Continued bleeding in periods

Menstruation - abnormal bleeding - Better Health Channel

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Summary

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Abnormal uterine bleeding is excessive menstrual bleeding or bleeding between periods.
In most cases, the cause is not known.
Known causes of abnormal uterine bleeding include polyps, fibroids, endometriosis, medication, infection and some forms of contraception.
Treatment can include medications, or dilatation and curettage (D&C) to remove the uterine lining.

Abnormally heavy or prolonged menstrual bleeding is also called 'abnormal uterine bleeding'. We sometimes use this general term to describe bleeding that does not follow a normal pattern, such as spotting between periods. It used to be referred to as menorrhagia, but this term is no longer used medically.

On average, a typical woman passes around 40 ml of blood during her menstrual period, which lasts around four to seven days. For some women, however, bleeding may be excessively heavy or go on for longer than normal.

A woman may have 'chronic' heavy or prolonged bleeding (for more than six months) or it may be 'acute' (sudden and severe). In most cases, the causes of abnormal menstrual bleeding are unknown. See your doctor about any abnormal menstrual bleeding.

Symptoms of abnormal uterine bleeding

Symptoms include:

bleeding for more than eight days
heavy blood loss during the menstrual period – for example, soaking through one or more sanitary pads or tampons every hour for several hours in a row
needing to change your pad or tampon during the night
have to change or restrict your daily activities due to your heavy bleeding
bleeding or spotting between periods (intermenstrual bleeding)
cramping and pain in the lower abdomen
fatigue
any vaginal bleeding after menopause.

If you think you may be experiencing heavy menstrual bleeding, you may find it useful to keep a pictorial blood loss assessment chart – this can help you give your doctor an idea of how heavy your period is.

Causes of abnormal uterine bleeding

While in many cases it is not possible to determine the exact cause, there are a number of reasons a woman may experience abnormal uterine bleeding. Some of the known causes of abnormal uterine bleeding include:

spontaneous miscarriage in pregnancy
ectopic pregnancy – lodgement of the fertilised egg in the slender fallopian tube instead of the uterine lining
hormonal disorders – conditions such as hypothyroidism (low levels of thyroxine), polycystic ovarian syndrome (PCOS) and hyperprolactinemia can disrupt the menstrual cycle
ovulatory dysfunction – this is when the ovary does not release an egg each month. Most commonly, this occurs at either end of a woman's reproductive years, either during puberty or at menopause
endometriosis – the cells lining the uterus (endometrial cells) can travel to, attach and grow elsewhere in the body, most commonly within the peritoneal cavity (including on the outside of the uterus or on the ovarian surface)
infection – including chlamydia or pelvic inflammatory disease (PID)
medication – may include anticoagulants, which hinder the clotting ability of the blood; phenothiazides, which are antipsychotic tranquilisers; and tricyclic antidepressants, which affect serotonin uptake
intrauterine device (IUD) – is a contraceptive device that acts as a foreign body inside the uterus and prompts heavier periods
hormonal contraceptives – may include the combined oral contraceptive pill, injections of a long-acting synthetic progesterone, a rod containing slow-release progesterone (implanted in the upper arm), or intrauterine system devices (progesterone-releasing contraceptive devices inserted into the uterus). The progesterone-only treatments commonly cause spotting
hormone replacement therapy – used as a treatment for menopausal symptoms
fibroids – benign tumours that develop inside the uterus
polyps – small, stalk-like projections that grow out of the uterus lining (endometrium). Polyps may be associated with fibroids
bleeding disorders – may include leukaemia and Von Willebrand disease
cancer – most uterine cancers develop in the lining of the uterus, though some cancers grow in the muscle layers of the uterus. They are most common after menopause.

Diagnosis of abnormal uterine bleeding

The diagnosis and identification of potential causes of abnormal uterine bleeding involves a number of tests including:

general examination
medical history
menstrual history
physical examination
cervical screening test
blood tests
vaginal ultrasound
endometrial biopsy.

Treatment for abnormal uterine bleeding

Treatment will depend on the cause, but may include:

medication – such as prostaglandin inhibitors, hormone replacement therapy or antibiotics
dilatation and curettage (D&C) – involving dilation and gentle scraping of the cervix and the lining of the uterus
change of contraception – it may be necessary to explore methods of contraception other than the IUD or hormones
surgery – to remove tumours, polyps or fibroids or to treat ectopic pregnancy
treatment of underlying disorders – such as hypothyroidism or a bleeding disorder
hysterectomy – the removal of the entire uterus is a drastic last resort, generally only considered for treatment of abnormal uterine bleeding when a serious disease, such as cancer, is also present.

Where to get help

Your GP (doctor)
Gynaecologist
Family planning clinic
Sexual Health Victoria Tel. (03) 9257 0100 or freecall 1800 013 952

FAQ – Abnormal uterine bleeding , 2017, ACOG. More information here.
Menorrhagia (heavy menstrual bleeding), 2014, Mayo Clinic, USA. More information here.
Patient – period blood loss chart. More information here.

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Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 28-04-2017

Pelvic inflammatory disease (PID) - Better Health Channel

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Summary

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PID is known as the silent epidemic because it is common and often does not cause symptoms.
The sexually transmitted diseases chlamydia and gonorrhoea are the most common cause of PID.
Use of condoms with any new partner and regular testing for sexually transmissible infections can help prevent PID.
PID can lead to scarring of the fallopian tubes and infertility if left untreated, or with repeated episodes.

Pelvic inflammatory disease (PID) occurs when an infection spreads from the vagina to the cervix, the endometrium (lining of the uterus) and the fallopian tubes. The infection is usually sexually transmitted. It can also occur after a ruptured (burst) appendix or a bowel infection.

Some surgical procedures, such as abortion, curette or insertion of an intrauterine device (IUD), can lead to PID. The infection usually occurs in three stages – the cervix is infected first, followed by the endometrium and then the fallopian tubes.

PID is often called the ‘silent epidemic’ because it is common among sexually active women, but does not always cause symptoms. About 10,000 women in Australia are treated for PID in hospital each year and many more are treated as outpatients. Women aged 20 to 29 have the highest reported incidence of PID.

Symptoms of PID

Signs and symptoms of PID include:

lower abdominal pain or tenderness
menstrual disturbances
a change in smell, colour or amount of vaginal discharge
deep pain during sexual intercourse
fever.

PID and female infertility

Scarring and blockage of the fallopian tubes is the most frequent long-term complication of PID. Infertility occurs because the fertilised egg cannot pass through the tube to the uterus.

Fertility risks that arise because of PID include:

One episode of PID doubles the risk of tubal infertility.
With three or more episodes of PID, the risk of fallopian tube blockage rises to 75 per cent.
One episode of PID increases the risk of ectopic pregnancy (where the fetus develops outside the uterus) sevenfold.

Causes of PID

The most common causes of PID are the sexually transmissible bacterial infections, chlamydia and gonorrhoea. Chlamydia is responsible for 50 per cent of sexually acquired PID cases, while gonorrhoea is the cause in 25 per cent of cases. Mycoplasma genitalium has recently been recognised as another sexually transmissible infection associated with PID.

The risk of fallopian tube blockage is slightly higher for PID caused by gonorrhoea.

Diagnosis of PID

Your doctor will test for possible causes such as chlamydia and gonorrhoea. In some cases, a laparoscopy is required to correctly diagnose PID. Laparoscopy involves inserting an endoscope (which is like a surgical video camera) into the abdomen to view the reproductive organs.

Treatment of PID

Chronic pain and, sometimes, severe disability can occur if PID is not treated. This is usually due to extensive scarring. Early treatment of PID may minimise the risk of complications.

Treatment usually involves:

taking a combination of antibiotics that are active against a broad range of organisms, usually taken for two weeks
testing male partners and treating them – symptoms may be mild or non-existent in men, however, for STI-related PID, all partners should be treated, regardless of test results
avoiding genital sexual contact until the treatment is complete and a negative test result is obtained.

Women with severe episodes of PID must be hospitalised for treatment.

Protecting yourself from PID

To help prevent the transmission of the bacteria that can cause PID:

use condoms during vaginal or anal intercourse with any new partner
have regular STI check-ups if you change your sexual partner.

The oral contraceptive pill and PID

Data collected in the 1970s indicated that sexually active women who were taking an oral contraceptive pill appeared to have only one third the risk of PID, compared to women not ‘on the pill’.

It is not known if the lower-dose contraceptive pills more commonly used now have the same protective effect, although it is likely that they do. Women taking the oral contraceptive pill still need to use condoms with any new partner to protect themselves from infection.

Where to get help

Your doctor
Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
Women’s Health Information Centre, The Royal Women’s Hospital, Melbourne
Tel. (03) 8345 3045, Regional or rural callers Tel. 1800 442 007
NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

Pelvic inflammatory disease (Acute salpingitis), 2011, Sexually Transmitted Diseases Services, Royal Adelaide Hospital, South Australia.

Taylor-Robinson D, Jensen JS, Svenstrup H, et al. 2012, ‘Difficulties experienced in defining the microbial cause of pelvic inflammatory disease’, International Journal of STD and AIDS, vol. 23, no. 1, pp. 18–24. More information here.

Haggerty CL, Taylor BD 2011, ‘Mycoplasma genitalium: an emerging cause of pelvic inflammatory disease’, Infectious Diseases in Obstetrics and Gynecology, vol. 2011, article ID 959816. More information here.

Shelton JD 2011, ‘Risk of clinical pelvic inflammatory disease attributable to an intrauterine device’. Lancetvol. 357, p. 443,

Hubacher D, Grimes DA, Gemzell-Daniellson K 2013, ‘Pitfalls of research linking the intrauterine device to pelvie inflammatory disease’, Obstet Gynecol, vol. 121, pp. 1091–1098.
This page has been produced in consultation with and approved by:
This page has been produced in consultation with and approved by:

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Reviewed on: 31-05-2012

Abnormal uterine bleeding in girls. What to do?

Introduction

Abnormal uterine bleeding (AMB) in puberty, which is often called juvenile, is one of the most common forms of menstrual dysfunction in girls and is the leading reason for adolescents to visit a gynecologist. The duration of the period of maturation of the relationship in the "hypothalamus - pituitary - ovaries" system and the formation of the reproductive system depends on the age of the menarche, and the individual duration of the menstrual cycle is set on average 6 years after the first menstruation [1]. During the first years after menarche, 80% of menstrual cycles are anovulatory with regular menstruation. Every 4-5th girl (20-25%) during the first 2 years may periodically experience delays in menstruation, after which spotting appears lasting more than 7 days. If these secretions are not abundant and do not lead to anemia, they should be considered as a variant of the norm that does not require medical correction. At the age of 14–16, the majority (95%) of girls have a regular menstrual cycle, but only by the age of 17–18 does a regular ovulatory peak occur with the formation of a full-fledged luteal phase [2].

Despite the variety of clinical manifestations, there is no single international classification of AUB in puberty. Juvenile bleeding can be both ovulatory and anovulatory, in the form of menorrhagia (bleeding with a preserved rhythm, but with a blood loss of more than 80 ml and lasting more than 7 days), polymenorrhea (bleeding that occurs against the background of a regular menstrual cycle lasting less than 21 days), menometrorrhagia (bleeding that does not have a cycle, with alternating episodes of oligomenorrhea and increased spotting). Anovulatory cyclic bleeding is most often observed against the background of atresia of the follicles, much less often against the background of persistence. These patients usually have profuse bleeding, leading to hypovolemic disorders and the development of iron deficiency anemia (IDA).

In accordance with modern recommendations, the criteria for the diagnosis of pubertal AUB include the duration of bleeding for more than 7 days, blood loss of more than 80 ml or more pronounced compared to normal menstruation [3]. The problem lies in the fact that the doctor is not always able to collect a full history from a teenage patient, and this makes it difficult to verify the diagnosis. Therefore, the doctor's first step in such a situation is to determine the level of hemoglobin (Hb). This will allow not only to make a correct diagnosis, but also to assess the amount of blood loss, which is fundamentally important when choosing a method of hemostasis.

It is the level of hemoglobin that is the basis for assessing the severity of AUB in adolescents, according to Emans et al. (2005). There is a mild degree (menorrhagia or polymenorrhea lasting 2 months or more, but without anemia - Hb more than 120 g / l), moderate (menorrhagia or polymenorrhea, causing mild anemia - Hb more than 100 g / l) and severe (menorrhagia, which causes a significant decrease in Hb - less than 100 g / l and can lead to unstable hemodynamics). Russian National Guide to Gynecology (2009d.) also recommends focusing on Hb indicators when choosing tactics for managing girls with juvenile bleeding [3].

Consideration should be given to the high prevalence of anemia in the population. According to a number of authors, in certain groups of the population, the incidence of iron deficiency states reaches 50 and even 70–80% [4–5]. The incidence of anemia over the past 10 years has increased by more than 6 times, and anemia is more common among women of childbearing age, pregnant women and children aged 12–17 years [6]. Thus, girls with AUB during puberty are at risk.

Own results

The aim of our study was to study the features of the clinical manifestation of AUB in pubertal age, the degree of anemia and the effectiveness of various types of hemostasis.

The study was non-randomized observational. An analysis was made of 40 pubertal girls with AUB who received treatment in the gynecological department of the State Healthcare Institution "CB SMP No. 7" in Volgograd during 2019. All girls were admitted urgently. The age of the patients ranged from 10 to 17 years and averaged 14 years ± 6 months. Half of the girls who entered were residents of Volgograd, half lived in the countryside.

The scope of the examination at admission included the clarification of complaints, the collection of anamnesis from the girl and her accompanying persons, more often the mother, a general examination with an assessment of height-weight and hemodynamic parameters, rectal examination, ultrasound examination (ultrasound) of the small pelvis with an assessment of the level of the endometrium. All girls urgently underwent a general blood test, which, along with pulse and blood pressure data, made it possible to assess the volume of blood loss.

Depending on the data obtained during the initial examination, the method of hemostasis was determined.

At admission, all patients complained of bloody discharge from the genital tract, in most cases (90%) of the type of menometrorrhagia, and only every
The 10th (10%) noted prolonged and heavy menstruation.

When collecting anamnesis, 45% of girls with juvenile bleeding revealed social problems (difficulties in learning, excessive workload in sports sections, climate change, moving from another city, conflicts in the family, with relatives, with friends). Each 5th (20%) had a recent illness in the anamnesis (ARVI, severe influenza that required treatment in an infectious diseases hospital, surgical treatment for appendicitis, umbilical hernia, intestinal dyskinesia with treatment in a surgical hospital for 2–3 months. before going to the gynecological hospital). It is noteworthy that every 10th girl with AUB revealed severe obesity and a body mass index of more than 35. In addition, quite often (10%) for the first time on admission, rectal examination diagnosed ovarian cysts of small sizes (up to 5–6 cm ), confirmed later by ultrasound. In addition, the level of the endometrium (M-Echo) was determined by ultrasound in all admitted girls. The results indicate that in 7 patients (17. 5%) the level of the endometrium was 15±5 mm, which was regarded as endometrial hyperplasia. In 10 patients (25%), the level of the endometrium was low — 4±2 mm. In the majority (23 patients - 57.5%) - 8 ± 2 mm.

In 10 patients (25%), anemia was not detected upon admission, the Hb level was 130±10 g/l, which did not require medical correction. In 25 patients (62.5%), Hb values were in the range of 100–120 g/l, which is typical for mild anemia. This condition does not threaten the patient's life, does not lead to hemodynamic disorders, but requires correction with iron preparations. In 2 patients (5%), upon admission, Hb was 75±5 g/l, which indicated significant blood loss.

The greatest concern was caused by 3 (7.5%) girls with heavy ongoing bleeding and severe anemia. The Hb level upon admission to the hospital was 60±10 g/l. At the same time, hemodynamic parameters were also changed: pulse within 90±10 beats/min, BP 75/50±10 mm Hg. Art., which corresponds to compensated hemorrhagic shock and requires urgent medical care. These patients, given the severity of the condition on the first day of admission to the hospital, were in the intensive care unit, where they underwent blood transfusion and plasma transfusion to replenish the volume of circulating erythrocytes and coagulation factors.

Depending on the results of the examination, a different method of hemostasis was chosen for each girl.

Symptomatic hemostasis was preferred in cases of AUB occurring for the first time in pubertal age, which did not lead to anemia. In addition, in girls with mild anemia, without severe somatic pathology, with a low or normal endometrial level, according to ultrasound, hemostasis was also performed without the use of hormonal and surgical methods. The basis of symptomatic therapy was hemostatic (tranexamic acid) and uterotonic (oxytocin) therapy aimed at reducing bleeding. These drugs are included in the Standards of primary health care and specialized medical care for minors with uterine bleeding during puberty [7]. Due to the lack of effect of the therapy within 3–4 days 9The patients were additionally prescribed hormonal hemostasis. In addition, in 5 patients from the study group, after symptomatic treatment for 6 months. AUB recurred, and they were prescribed hormonal hemostasis during re-hospitalization.

In moderate anemia or repeated AUB of puberty, hormonal hemostasis was performed, since it, influencing the pathogenesis of this condition, has a therapeutic effect much faster compared to symptomatic methods of stopping bleeding. Ethinylestradiol as part of combined oral contraceptives provides a hemostatic effect, and progestogens stabilize the stroma and basal layer of the endometrium. The most commonly used low-dose monophasic contraceptive containing desogestrel 0.15 mg and ethinylestradiol 0.03 mg. In the study group, this contraceptive was prescribed for the purpose of hemostasis at admission to 10 patients: 5 of them due to severe anemia and anemia of moderate severity, and 5 due to recurrent AUB. After discharge from the hospital, all these patients were recommended to continue hormonal and antianemic treatment for 3 months.

In order to treat IDA, all patients were prescribed a drug in which iron is in the form of a stable complex compound of iron (III) polymaltose hydroxide, similar in structure to the natural iron compound, ferritin. Iron, which is part of the drug, quickly compensates for the lack of this element in the body, restores the level of hemoglobin. According to the instructions for use of oral forms (syrup or chewable tablets) of this drug, it is recommended for the treatment of latent iron deficiency, IDA, and the form for intramuscular administration is recommended for use in the treatment of all forms of iron deficiency conditions that require rapid replenishment of iron stores, including severe iron deficiency due to blood loss and impaired absorption of iron in the intestine, as well as in conditions where the drug is taken per os is ineffective or not possible. This drug has a good safety profile and is well tolerated, which makes its use in patients with adolescent bleeding a priority.

Patients with mild to moderate IDA received this drug 1 tablet 2 times a day from the moment anemia was detected. All girls with juvenile bleeding had a significant positive effect from ongoing antianemic therapy with this drug. During the stay in the hospital when taking the drug for 10±3 days, the hemoglobin level increased by 15±5 units. With hemoglobin values less than 85 g/l, but more than 70 g/l, anemia was treated by administering the drug intramuscularly. In this case, the doses were selected individually depending on the iron deficiency and body weight of the girl in accordance with the instructions for the drug. The advantage of parenteral administration of this drug is the rapid onset of effect.

In our observations, there were no refusals to take the drug due to an allergic reaction or poor tolerance.

The surgical method of stopping bleeding at puberty is extremely rare. In this sample, surgical hemostasis was performed in one patient (2.5%) in the absence of the effect of conservative therapy and the ineffectiveness of hormonal hemostasis.

Clinical observation

Patient S., 11 years old 9months., was admitted to the gynecological hospital with a diagnosis of AUB puberty. Complaints about prolonged bloody discharge from the genital tract for 1 month. type of menometrorrhagia.

From the anamnesis : this is the first menstruation - menarche (the only case in the study group), about 2 months. ago suffered ARVI, treatment in an infectious diseases hospital. There is no somatic pathology, there were no operations. Taking into account the continued heavy bleeding and the level of Hb, upon admission of 85 g / l, hormonal hemostasis was started (low-dose monophasic contraceptive containing desogestrel 0.15 mg and ethinyl estradiol 0.03 mg, according to the scheme), hemostatic therapy (tranexamic acid 750 mg intravenously, tranexamic acid 250 mg 3 r. /day per os ), uterotonic therapy (oxytocin 1.0 ml 3 times a day intramuscularly), antianemic therapy (iron (III) hydroxide complex with dextran intramuscularly). Given the duration of bloody discharge and the risk of infectious complications, anti-inflammatory therapy was started.

Survey completed. Magnetic resonance imaging of the brain: there are no data for pathological changes in the brain. Ultrasound of the thyroid gland: no structural changes. Hormonal profile: follicle-stimulating hormone up to 0.1 mIU / ml, human chorionic gonadotropin up to 1.0 mIU / ml, luteinizing hormone up to 0.1 mIU / ml, T4 14.4 pmol / l, thyroid-stimulating hormone 0.686 μIU / ml, cortisol 353 nmol/l, prolactin 223 mIU/l. Echocardiography and electrocardiography: no pathologies. Panoramic ultrasound of the abdominal cavity: no structural changes. Examined by a pediatrician (anemia of moderate severity), a hematologist (no hematological pathology). Ultrasound of the pelvic organs revealed M-Echo 23 mm, heterogeneous. Conclusion: endometrial hyperplasia.

Against the background of the ongoing for 2 weeks. conservative therapy and hormonal hemostasis failed to achieve an effect, a decrease in hemoglobin level to 79 g/l was noted. In this regard, it was decided to use a surgical method of hemostasis using hysteroscopy, vacuum aspiration of the endometrium, which was performed. Histological conclusion: in the preparations - fragments of the endometrium with glands of different sizes: small hypoplastic type and larger, some cystically dilated indifferent type, the picture corresponds to endometrial hyperplasia. In the postoperative period, hormonal, antianemic therapy was continued with the use of a complex of iron (III) hydroxide with dextran intramuscularly, then the transition to a tablet form (iron (III) hydroxide polymaltose). Achieved complete hemostasis, condition at discharge is satisfactory, Hb 106 g/l. It is recommended to continue hormonal and antianemic treatment on an outpatient basis for at least 3 months.

Conclusion

The results of the study show that AMC remain relevant and have a negative impact on the formation of the reproductive function of girls in the puberty period. AUB against the background of somatic pathology tend to re-manifest, and therefore the symptomatic nature of hemostasis is justified in cases where socio-psychological problems act as a trigger. All patients with uterine bleeding in the pubertal period are recommended for dynamic observation 1 rub./month. until stabilization of the rhythm of menstruation, then control examination 1 time in 3-6 months. Conducting echography of the pelvic organs should be carried out at least 1 time in 6-12 months.

Long-term antianemic therapy is required in all cases of juvenile bleeding. In this case, the choice of the drug should be carried out taking into account its tolerability by the patient and the cost, since the duration of admission should be at least 3 months. The study showed good adherence of pubertal patients with AUB to treatment with the indicated iron preparation. Due to different forms of administration, a quick effect was achieved, there were no cases of drug intolerance or refusal due to side effects. A good safety profile makes it the drug of choice for the treatment of anemia in girls with juvenile bleeding.

Federal clinical guidelines for the diagnosis and treatment of IDA determine the duration of the course of treatment of anemia with iron preparations for at least 3 months. with mild anemia, 4.5 months. with moderate anemia and 6 months. with severe anemia [8]. Currently, the intake of iron supplements is recommended by WHO experts (2016) to all menstruating women of reproductive age and adolescent girls at a dose of 30-60 mg daily for 3 months. in a year.

Author information:

¹ Selikhova Marina Sergeevna — Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology, ORCID iD 0000-0002-4393-6111;

² Zvereva Ekaterina Sergeevna — obstetrician-gynecologist of the State Healthcare Institution of the City Clinical Hospital No. 7, Volgograd, ORCID iD 0000-0002-5076-7168.

¹ Volg State Medical University of the Ministry of Health of Russia. 400131, Russia, Volgograd, Fallen Fighters Square, 1.

² State Healthcare Institution "KB SMP No. 7". 400002, Russia, Volgograd, st. Kazakhskaya, 1.

Contact information: Selikhova Marina Sergeevna, e-mail: [email protected] Financial transparency: none of the authors has a financial interest in the presented materials or methods. No conflict of interest . Article received 09/18/2019.

About the authors:

¹ Marina S. Selikhova - MD, PhD, Professor of the Department of Obstetrics and Gynecology, ORCID iD 0000-0002-4393-6111;

² Ekaterina S. Zvereva - MD, obstetrician and gynecologist, ORCID iD 0000-0002-5076-7168.

¹ Volgograd State Medical University. 1, Pavshikh Bortsov square, 400131, Volgograd, Russian Federation.

² Emergency Clinical Hospital No. 7. 1, Kazakhskaya str., 400002, Volgograd, Russian Federation.

Contact information: Marina S. Selikhova, e-mail: [email protected] Financial Disclosure: no author has a financial or property interest in any material or method mentioned. There is no conflict of interest. Received 09/18/2019.

Premenopause: what is it, symptoms, signs of premenopause, treatment | Menstruation in premenopause (before menopause)

What is premenopause

To begin with, let's understand the terms. According to the definition of the World Health Organization (WHO),

menopause is the last spontaneous menstruation, a kind of starting point, which can be discussed if menstruation is absent for more than one year;
pre-menopause — the period from the onset of "failures" of the menstrual cycle to the onset of menopause;
perimenopause — the period of menstrual irregularities preceding the cessation of menstruation and continuing one to two years after menopause;
post-menopause - the period from menopause to the end of a woman's life ^{1. 2} .

The first symptom of premenopause in women is the instability of the menstrual cycle. Periods that used to come “by the clock” are now late or start more than 7 days ahead of schedule ¹ . This is primarily due to a decrease in the synthesis of sex hormones - estrogen, involved in the regulation of all processes occurring in the female genital organs ^1.2 .

The drop in estrogen levels is due to the depletion of follicles (vesicles in which eggs mature) and a decrease in their sensitivity to pituitary hormones that are responsible for the functioning of the ovaries. Follicles stop growing and synthesizing estrogens, eggs stop maturing, and this leads to menstrual irregularities ² If a blood test for hormones is done at this time, it will detect these changes.

When premenopause occurs

The first signs of ovarian failure can be seen already at the age of 35 ¹ . However, they do not manifest themselves outwardly: menstruation remains regular, and a woman, if desired, can still give birth to a child.

Premenopausal changes begin on average 5 years before menopause, that is, around the age of 45-46 years. Menopause in most European women occurs at 50-51 years (world average of 48.8 years) ^1.2 .

Sometimes menstruation stops much earlier - in 40-45 years. In this case, we speak of early menopause. If they disappear before the age of 40 - about premature menopause. Early and premature menopause cannot be considered normal. Therefore, if you have symptoms of premenopause earlier than the prescribed age, you need to undergo treatment. Consult a gynecologist, he will conduct an examination and prescribe the necessary therapy.

Managing premenopausal symptoms

If you are practically healthy, there is a chance that you will endure menopause more or less easily. Chronic diseases, which, unfortunately, many people have by the age of 45-50, often complicate the period of hormonal changes. Therefore, half of the women fully feel what premenopause is ^{1. 2} .

What are the possible symptoms?

Tides.
Excessive sweating.
Chills.
Drowsiness.
Irritability.
Anxiety and depression.
Memory impairment and inattention.
Periodic headaches.
Blood pressure fluctuations.
Attacks of palpitations.
Weight gain.
Decreased sex drive ^1.2 .

Hot flashes occur in most women, but the severity varies1. Some note the sudden onset of heat in the face, neck and shoulders, profuse sweating, others in addition to this experience bouts of lightheadedness, dizziness and even fainting associated with a temporary disruption of blood flow to the brain. Hot flashes may appear at the very beginning of perimenopause and persist for up to 5 years, and sometimes more than ¹ .

Hormonal imbalance, characteristic of menopause, sometimes leads to disruption of the processes occurring in the uterus ¹ .

Learn more

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