What is the NMC: the reasons causing this problem. Causes and types of menstrual irregularities in girls and women Treatment of nmc in gynecology presentations

Throughout her life, a woman goes through a wonderful path from a girl to a woman capable of giving life to another person. It is the stage when this ability can and should be used is called childbearing. A woman's reproductive age is assessed differently in different countries and various specialists. But one thing is unanimous - the opinion that a woman should give birth from 20 to 35 is supported everywhere. It is optimal to give birth to the first child before the age of 25-27, when the body is already fully matured and ready to bear, but, at the same time, is not worn out.

It is believed that after 45-50 years of age, eggs cease to be produced, as a result of which a woman's ability to conceive disappears. Nevertheless, in the world there are cases of the birth of children by women over 50 years old. This is largely facilitated by modern technologies.

It's believed that early pregnancy dangerous for both the woman and the baby she carries. Too young mothers have an increased risk of spontaneous miscarriage, bleeding and toxicosis. Babies born to mothers who have not yet turned 20 years old are often underweight, after birth they gain it poorly, poorly adapt to new conditions for them. In addition, the girl may not be psychologically ready for motherhood. She does not have all the necessary knowledge to implement proper care for the child.

In the case of late planning of pregnancy, problems with conception and bearing may arise, because a woman by the age of 36 or more, as a rule, has certain diseases, deviations in health that do not allow her to conceive or give birth to a baby. In addition, after 40 years, there is a high probability of giving birth to a child with genetic disorders.

DMC of reproductive age

The question of a woman's reproductive age is often associated with a question (MQM). Women care if they are manifestations of menopause. According to statistics, DMK occurs in 4-5 women of reproductive age. They manifest themselves as a violation menstrual cyclewhen menstruation occurs after a significant delay or before the expected date. Most often, the cause of DMC is a malfunction of the ovaries. Other causes may be diseases of the lungs, kidneys or liver. With DMC, ovulation does not occur, corpus luteum does not form, and progesterone levels are low. All this makes it impossible to conceive a child. DMC usually occurs in women who have had abortion, an ectopic pregnancy, an infectious disease, or an endocrine system disorder.

NMC in reproductive age

Violation of the menstrual cycle (MMC) during the reproductive period is not uncommon. The NMC includes:

• amenorrhea - absence of menstruation;
• hypomenorrhea - scanty menstruation on time;
• hypermenorrhea - too abundant menstruation, which occurs on time;
• polymenorrhea - too long (6-8 days) menstruation;
• - too short (1-2 days) menstruation;
• tachymenorrhea - shortened menstrual cycle;
• opsomenorrhea - too rare menstruation (with a cycle of more than 35 days).

Woman's reproductive age in different countries

In Russia and other European countries, there is an established opinion that a woman of reproductive age should be between 18 and 45 years old. During this period, it is believed that Slavic and European women can conceive and give birth to a child. At the same time, in women of southern national groups, reproductive age begins and ends much earlier. Eastern girls mature early and get married, and when they are mature women, they age much faster. The opposite trend is observed in Western European countries - in the direction of a shift at a later date: childbirth far beyond 30 and even over 40 years is considered normal, respectively, and menopause is postponed, which is facilitated by the widespread use of hormonal drugs.

How to prolong a woman's reproductive age?

To prolong childbearing age, women need to closely monitor their health, treat any diseases in time, and monitor their hormonal levels. Avoiding abortion is a guarantee of the duration of reproductive age.

A regular menstrual cycle (21 to 35 days) is one of the signs of the health of the female reproductive system. Any failure in her work can prevent the onset of the desired pregnancy.

Opsomenorrhea is a violation of the menstrual cycle (MCI), which is characterized by an increase in the time between menstruation (36–90 days).

Opsomenorrhea-type NMC is caused by congenital or acquired factors.

Primary violations are noted from the moment of menarche (first menstruation), they are the result of pathology in the development of the reproductive system or its underdevelopment (infantilism).

A violation of the menstrual cycle, such as secondary opsomenorrhea, can be talked about if a woman's menstruation earlier was regular, but under the influence of external or internal reasons the cycle length has increased.

Opsomenorrhea takes two forms:

1. An extended biphasic stage, in which the process of follicle maturation is delayed. In the first phase of the cycle, the follicle does not develop at all or its growth stops. Estrogen levels are low. During the second phase, the follicle still matures, but the timing of ovulation is postponed, which can cause infertility.
2. Monophasic type - occurs several times less often, it is characteristic of hypoplasia of the genitals. In this case, the phase of the corpus luteum does not occur, the amount of estrogen drops sharply, and the endometrial cells are rejected.

All NMCs in reproductive age lead to disturbances in the course of phases and negatively affect fertility, so every woman should know what opsomenorrhea is.

Causes of opsomenorrhea

Primary opsomenorrhea is genetic in nature or arises as a result of a delay in the general and sexual development of the child. There are many more reasons for the development of secondary opsomenorrhea:

Thus, NMC is not an independent disease. After the root cause is eliminated, menstruation is restored.

Symptoms of pathology

With opsomenorrhea, women note an increase in the duration of the menstrual cycle and a decrease in the intensity of bleeding. The nature of menstruation changes, there are spotting for 2-3 days.

With this form of disturbance, ovulation can occur with a great delay. In some cases, pulling pains lower abdomen, general weakness, increased body fatigue. There are signs of an underlying disease that led to the NMC.

The condition of the reproductive system worsens if untreated, secondary opsomenorrhea can lead to the onset of secondary amenorrhea (cessation of menstruation). The gynecologist can determine the exact cause of the violations after a diagnostic examination. During puberty, you need to monitor the development of the girl so as not to miss the symptoms of primary opsomenorrhea. Before menopause, changes in the length of the menstrual cycle have physiological causes.

Diagnosis of the disease

To determine the causes of opsomenorrhea, a detailed diagnosis is required. If an NMC is suspected, the gynecologist records the woman's subjective complaints.

An examination in a gynecological chair helps to visually determine possible defects in the development of the genitals and take smears for colpocytological examination.

The next diagnostic measure should be ultrasound, during which anatomical abnormalities in the structure of the pelvic organs can be determined and inflammatory processes.

Infectious status is studied by testing for HIV and sexually transmitted diseases.

In the event that the NMC is extragenital (not having gynecological reasons) character, a woman should be additionally examined by a neurosurgeon and endocrinologist. The treatment plan depends on the diagnosis of the underlying causes of the disease.

Opsomenorrhea treatment

Treatment for opsomenorrhea depends on the underlying causes, the woman's age and reproductive intentions:

1. It is difficult to correct the primary form of the disease caused by congenital anatomical pathologies and serious forms of sexual infantilism. The attending physician prescribes therapy, and also refers to a geneticist and endocrinologist for consultations.
2. If a neoplasm of the brain is the cause of NMC or, it may be necessary surgical intervention... To restore the cycle, hormone therapy is actively used, ovulation is stimulated.
3. Secondary opsomenorrhea caused by inflammatory processes of the genital organs is treated with antibiotics, vitamin therapy and immunostimulating drugs. Massage, mud therapy, hirudo and reflexology are used as auxiliary methods.
4. In case of menstrual irregularities caused by underweight, a balanced diet with a surplus of calories is developed for a woman. In the case of anorexia, it is necessary to involve a psychotherapist.

NMC

scientific and methodological center

education and science

Dictionary:S. Fadeev. Dictionary of abbreviations of the modern Russian language. - S.-Pb .: Polytechnic, 1997 .-- 527 p.

NMC

applied milky colored glass

Dictionary:S. Fadeev. Dictionary of abbreviations of the modern Russian language. - S.-Pb .: Polytechnic, 1997 .-- 527 p.

NMC

beginning of a small cycle

1. ANO NMC

Scientific and Methodological Center for Driver Training

auto, education and science, organization

NMC

National Monitoring Center

Perm, organization, RF

Source:http://nnit.ru/news20/no85118/

NMC

violation of the menstrual cycle

honey.

NMC

initial (maximum) price

in the bidding (tenders) documentation

... Academician. 2015.

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One of the main indicators women's health - menstrual function of the body. Its disorders can manifest itself in the form of oligomenorrhea, which is one of the types (weakening of menstruation) of the syndrome and occurs in 2-3% of women.

Oligomenorrhea is a violation of the menstrual cycle (MMC) in the form of short, less than 2 days, regular spontaneous menstruation with an interval between them from 36 days to six months. Understanding the causes of this syndrome is impossible without a general understanding of the physiological processes of the regulation of menstrual cycles.

Physiology of the regulation of menstrual cycles

Menstrual cycles are repetitive cyclical changes in the female body, especially in various parts of the reproductive system. Its culminating external manifestation is menstruation, which are repeated at a certain interval throughout the reproductive period, except for periods of pregnancy and lactation. Failure of these processes leads to the development of disorders, including oligomenorrhea. After the first menstruation (menarche), which appears, as a rule, at 10-12 years old, the regularity of the cycles can be established for 1-1.5 years.

The normal course and cyclical nature of these processes, accompanied by changes throughout the body, is provided by a single neurohormonal system, consisting of central (uniting) and peripheral effector (executive) structures, as well as intermediate links. In the mechanism of reproductive regulation, 5 levels are conventionally distinguished, which interact with each other in accordance with the principles of positive and negative direct and feedback.

The highest, or first level

It is represented by the cerebral cortex and some other structures of the latter. They are involved in the perception and the corresponding influence on other parts of the reproductive system, depending on the frequency, severity and duration of exposure to external (severe stress, instability of the psychoemotional sphere, etc.) and internal stimuli. In the latter case, this occurs with the help of specific receptors for estrogens, androgens and progesterone. In response to the action of stimuli in these structures of the brain, they are synthesized, released and undergo biochemical transformations biologically active substancesinfluencing the corresponding function of another brain formation - the hypothalamus.

Second level

The hypothalamus, as a neuroendocrine structure, is the second level of regulation. It has the properties of both neurons, which reproduce electrical impulses, and cells that release the hormonal substances liberins (stimulating) and statins (blocking). The activity of the hypothalamus depends both on the regulating influence of the structures of the first level, and on the content of sex hormones in the blood. The hypothalamic gonadotropic liberins are called gonadotropin-releasing hormone (GnRH). Its secretion is genetically programmed and has a circhoral (pulsating) character. The maximum activity of the hypothalamus lasts several minutes, the intervals of activity are from 1 to 3 hours, which is also influenced by the concentration of estradiol in the blood in the luteal or follicular phase of the menstrual cycle.

Third level

The anterior pituitary gland is the third level of neuroendocrine regulation. This part of the brain secretes hormones:

• FSH (follicle-stimulating), which stimulates the growth and maturation of follicles in the ovaries;
• LH (luteinizing), which together with the former promotes the production of progesterone;
• prolactin, which controls the release of progesterone by the corpus luteum into the blood, and also stimulates the growth of the mammary glands and regulates lactation;
• TSH (thyroid-stimulating), STH (somatotropic) and ACTH (adrenocorticotropic).

Only with a balanced secretion of these hormones is it possible for the reproductive system to function adequately, to establish a regular menstrual cycle and the absence of such disorders as oligomenorrhea, etc.

Fourth level

Consists of peripheral endocrine organs, which include the ovaries, thyroid and the adrenal glands. The ovaries, in which the follicles grow and mature, sex hormones are synthesized, the corpus luteum is formed, and play a major role. Hormones synthesized in the ovaries are decisive not only in functional changes in the reproductive system itself, but they also have an active effect on metabolic processes in tissues and organs that have receptors for sex hormones, aminopeptides, insulin and glucagon.

The fifth level

Make up the mucous membrane of the vagina, the uterus, especially its mucous membrane (endometrium), in which cyclic processes are expressed as much as possible, the fallopian tubes and mammary glands. Cyclic changes in the endometrium, consisting of cell proliferation, secretion and menstruation itself, depend both on the concentration of sex hormones in the blood, and on the state of the tissue receptor apparatus for sex hormones.

These levels form the hypothalamic-pituitary-ovarian axis. The principles of direct and reverse interaction through specific receptors for hormones at all levels ensure the cyclicity and adequate functioning of the reproductive system.

The "direct" connection means the stimulating effect of the hypothalamic region of the brain on the pituitary gland, followed by the synthesis of sex hormones in the ovaries, under "reverse" - the effect of the level of concentration of sex hormones on the hypothalamus and pituitary gland.

One of the main summary indicators that reflects the interaction different levels the axis of the hypothalamus-pituitary-ovaries and the ability to implement the main function of the body's reproductive system, is the menstrual cycle. Its nature makes it possible to clinically determine the level of the state of the reproductive system, due to the correct relationships in the hypothalamus-pituitary-ovary system.

Thus, oligomenorrhea-type nmc, like other types of these disorders, can be triggered by factors that cause disorders in the interaction of parts of the neuroendocrine system at one or more levels.

The reasons for the development of oligomenorrhea

Oligomenorrhea can be physiological and pathological in nature. Physiological oligomenorrhea is a disorder that accompanies physiological conditions. It occurs in adolescence, when the formation of the menstrual cycle occurs, and during premenopause, that is, the extinction of the functions of the reproductive system (what is and when the menopause begins, read). In the latter case, it precedes menopausal amenorrhea.

The pathological syndrome differs as:

1. Primary oligomenorrhea - occurs during the formation of the menstrual cycle. In this case, it is an external sign of the beginning of the development of the process, which in the fertile period determines the violation of the neuroendocrine function of the reproductive system of the body. By the end of adolescence, disorders in the hypothalamus-pituitary-ovary system, which are initially functional in nature, acquire relative stability and retain their main features already in childbearing age.
2. Secondary oligomenorrhea - develops after the established normal regular menstrual cycle.

Having an idea of \u200b\u200bthe levels of physiological regulation of the menstrual cycle, it becomes clear that the cause of oligomenorrhea can be any organic or functional disorder at one of the levels. These reasons can be:

1. Anatomical changes in the brain due to trauma, pituitary and other tumors of different nature, Itsenko-Cushing's disease and syndrome.
2. Chronic negative psychogenic stress or severe stressful conditions.
3. Excessive long physical exercise and an abrupt change in climatic or time zone.
4. Sharp infectious diseasescomplicated by neuroinfection, as well as transferred meningitis or encephalitis.
5. Diseases of the endocrine organs (hypothyroidism, pancreatic disease, adrenal tumor, some forms of menopause and).
6. Familial predisposition to reproductive dysfunctions (read more about female infertility).
7. Congenital anomalies development of the genitals.
8. Metabolic disorders in obesity, rapid body weight loss, unbalanced diet, body weight deficit for a long time.
9. Long-term use of estrogen-containing opioids, metoclopramide (an antiemetic), hallucinogens and some drugs, long-term or inadequate treatment with hormonal (glucocorticosteroids) drugs.
10. Ovarian diseases (,).
11. Oligomenorrhea can be caused by frequent infectious diseases in childhood and adulthood, including chronic inflammatory processes and post-inflammatory changes in the endometrium, as well as tumors, surgical intervention on the uterus and ovaries, trauma (abortion).
12. Diseases of the liver and cardiovascular system (rare).

IN International classification diseases (ICD-10) also introduced such a category as "unspecified oligomenorrhea." She belongs to the class of diseases genitourinary system, block "Non-inflammatory diseases of female genital organs." This category includes oligomenorrhea, which can be caused by the syndromes of exhaustion, dysgenesis, ovarian hyperinhibition, or immune disorders, covering the humoral and cellular links of immunity and manifested, possibly, by autoimmune oophoritis or other disorders in the ovaries of an unknown cause.

Symptoms of oligomenorrhea

Changes in the nature of bleeding during menstruation and the interval between them are often accompanied by disorders of fat metabolism in the form of excess body weight (in 80%), the appearance of acne on the face, on the skin of the front and back surfaces chest, development acne, increased oiliness, porosity and cicatricial changes (striae) skin... In 25% of women with this syndrome, there are phenomena of hirsutism, that is, excessive development of the hairline in the face, abdomen, mammary glands, chest.

In some women, the development of a male physique and a decrease in libido, headaches and dizziness, deviations from the norms of indicators are noted blood pressure, asymmetric blood pressure indicators, numbness of the fingers of the extremities, autonomic disorders, sleep and appetite disorders, tearfulness, irritability, emotional instability.

Diagnostics

The diagnosis of a disease that causes menstrual irregularities is established on the basis of complaints and anamnesis, general objective and gynecological examinations, as well as an assessment of the state of the psychoemotional sphere and neurological state.

Additional methods for diagnosing oligomenorrhea are the definition basal temperature with the construction of a graph, ultrasound and by means of a vaginal sensor, magnetic resonance imaging of the skull. In addition, laboratory research the content of pituitary hormones (prolactin, follicle-stimulating and luteinizing hormones) and sex hormones (progesterone, estradiol, testosterone) in the blood serum, as well as glucose and cholesterol, the content of 17-ketosteroids in urine (to assess adrenal function) is determined.

Treatment

Treatment of oligomenorrhea consists in the treatment of diseases and correction of pathological conditions, the consequence of which it is. In order to stimulate ovulation, clomiphene or gonadotropic drugs are prescribed according to certain schemes, oral combined contraceptives, urozhestan, parlodel, etc.

Recommendations are given in the plan proper nutrition, drugs with a sedative and, if necessary, antidepressant effect, physiotherapy are prescribed. If brain tumors, pituitary adenomas, and some ovarian diseases are detected, surgical treatment may be recommended.

Timely correction of functional disorders of neuroendocrine regulation can slow down their development or lead to full recovery... In the case of late diagnosis and treatment, functional disorders become irreversible and lead to organic changes in the reproductive organs.

Is it possible to get pregnant with oligomenorrhea?

This largely depends on the reasons for the development of the syndrome. If, at the same time, hormonal disorders occur, there is no ovulation, disorders of rejection and restoration of the uterine mucosa, then naturally, pregnancy becomes impossible. In cases of infantilism, the possibility of pregnancy depends on the degree of uterine hypoplasia, the degree of hormonal functioning of the ovaries, on the presence of concomitant pathological conditions.

According to the data of the World Health Organization for 1985, among all the causes of infertility, 14.7% are accompanied by this type of pathology. Among all infertile women suffering from any irregularities in the menstrual cycle, the frequency of oligomenorrhea is 41.6%. Spontaneous pregnancy occurs in only about 20% of women with this syndrome.

Realizing the opportunity to become a mother is extremely important for a woman. Sooner or later, but everyone thinks about having a child. And a necessary condition for conception is the normal functioning of the reproductive system, the main indicator of which is the menstrual cycle. And every woman should keep track of her periods, paying attention to any deviations. And if you notice any changes, you should immediately go to the doctor. But you can often come across a situation when you first consult with friends or acquaintances. One way or another, the question of what is an NMC in gynecology is relevant and requires clarification.

General information

Before considering violations, it should be mentioned what cyclical processes occur in a woman's body and how they are normally characterized. The main changes occur in the pituitary-ovary-uterus system, but other organs that depend on hormonal substances are also involved. The menstrual cycle is influenced by the main regulators - follitropin and lutropin, which are produced in the brain and "monitor" the function of the ovaries.

Normally, the cycle lasts from 21 to 34 days (an average of 28 days). After the end of menstruation, which lasts no more than a week, a dominant follicle begins to form in the ovary (first phase). This is accompanied by a gradual increase in the concentration of estradiol, which stimulates the proliferation of the endometrium in the uterus. In the middle of the cycle, that is, approximately on the 14th day, ovulation occurs - the release of the egg from the mature follicle, and in its place the corpus luteum is formed (second phase). The latter produces progesterone, under the influence of which the endometrium swells, and the number of glandular cells in it increases. This creates the conditions for the implantation of the embryo. But if the pregnancy has not come, then everything starts again, and the next period comes.

The characteristics of the menstrual cycle are determined by the balance of hormones in the female body.

Causes and mechanisms

Already many have probably guessed that NMC stands for menstrual irregularities. But this is not considered a generally accepted abbreviation in medicine, and therefore it is undesirable to use it. This situation is common among many women, but each has its own reasons. They cover both functional and specific organic conditions - most of them are directly related to the reproductive system. For example, the menstrual cycle can be disrupted due to diseases of the ovaries and uterus:

1. Polycystic.
2. Adnexitis.
3. Fibroids.
4. Endometriosis.
5. Developmental anomalies.

Change reproductive function trauma and surgery on the uterus, such as frequent abortions, also contribute. Are important common diseaseswhen the whole organism suffers. A similar effect can have diabetes, infectious pathology, severe kidney, heart and liver diseases, oncology. But, despite this, external factors still take a significant share among the causes of menstrual dysfunction:

• Malnutrition, vitamin and mineral deficiencies.
• Overweight and obesity.
• Physical stress.
• Psycho-emotional stress.
• Change of climatic zones.
• Hypothermia and overheating.
• Radiation exposure.
• Taking certain medications (contraceptives, antidepressants, anticoagulants, etc.).

This can also happen for quite physiological reasons, for example, in adolescent girls, when menstruation is just beginning to be established, as well as in women 45-50 years old with the approach of menopause. The absence of cyclic discharge is the norm after childbirth and during breastfeeding.

The main mechanism of menstrual dysfunction is considered to be hormonal changes in the body - both sudden and gradual. This violates the well-established relationships in the regulatory system and leads to various clinical manifestations.

The menstrual cycle is disrupted due to various external and internal factors that affect the hormonal background and the ovary-uterus system.

Symptoms

There are various options for menstrual irregularities. There may be a change in the duration of menstruation, their frequency and abundance. The cycle itself is shortened or lengthened, respectively. Possible clinical forms menstrual dysfunction include:

• Amenorrhea.
• Algodismenorrhea. - painful periods with general violations.
• Hypermenstrual syndrome.
• Hypomenstrual syndrome.
• Uterine bleeding.

The first situation is accompanied by a complete absence of menstruation for six months. They talk about algodismenorrhea if a woman's onset of cyclical discharge is accompanied by tangible pain in the lower abdomen and general disorders: malaise, nausea, dizziness and headache. If we talk about hypomenstrual syndrome, then in its structure it should be noted:

• Polymenorrhea - the duration of menstrual bleeding for more than a week.
• Hypermenorrhea - the volume of discharge exceeds 150 ml.
• Proroyomenorrhea - frequent periods, the interval between which is less than 21 days.

This situation is also called menorrhagia. Of course, it leads to chronic blood loss, which affects the general well-being of a woman. Is developing iron-deficiency anemia, and she, in turn, is accompanied by general weakness, dizziness, increased heart rate, pale skin, brittle hair and nails.

With hypomenstrual syndrome, the opposite situation develops - there are less menstruation than physiology requires. Its structure includes the following violations:

• Oligomenorrhea - the duration of menstruation is only 1-2 days.
• Hypomenorrhea - the volume of discharge is less than 50 ml.
• Opsomenorrhea is rare, and the interval between them is increased to 35 days or more.

There are also one-phase cycles, when ovulation does not occur, and the follicle is either atresized (did not have time to mature and became desolate), or persists (formed, but does not rupture). Then there are dysfunctional uterine bleeding... It must be borne in mind that any irregularities in the menstrual cycle can become an obstacle to conception and pregnancy, that is, they often lead to infertility.

Clinically, violations of the female cycle are combined into several options, each of which has its own characteristics.

Additional diagnostics

Additional testing is required to confirm menstrual dysfunction, determine its nature, and determine the cause. Therefore, after a clinical and gynecological examination, the doctor prescribes certain laboratory and instrumental studies:

1. Basal temperature measurement.
2. General blood and urine tests.
3. Blood biochemistry (hormonal spectrum, glucose, antibodies to infections, tumor markers, etc.).
4. Analysis of vaginal discharge.
5. PAP test (for atypical cells).
6. Colposcopy.
7. Hysterography, etc.

Consultation of related specialists, most often an endocrinologist, may also be required. And only a complete picture of changes in a woman's body will be the key to a correct diagnosis. And on its basis, menstrual dysfunction is already being treated, the methods and methods of which are strictly individual - they are determined by the cause and nature of the pathology.