causes of uterine bleeding is to exclude the presence of a complicated pregnancy (threatening abortion, abortion in progress, incomplete abortion), benign diseases of the pelvic organs (uterine fibroids, endometrial and cervical canal polyps, adenomyosis or endometriosis), malignant tumors of internal genitals. Differential diagnosis of DMC and disorders of the blood coagulation system, as well as somatic pathology, is carried out. Treatment of DMC consists of three stages.

The first stage. Its task is to stop bleeding using surgical, hormonal and non-hormonal hemostasis. Surgical hemostasis is a separate diagnostic curettage of the uterus and cervical canal. After diagnostic curettage, the bleeding stops, and based on the results of histological examination (endometrial biopsy), differential diagnosis is carried out with organic pathology of the uterus or the presence of pregnancy. Hormonal hemostasis is the main method in the treatment of DUB in women of any age. This method uses oral contraceptives with different hormone contents: combined, monophasic, oral. Non-hormonal hemostasis is the use of medications to help stop bleeding. This:

1) uterotonic agents (oxytocin, ergotal);

2) drugs that increase the contractile ability of the myometrium (calcium chloride, calcium gluconate, ATP, cocarboxylase);

3) drugs that stimulate the coagulation ability of the blood (etamsylate, transamic acid, aminomethylbenzoic acid);

4) vitamins (ascorbic acid, rutin, vikasol, vitamin E, B vitamins).

Non-hormonal hemostasis is usually used in combination with hormonal methods.

The second stage - Prevention of relapses, correction of concomitant complications. Prevention of relapses of DMC and correction of associated complications is carried out by hormonal methods, including the appointment of estrogen-progestogen drugs or pure progestogens (dydrogesterone, levonorgestrel-containing IUD, medroxyprogesterone acetate, etc.).

The third stage - preservation of fertility and the onset of ovulation in women who wish to become pregnant. Women who want to become pregnant are prescribed ovulation stimulation.

Author: Ivanov A.I.

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