Endometrial hyperplasia

The reasons

Kinds

Manifestations of endometrial hyperplasia

Diagnostics

Treatment of endometrial hyperplasia

Complications and prognosis

Hyperplasia (pathological growth) of the endometrium is a benign process of an excessive increase in the volume and thickness of the inner lining of the uterus.

Endometrial hyperplasia occurs as a result of the proliferation of glandular and other tissue cells. It leads to a violation of the functional activity of the endometrium (menstruation disorder, problems with conception).

Under normal conditions, the endometrium grows in the first phase of the cycle under the action of estrogen, and is restrained in the second phase of the cycle under the action of progesterone. In pathology, the endometrium grows uncontrollably, it can capture certain areas (focal hyperplasia) or the entire inner membrane.

The reasons

The main cause of endometrial hyperplasia today is considered the excess of the physiological level   estrogen   with relative deficit   progesterone . This condition can lead to:

  • taking estrogen-containing drugs without taking progesterone,
  • period menopause,
  • syndrome   polycystic ovaries,
  • female obesity
  • transitional age with hormonal surges and hormonal metabolic disturbances.

Most often, endometrial hyperplasia occurs in young women who have not given birth or in premenopausal women.

Concomitant diseases that may exacerbate the manifestations of hyperplasia are hypertension, sugar diabetes both types, thyroid disease, problems with the breast and adrenal glands. Predispose to the development of hyperplasia:

  • genital inflammation,
  • production abortions and scraping,
  • uterine fibroids,
  • adenomyosis,
  • unfavorable heredity of genital diseases.

Kinds

The predominance of certain elements in the growing endometrium, stands out:

  • hyperplasia of the glandular type (endometrial glands proliferate),
  • hyperplasia cystic glandular type (cysts and glands grow approximately the same),
  • adenomatous hyperplasia with the presence of atypical cells, precancerous. The rebirth of such hyperplasia reaches 10%.
  • polypous form of hyperplasia. This focal growth of the endometrium, which has the character of fibrous, fibro-glandular and glandular. May be on the leg, become rarely malignant, but may be an adverse background for various gynecological diseases.

Manifestations of endometrial hyperplasia

Endometrial hyperplasia is mainly manifested by recurrent non-cyclical bleeding.

Blood discharge may be between menstruation or after menstruation, prolonged spotting secretions. They are of a moderate nature, smearing, blood coagulated.

In adolescence, there may be heavy bleeding with clots, leading to anemization. The menstrual cycle is anovulatory, due to the suppression of the maturation of the egg by an excess of estrogens. In rare cases, hyperplasia is asymptomatic, giving effect to infertility.

Endometrial hyperplasia during menopause manifests itself again after a period of menstruation. bleeding non-cyclical nature.

Hyperplasia is considered as a precancerous condition, in connection with which it requires special observation, according to doctors, up to 1% of cases of hyperplasia turn into uterine cancer.

Diagnostics

The basis for the diagnosis of endometrial hyperplasia is the examination of a woman by a gynecologist, laboratory and instrumental examinations.

The main of them include:

  • Ultrasound of the uterus and appendages with a vaginal sensor,
  • hysteroscopy with material sampling for histological examination and possibly diagnostic curettage of the uterus,
  • if it is necessary to clarify the type of hyperplasia, an aspiration biopsy is performed.

One of the most important laboratory tests is to determine the level of sex hormones in the blood serum, as well as the level of adrenal hormones and thyroid gland.

Treatment of endometrial hyperplasia

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Treatment is carried out immediately after diagnosis, the method is chosen based on the age and manifestations of the disease.

The most effective method is hysteroscopic removal of polyps or separate diagnostic curettage of the endometrium during a diffuse process.

However, the treatment of endometrial hyperplasia is multi-stage.

First of all, scheduled or emergency scraping is performed. Emergency resorted to with bleeding and anemizatsii patients.

After obtaining the results of histology prescribe:

  • combined oral contraception – Janine, Yarin, regulon, for six months according to the traditional regimen,
  • with bleeding in girls at a young age, oral contraceptives can be used in several large doses for non-operative bleeding,
  • progestin drugs (utrozhestan, djufaston) a second phase of the cycle,
  • intramix spiral Mirena with gestagens,
  • drugs gonadotropin antagonists ( buserelin ) after the age of 35 years.

These drugs create an effect similar to climax, but quite reversible.

After the curettage operation, the control is carried out within six months, but if the adenomatous form of endometrial hyperplasia recurs, the removal of the uterus is indicated. With other recurrent forms of the process and the ineffectiveness of other treatment methods, ablation of the endometrium, its artificial destruction is carried out.

Complications and prognosis

The most dangerous complication of endometrial hyperplasia is the transformation into uterine cancer.

Not less dangerous relapses and persistent bleeding with the development of anemia, infertility.

The prognosis in most cases is favorable, the disease can be cured within 6-12 months of medication and surgery.

Vulvitis in girls and women

Kinds

The reasons

Symptoms of vulvitis

Diagnostics

Treatment of vulvitis

Consequences and prognosis

The term “vulva” includes the female external genital organs, which include the labia minora and labia vulva, the eve of the vagina, the external opening of the urethra, and the clitoris.

About vulvitis say when the inflammation of the mucous vulva, that is, all of the listed anatomical structures.

Women of premenopausal and menopausal age often suffer from Vulvitis and girls, as a rule, up to 10 years.

Kinds

Downstream distinguish

  • acute vulvitis, which lasts for one month,
  • subacute vulvitis lasting up to three months
  • chronic process lasting more than three months.

Also, the disease can be infectious, that is, due to pathogenic microorganisms, and non-infectious (allergic, atopic, traumatic vulvitis ). In turn, an infectious vulvitis may be nonspecific and specific ( trichomonas, gonorrhea, candidal ).

In addition, vulvitis is classified into primary and secondary. Primary vulvitis is talked about when the process has evolved against the background of non-compliance with intimate hygiene, injuries and other factors. Secondary vulvitis is a disease that appears on the background of any other (helminthiasis, endometritis, diabetes mellitus ).

The reasons

The causes of vulvitis in girls and women are very similar. These include:

  • failure to comply with the rules of intimate hygiene (frequent, using soap washing, neglect of hygiene);
  • diseases of the internal genital organs (vulvar irritation, pathological leucorrhoea);
  • genital infections;
  • allergic reactions (diaper dermatitis, the use of nappies with fragrances, the use of pads and deodorizing personal care products);
  • endocrine pathology (diabetes, hypothyroidism );
  • wearing tight linen and tight pants;
  • genital trauma (masturbation, foreign bodies, rough sexual intercourse);
  • lack of vitamins;
  • hormonal adjustment (during pregnancy and   menopause );
  • weakened immunity;
  • improper feeding (in infants);
  • helminthiasis;
  • long-term antibiotic treatment;
  • urinary tract infections;
  • urinary incontinence;
  • anatomical features: lack of posterior commissure, gaping genital slit (in girls);
  • childhood infections;
  • obesity;
  • vegetoneuroses (vulva scratching).

Infectious pathogens of the disease can be E. coli, fungi, viruses, and specific microorganisms ( chlamydia , gonococci, trichomonads).

Symptoms of vulvitis

The clinical picture of the disease is similar in both girls and women.

On examination, there is swelling of the labia and clitoris, their color changes to bright red. Older girls and women often have a sore clitoris that interferes with walking and causes pain. Permanent combing of the vulva (in girls) leads to ulceration. In some cases, the process extends to the skin of the pubis and internal labia.

Girls become restless, capricious, their sleep is disturbed. In children under one year, there is anxiety, crying, especially during urination, and rejection of the breast. Sometimes the process is so pronounced that the girl’s temperature rises and the inguinal lymph nodes increase. Women, in addition to itching and burning in the vulva, complain of pain during intimacy, urination, and when walking.

Another characteristic sign of vulvitis is whiter. In girls, they are usually abundant, transparent or watery, but can change their color and character depending on the pathogen.

Diagnostics

Differential diagnosis of vulvitis should be carried out with herpes infection, diabetes mellitus, diseases of the internal genital organs, children’s infections ( measles, scarlet fever ), sexually transmitted infections.

The diagnosis is established on the basis of characteristic complaints and the clinical picture.

Mandatory microscopy of vaginal (in girls) and cervical smear, smear from the urethra.

In addition, it is shown to conduct bacteriological examination of whiter to identify the pathogen and determine its sensitivity to antibiotics.

PCR diagnostics for genital infections, complete blood and urine analysis, feces for helminth eggs and blood sugar.

Treatment of vulvitis

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The treatment of vulvitis in girls is carried out by a pediatric gynecologist, in women a gynecologist.

First of all, before starting treatment, it is necessary to establish and eliminate the cause that led to the disease. For example, changing diapers, refusal of intimate hygiene products, revision of complementary foods, removal of a foreign body from the vagina and so on. This stage is crucial in the treatment of the disease.

Further, treatment is prescribed depending on the identified pathogen (in the case of the fungal etiology of vulvitis, antifungal agents are indicated, in the infectious nature of the disease antibiotics are prescribed).

Children, as a rule, are not prescribed antibiotics, but if the course of the disease is severe, and even more so if vulvitis is caused by a specific microflora, antibiotic therapy is necessary.

Warm baths with decoction of medicinal herbs (calendula, chamomile, and St. John’s wort) and antiseptic solutions ( furacilin, chlorhexidine, boric acid) are shown as symptomatic therapy.

With severe itching, ointments are prescribed.   for external use with anesthesin, painkillers.

In case of restless sleep, sleeping pills are prescribed.

For the time of treatment, girls are shown bed rest, women are banned from sex.

The treatment of acute vulvitis takes 7-10 days, while the treatment of chronic can take a month or more.

Consequences and prognosis

One of the consequences of the disease is the chronization of the process (with poor quality or incomplete treatment).

In girls, acute vulvitis is dangerous in the development of synechiae (adhesions)   labia, narrowing of the vagina, deformation of the external genital organs, which impede the intimate life in the future, urethritis, erosion of the cervix .

In women, an infection from the vulva can penetrate higher into the cervix, uterus and appendages with the development of inflammatory diseases.

The prognosis for the timely treatment of vulvitis favorable.

Types of abortion

What week is it possible to have an abortion

Ways of abortion

Contraindications for abortion

Analyzes and algorithm of examination of a woman before an abortion

Complications of abortion

What week is it possible to have an abortion

In the early stages

Domestic legislation allows you to make a decision on the artificial termination of pregnancy up to 12 weeks (abortion in the early period) to any pregnant woman. An early abortion can also be prescribed by a doctor due to some circumstances that prevent the normal course of pregnancy.

In the early stages of up to 12 weeks, the following methods of abortion are allowed: 

  • Drug method – taking pills that cause miscarriage (is the safest method) 
  • Vacuum aspiration of the uterus (vacuum abortion) – sucking the ovum from the uterus using a vacuum apparatus; 
  • The method of surgical curettage (curettage) of the uterus (the method is allowed, but is not currently recommended for widespread use).

Do not forget that any artificial abortion entails complications that can occur immediately after the manipulation, and can be delayed for up to several years. 

On late terms

When the gestation period is from 12 to 22 weeks, abortion can be performed only in the hospital and only because of medical or social indications that have appeared. This is explained by the fact that at such late stages of pregnancy her interruption can have a very negative effect on the health of the woman.

Medical indications for late pregnancy (from 12 to 22 weeks) can occur on the mother’s side and on the side of the fetus:

  • On the mother’s side, these can be diseases in which further pregnancy will threaten the life of a woman. For example, a case of cancer that requires urgent treatment of a woman with chemotherapy drugs that are not permissible during pregnancy.
  • fetal pathologies identified during pregnancy (genetic abnormalities, malformations incompatible with life, missed abortion).

The decision on the need for termination of pregnancy in a long term is taken by the medical commission (as part of the commission, the attending physician is an obstetrician-gynecologist, the chief doctor or his deputy, a consultant — for example, a genetic doctor with a chromosomal fetus or cardiologist who has a heart disease in a woman).

The decision to conduct a late abortion on social indicators from 12 to 22 weeks is made only when the pregnancy arose as a result of the rape of a woman. The fact of rape must be documented (the patient’s treatment for medical assistance and to the police after the incident was recorded).

Termination of pregnancy in the later period occurs by the drug method (the dose and method of administration of drugs differ from the drug interruption in the early stages).

After 12 weeks, the dilation of the cervix and the scraping with sharp surgical instruments are not carried out due to the large size of the fetus and the pregnant uterus. The walls of the uterus become soft and stretched, they are easy to perforate (accidentally poke) tools for expanding the cervix and the evacuation of the ovum. In this case, the risk of surgery is too high for a pregnant woman.

Scraping of the uterus in a large period is possible only after a miscarriage with a reduced uterus (this sometimes has to be done in the case of residues of the ovum in the uterus and signs of bleeding).

Ways of abortion

Medical abortion

Medical abortion is performed using a drug called mifepristone ( mifegin ), which reduces the effect of progesterone, which is the main hormone of pregnancy, and is used in conjunction with prostaglandins – these are drugs that can enhance the contraction of the uterus and help reject the fertilized egg. 

Medical abortion is performed on an outpatient basis with a gestation period of up to 8 weeks inclusive (63 days of delayed menstruation) and provided that the pregnancy proceeds without complications.

In pregnancy between 9 and 12 weeks or more, medical termination of pregnancy is carried out only in the hospital. For drugs in this period, efficiency is somewhat reduced (the shorter the period, the more effective the drugs).

With the ineffectiveness of medical abortion and the progression of pregnancy, the patient is asked to terminate the pregnancy by vacuum aspiration.

Vacuum abortion

To terminate a pregnancy, the vacuum aspiration method is used, that is, a vacuum apparatus is used, with the help of which the fertilized egg is destroyed and sucked out of the uterus. Abortion by the vacuum aspiration method is more gentle in comparison with curettage (curettage), since it does not involve the use of an acute obstetric curette and does not injure the uterine wall.

  • Vacuum abortion is called a mini-abortion if it is carried out with a gestation period of not more than 5 weeks. At this gestational age, it is not necessary to dilate the cervix with special metal dilators, because the tool for sucking a small gestational sac has a narrow diameter. 
  • Vacuum abortion with a period of 6 to 12 weeks is carried out with the expansion of the cervical canal of the uterus. Here, the size of the ovum requires the use of a nozzle for a vacuum suction of a larger diameter.

Scraping or curettage of the uterus (surgical abortion)

Scraping is carried out with a gestation period of 6 to 12 weeks and is performed only in a hospital setting. Before curettage, the cervix also requires mechanical expansion, then the fetal egg is destroyed and scraped out of the uterus with a sharp surgical instrument – an obstetric curette.

Currently, abortion by the method of curettage using a curette is allowed, but is considered gradually obsolete technology. Not recommended for widespread use.

The abortion curettage method is allowed in rare cases:

  • when it is not possible to apply more benign methods (vacuum aspiration of the ovum and medical abortion);
  • curettage is carried out in the case of residual ovum after a previous abortion, in order to completely empty the uterus;
  • curette curettage is necessary in case of tight attachment of the tissues of the ovum and bleeding. This often happens after a spontaneous abortion in a late period (from 12 to 22 weeks), after abortion in a late period. In these situations, tightly adhered tissues cannot be completely removed by vacuum suction. We have to resort to the use of curettes.

Contraindications for abortion

The main reasons that prevent the conduct of vacuum abortion and curettage:

  • inflammatory diseases of the genital organs;
  • the presence of foci of purulent infection, regardless of their location in the woman’s body;
  • acute infectious diseases.
  • six months after the previous pregnancy was interrupted.

Analyzes and algorithm of examination of a woman before an abortion

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  1. In case of delayed menstruation and suspicion of pregnancy, it is reasonable to start with a test for the presence in the woman’s body of human chorionic gonadotropic hormone ( hCG ). At home, women use for this purpose the usual pregnancy test “two strips”, and when preparing for an abortion in the laboratory, a blood sample for hCG is examined. The patient turns to a gynecologist, the duration of pregnancy is specified.
  2. Then, an ultrasound (US) is performed, which is used to determine the presence of a fertilized egg in the uterus. Confirmation of uterine pregnancy on ultrasound is a prerequisite before abortion (ectopic pregnancy is excluded).
  3. At the reception at the gynecologist, the uterus is examined and the discharge from the genital tract is evaluated. A smear is taken for vaginal purity and oncocytology . In the presence of inflammation in a smear or inflammatory secretions when viewed on a gynecological chair, sanation of the genital tract is prescribed. It is impossible to perform an abortion in the presence of an infection – with the tools for abortion and cervical dilatation, microorganisms from the vagina will spread higher into the uterus and fallopian tubes.  
  4. A general clinical examination is also appointed: complete blood and urine analysis , determination of blood group and Rh factor, blood test for syphilis, HIV infection, hepatitis B and C.   
  5. The result of the ECG and the examination of the therapist are needed before the use of intravenous anesthesia (usually abortion with a period of more than 5 weeks requires full pain relief).
  6. In the presence of concomitant diseases in women, the scope of the survey can be expanded. For example, in case of blood diseases, severe anemia, bleeding, surgical procedures have previously been prescribed additional studies of the blood coagulation system . 
  7. At the first treatment of a patient with an unwanted pregnancy, the gynecologist should refer her for a consultation with a psychologist if there is such a specialist in the place of residence of the pregnant woman. In large cities, special medical and social offices are created in women’s clinics to support pregnant women who find themselves in difficult situations.

Complications of abortion

Complications of Medical Abortion

  • uterine bleeding, requiring instrumental emptying of the uterus in the hospital ( vacuum – aspiration of the uterus) and the use of uterus-reducing means;
  • incomplete abortion (remnants of the ovum are also removed using vacuum aspiration of the uterus in the hospital);
  • infectious complications (the risk of their development is less than 1% of cases);
  • the progression of pregnancy in a situation where there was no rejection of the ovum.

Complications of the vacuum and surgical methods

Complications can be divided into:

Early, occur directly during the procedure or on the first day after the interruption – 

  • bleeding;
  • cervical injury;
  • allergic reactions to narcosis drugs.

Late, observed in the period from a week to several months:

  • a hematometer (accumulation of blood due to the fact that the cervical canal was closed too early);
  • incomplete abortion;
  • depression;
  • inflammatory processes ( endometritis, adnexitis ) 

The long-term effects of abortion can be observed years after the procedure:

  • hormonal disorders – one of the causes of infertility;
  • adhesions, obstruction of the fallopian tubes;
  • Difficulties in carrying a pregnancy.

It is necessary to clearly realize that as though a vacuum abortion was not low-impact, it is still an intervention in the female body and cannot be considered absolutely safe. Surgical abortion (curettage) is an aggressive method of abortion, and the risk of developing complications for the reproductive health of women is clearly increasing.

Vacuum abortion

Indications for Vacuum Abortion

Contraindications

Required tests

Vacuum abortion

After abortion

Complications

Vacuum abortion is done in up to 12 weeks:

  • up to 5 weeks, it is possible to carry out the so-called vacuum mini-abortion – on an outpatient basis without cervical dilatation.
  • From 6 to 12 weeks vacuum abortion is performed in the hospital using anesthesia.

To terminate a pregnancy using this method, a vacuum apparatus is used with which the fertilized egg is sucked from the uterus area. This method is less traumatic compared to a surgical abortion, since it requires minimal intervention in the woman’s body, which reduces the likelihood of damage to the uterus and the appearance of bleeding.  

An alternative to vacuum aspiration is a medical abortion.  

Indications for Vacuum Abortion

  • For a period of up to 12 weeks, a woman may terminate a pregnancy on her own initiative.
  • Also, the doctor may recommend aborting the pregnancy on the basis of medical indications.

Contraindications

The main reasons that impede a vacuum abortion are the following:

  • gestation period exceeds 12 weeks;
  • 6 months after the previous pregnancy was terminated;
  • the presence of foci of purulent infection, regardless of their location in the orgizm women;
  • inflammatory diseases of the genital organs;
  • acute infectious diseases.

Required tests

  • To confirm uterine pregnancy, blood is donated to determine hCG – a hormone that increases hundreds of times during pregnancy.  
  • Then, an ultrasound is performed ( ultrasound ), which is used to determine the position of the fertilized egg and thereby eliminate ectopic pregnancy.
  • Next, take a smear on the degree of purity of the vagina. If inflammations are detected, vaginal debridement is obligatory – antiseptic treatment.  
  • General analysis of blood and urine, blood type and Rh factor, blood for HIV, hepatitis and syphilis.
  • With a period of more than 6 weeks, ECG is required, because the procedure will be under anesthesia.
  • If the patient has comorbidities, additional tests may be prescribed.
  • If the pregnancy is terminated without evidence on the initiative of the woman, a conversation with a psychologist is scheduled.

Vacuum abortion

Mini abortion with a gestation period of not more than 5 weeks

It is performed using local anesthesia on an outpatient basis, i.e. After the procedure, the patient goes home.

Local anesthesia involves the introduction of an anesthetic drug in the cervical tissue. In addition, 30–40 minutes before the procedure, the woman was recommended to take the anesthetic drug in pills.

When conducting a mini-abortion, the woman is on the gynecological chair, the cervix is ​​exposed in the mirrors. A special soft catheter is inserted through the cervical canal (without its expansion). Vacuum suction creates a negative pressure in the uterus, which forces the fertilized egg, implanted in the wall of the uterus, to break away from the wall and leave the uterus.

Entering a soft catheter and the absence of mechanical expansion of the cervix minimizes the risk of traumatic effects on the female body. This reduces the risk of infection, damage to the walls of the uterus and subsequent bleeding. The time of a mini-abortion in normal practice does not exceed 10 minutes.

Vacuum abortion for a period of 6 to 12 weeks

Conducted in a gynecological hospital.

The principle of emptying the uterus is the same: a vacuum suction creates a negative pressure in the uterine cavity and sucks its contents. But with such a gestation period, the diameter of the vacuum suction head is already larger, and this requires dilation of the cervix. It is carried out mechanically with the help of metal extenders Gegar and may be accompanied by cervical microtraumas.

A complete vacuum abortion procedure usually lasts about 20 minutes under intravenous anesthesia.

If for some reason the patient cannot be given intravenous general anesthesia, or she herself does not want to completely turn off the mind during the procedure, an alternative anesthetic regimen can be applied. In this case, the doctor prescribes an intramuscular injection of a narcotic analgesic and a sedation medication (soothing, reducing anxiety and pain threshold) 40 minutes before the procedure. Immediately before the manipulation on the gynecological chair, the doctor additionally introduces an anesthetic agent paracervical, that is, in the tissue of the cervix.

Abortion requires the appointment of antibacterial drugs:

  • For the prevention of inflammatory complications once a day of the procedure – in patients without risk factors for the addition of infection, examined for the presence of chlamydia (with a negative result).
  • The course for 7-10 days – in patients with identified chlamydial or other infection, as well as in the presence of risk factors for the addition of inflammatory complications (with bum vaginosis previously in a smear requiring reconditioning before an abortion, in women with low socioeconomic status).

When an Rh-negative woman’s blood is used during an abortion, a dose of anti-Rh immunoglobulin is recommended to prevent immunization and the development of Rh-conflict during the next pregnancy. This must be done in the event that the partner has Rh-positive blood.

Usually in the hospital the patient is observed during the day after surgery. The next day, examination by a gynecologist eliminates early complications. The patient should be determined with the subsequent method of contraception to avoid repeated unwanted conception. In the absence of contraception, pregnancy may occur within 1-2 months after surgery.

After abortion

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Sex life after an abortion is not recommended for 3 weeks.

For at least 6 months, the development of a new pregnancy cannot be allowed.

If desired, to be protected by oral contraceptives, the patient should take the first pill from the package on the day of the abortion.

The intrauterine device can be inserted during a gynecological examination on the day after the abortion, or during the next normal menstruation.

Spotting may persist for up to 2 weeks. With satisfactory well-being, an ultrasound scan is recommended for 5-7 days from the start of the first post-abortion menstruation. If there are complaints (fever, abdominal pain, bleeding or purulent “leucorrhœa” from the genital tract), the patient should immediately consult a doctor.

Complications

  • Incomplete abortion is a frequent complication of abortion by the method of vacuum aspiration. It occurs when the fertilized egg is not completely removed from the uterus. This can lead to the development of severe inflammation and require surgical intervention. To prevent incomplete abortion, it is imperative that the procedure be performed under ultrasound control.
  • After abortion increases the risk of hormonal disorders – endocrine factor infertility in the future.
  • Attaching inflammations and infections often occurs after abortions, because the uterus is traumatized and vulnerable.

Despite the fact that the procedure of vacuum abortion is quite low-impact (especially mini-abortion for up to 5 weeks), we should not forget that this is a side intervention in the woman’s body that cannot be called completely safe.

Vaginitis

General information

Vaginosis or Vaginitis

Types of Vaginitis

Can I get infected from a partner

What is dangerous vaginitis during pregnancy

Causes of Vaginitis

Symptoms of acute, chronic and atrophic vaginitis

Vaginitis in girls

How to diagnose

Treatment

Control after treatment

A bit of terminology

Vulvovaginitis is an inflammatory disease of the female genital tract.

Vulvovaginitis is divided into vulvitis and vaginitis by localization.

With vaginitis (the second name is “ colpitis ”), the vaginal mucosa is inflamed. When the vulva inflames the mucous membrane of the labia minora and vaginal vestibule. 

General information

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Vaginitis and vulvovaginitis are one of the most frequent reasons for patients to go to a gynecologist, and the most common complaints are abundant discharge (“whiter”), itching and redness in the genital area, pain in the vagina.

Also, the diagnosis of ” colpitis ” or “vaginitis” can be exposed to a woman during a physical examination, during examination on the result of a vaginal smear.

Normally, lactic acid bacteria ( lactobacterium and bifidobacteria) predominate in the smear . The cells of the vaginal epithelium under the action of sex hormones accumulate the substance glycogen, and lactobacteria break it down into lactic acid, therefore the environment in the vagina is normally acidic (pH = 3.8-4.5). This is an ideal habitat for beneficial bacteria, as well as their protection from other microorganisms – “competitors”. In normal vaginal discharge light, dairy to 2-3 ml per day. Dryness in the vagina in a woman of young childbearing age should not be. Symptom of dryness is in menopause and ovarian dysfunction and indicates a decrease in the level of sex hormones.

Vaginosis or Vaginitis

Bacterial vaginosis is inherently neglected dysbacteriosis without inflammation of the tissues in the vagina, replacing the useful normal microflora with bacteria, which are normally insignificant. They do not cause inflammation, because the body knows them, got used to them. But to maintain the normal state of the vagina, these microorganisms can not, can not cope, because the manifestation of dysbiosis – pathological discharge with smell.

Vaginitis means primarily inflammation of the mucous membrane in response to the introduction of an infectious agent (pathogenic flora).

  • Vaginitis is inflammation
  • Vaginosis – a violation of microflora.

Also, do not confuse bacterial vaginitis (inflammation caused by bacteria) and bacretiary vaginosis.   

Types of Vaginitis

Bacterial

If the infectious agent is a bacterium, then vaginitis is called bacterial. Bacterial vaginitis can be divided into aerobic (caused by bacteria that consume oxygen in the process of life), and anaerobic (in this case, bacteria do not need oxygen). Yeast mushrooms can also cause vaginitis. Most often these are fungi of the genus Candida, hence the name Candida colpitis (vaginitis).

Specific

Specific vaginitis – the term means that a specific pathogen (for example, gonococcus, trichomonas, yeast mycelium filaments) is clearly identified by smear or seeding from the vagina. The treatment of such vaginitis will also be specific, taking into account the sensitivity of the microorganism to antibiotics.

Non-specific

Non-specific vaginitis does not clearly indicate a specific sexually transmitted infection. The cause of nonspecific vaginitis can be a group of staphylococci, streptococci, Escherichia coli, which are rarely present in the healthy vagina, but cause inflammation, replacing the lactobacilli.

Hence the answer to the following question that concerns many people:

Can I get infected from a partner

Only specific vaginitis is transmitted sexually through contact with a partner (that is, it is easy to get gonorrhea or trichomonas vaginitis in the case of unprotected sex). With non-specific vaginitis, there is no risk of infection.

What is dangerous vaginitis during pregnancy

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In a pregnant woman, the course of vaginitis and the presence of inflammation in a smear (both specific and non-specific) can lead to an unfavorable outcome of pregnancy, including:

  • infected miscarriage
  • intrauterine infection of the fetus,
  • insufficiency of the function of the placenta due to its infection, which leads clinically to fetal growth retardation, to polyhydramnios or low water,
  • preterm labor,
  • premature rupture of amniotic fluid.

In addition, if vaginitis appeared during pregnancy, then in childbirth a woman sets foot with irritated, red, edematous mucous walls of the vagina. When vaginitis, the walls are more prone to cracking, abrasions and ruptures of the mucous membrane during childbirth occur easily. In the face of reduced immunity, anemia (often during pregnancy and childbirth), lack of sleep, vaginitis after delivery against the background of an injury to the vaginal mucosa can become recurrent in nature.

Causes of Vaginitis

When vaginitis occurs

  1. When ingested specific microorganism , which causes inflammation, through sexual intercourse ( trichomoniasis, in candidal candidiasis, gonorrhea, mycoplasmosis, chlamydia );    
  2. When activating its own non-pathogenic microflora in the vagina, which supplanted both bifidobacteria and started the process of inflammation.

Factors contributing to this:

  • any decrease in immunity in a woman (during pregnancy, diabetes, infectious diseases, long-term administration of glucocorticoids, for example, in case of bronchial asthma or rheumatoid arthritis, during treatment for cancer with chemotherapy);
  • non-compliance with personal hygiene;
  • lack of hygiene of sexual life (frequent change of sexual partners, unprotected sexual contact);
  • prolonged or irrational use of antibiotics, which leads to the destruction of beneficial lactobacilli and dysbacteriosis;
  • malnutrition of the mucous membrane while reducing the level of sex hormones (premature menopause syndrome, senile atrophy, the creation of artificial menopause in the treatment with chemotherapy) and during radiation therapy of cancer;
  • other disorders of the female endocrine system (for example, in diabetes mellitus and high blood sugar levels, the vaginal epithelium cells accumulate glycogen excessively, a favorable environment for the development of fungal flora is created, so diabetes mellitus is very characteristic of recurrences of thrush; in obesity in hot weather, irritation often occurs and diaper rash in the folds, groin, perineum);  
  • violation of the anatomy of the vagina due to the omission of its walls, prolapse of the uterus – there is a constant microtrauma of the mucous membrane;
  • vaginitis after childbirth can have a recurring nature, if there is a gaping genital slit as a result of cicatricial changes after ruptures in childbirth or with poor episiotomy healing – the entrance to microorganisms is open;
  • damage to the mucous membrane during manipulation in the vagina and in the uterus (for example, trauma to the mucous membrane with the introduction of mirrors and other tools, abrasions and micro-tears during labor);
  • allergies (for example, condom gum, or the use of vaginal creams or pills for contraception, or synthetic underwear). 
  • vaginitis with menstrual irregularities. For example, the patient has menstruation for 7 days, and then another ten days for spotting, the next menstruation generally lasted 2 weeks – all this time, when menstrual blood leaks into the vagina, its normal acidic environment changes to a more alkaline direction. Lactobacilli in such an environment is not comfortable living. The number of normal microflora is reduced, thus, with menstrual disorders, prerequisites for the occurrence of vaginitis are created.

All of the above points contribute to the settlement in the vagina of an unusual microflora with the further development of inflammatory changes.

Cystitis is an acute inflammatory disease of the bladder, the symptoms of which are painful …   

Symptoms of acute, chronic and atrophic vaginitis

Acute Vaginitis

In the acute stage of vaginitis, the patient complains of contamination of the underwear with vaginal secretions – “belium”.

The discharge in acute vaginitis can be thick, viscous, whitish to brown, abundant (up to 20 ml per day at a rate of up to 2-3 ml). Abundant frothy yellow-green discharge is characteristic of Trichomonas colpitis . When thrush, or yeast fungal colpitis , discharge resembles cottage cheese, flaky, with the smell of yogurt. Admixture of pus to the mucous discharge in gonorrhea makes the discharge ” creamy “, yellowish.

Patients in the acute stage also often complain of itching and burning in the area of ​​the vulva, the entrance to the vagina, sometimes because of this the patient’s sleep is disturbed. Sexual intercourse is painful – it is called in medicine the term ” dyspareunia .”

Often a burning sensation during urination and pain in the lower abdomen, lower back joins acute vaginitis. This most often happens when a specific microbe is infected with the mucous membrane of the urethra – cystitis joins. 

There is usually no increase in temperature in vulvovaginitis, hyperthermia occurs with complicated forms of the disease (abscess of the vulva, ulceration of the vulva) and with the spread of infection (ascending path from the vagina through the cervix into the uterus, fallopian tubes, appendage area).

Chronic vaginitis

In the chronic stage of vaginitis in adult patients, complaints of discharge from the genital tract persist, less prone to itching and discomfort in the vaginal area. Chronic vaginitis implies a sluggish long-term course and a tendency to relapse more often 4 times a year.

Atrophic ( postmenopausal or senile) vaginitis

Atrophic vaginitis usually occurs 3-5 years after the end of menstruation, as a result of a decrease in the level of sex hormones (estrogens) with age. In conditions of lack of estrogen, the epithelium of the vagina does not accumulate glycogen, it becomes thinner and unfavorable for the life of lactic acid bacteria. Lactobacilli becomes less and less, and clinically in a woman in menopause, this is manifested by severe dryness in the vagina, burning sensation when urinating and washing with the use of soap, soreness during sexual intercourse, the appearance of bloody discharge after sexual intercourse. Most often in the atrophic smear in general any microflora is absent, but sometimes microbial nonspecific or specific vaginitis can occur. In this case, ulceration will easily appear on the thinned pale bleeding mucous membrane.

Vaginitis in girls

Sometimes little girls with symptoms of vulvitis and vulvovaginitis are brought to the gynecologist’s appointment . After all, a child may also experience a decrease in immunity, activation of its own non-pathogenic flora, it can also receive antibiotics, and diabetes.

Girls in such cases complain of itching on the eve of the vagina, the mother can see “whites” on the panties, sometimes the child just starts crying, holding a hand over the lower abdomen and perineum. It happens that small girls of 3-5 years old (at the age of increased attention of the child to their genitals) can introduce small toys on the eve of the vagina, for example, details from the designer or “kinder surprise”, which then cause inflammation inside.

If you notice something wrong in time, then everything is fixable. In the chronic form, young girls experience synechiae (adhesions) of the vaginal walls, white adhesions in the urethra and perineum. Such adhesions then need to be separated and treated for a long time.

How to diagnose

The doctor draws attention to the nature of the patient’s complaints, asks her about a possible provocation of the disease – a woman can tell about a change of sexual partner, an episode of uncontrolled antibiotics, a recent abortion, taking oral contraceptives with a high content of estrogen, etc.

What will see the gynecologist during the inspection

  • When viewed on a gynecological chair, the redness of the mucous membrane of the labia minora and the skin around the entrance to the vagina draws attention to itself, there may be a whitish bloom and cheesy flakes on the mucosa.
  • The urethra may be swollen and swollen.
  • The mucosa is also irritated, red, swollen, and may bleed upon contact with a gynecological mirror.
  • On the walls of the vagina there may also be an inflammatory white patina, cheesy discharge, and foamy, creamy or abundant milky discharges on the mirrors, sometimes with a smell.

The main methods of diagnosis and confirmation of vulvovaginitis –

  • bacterioscopic (examination of smears from the vagina, cervix, and urethra on the glass under a microscope)
  • bacteriological (seeding of secretions on media with observation of the growth of microorganisms). In the process of sowing microbes, it can also immediately determine its sensitivity to various antibacterial drugs, which in some cases makes it easier to choose a treatment regimen.

Patients with fever and frequent recurrences of vaginitis are prescribed pelvic ultrasound to prevent the spread of infection above the vagina (uterus, fallopian tubes, and ovaries).  

If during the examination revealed vaginitis and cervical erosion , signs of inflammation of the cervical canal of the cervix, condyloma – the patient should be examined for ureaplasmosis , chlamydia and human papillomavirus and herpes virus. Under conditions of infection and vaginitis, cervical erosion does not heal for a long time, bleeds, and requires first treatment of the inflammatory process.      

Treatment

Treatment of vulvovaginitis should be a two-step process – antibacterial therapy is first carried out to eliminate the pathological microflora, and then preparations are used to restore normal biocenosis.

In addition, as far as possible, predisposing moments of the disease should be eliminated, attention should be paid to the treatment of associated diseases and functional disorders. For example, in ovarian hypofunction, it is necessary to correct their activity, aimed at filling the body’s hormone deficiency, when omitting the vaginal walls, to perform a planned operation to restore the pelvic floor, and in case of diabetes, together with the endocrinologist, to adjust the blood sugar level close to the target.    

At stage 1 of drug treatment of vaginitis, antibacterial and local sanitizing therapy is prescribed.

Non-specific vaginitis

If the causative agent of inflammation is not identified, then broad-spectrum antibacterial drugs are prescribed (that is, effective against most known microbes).

The recommended (main) scheme for the treatment of acute vaginitis of non-pregnant women:

  • candles with hlogeksidiny ( hexicon ) vaginally 1-2 times a day for up to 7-10 days;
  • or clindamycin candles (1 candle daily for 6 days in a row);
  • or metronidazole (in vaginal suppositories twice a day for 5 days in a row or in tablets of 0.5 mg for oral administration twice a day for a week).

In cases of chronic course and relapse, an alternative treatment regimen is recommended:

  • clindamycin 300 mg tablets take 2 times a day during the week;
  • or metronidazole orally once in a dose of 2 grams;
  • or tinidazole in a dose of 2 grams taken orally once.

Therapy for Specific Vaginitis

If the cause of vaginitis is a specific microorganism (for example, trichomonads, gonococcus, fungi of the genus Candida , etc.), then antibacterial drugs at stage 1 are prescribed for sensitivity to these pathogens.

Trichomonas colpit is effectively treated using metronidazole: vaginal suppositories with metronidazole are used daily at night, one at a time and simultaneous intake of metronidazole in tablets (total for a course of 5-7.5 g of metronidazole, with obesity, the dose increases to 10-15 g per course). 

In pregnant women, you can use this drug from the second trimester of pregnancy.

When gonorrhea is usually used ceftriaxone 250 mg / m once, or azithromycin 2 g orally once, it is also possible to use ciprofloxacin, ofloxacin . In persistent cases of vaginitis, vaginal baths are used: after preliminary douching with soda solution, 1–2 tablespoons are introduced through a round vaginal mirror. l 2-3% solution of silver nitrate, 3-10% solution of protargol. After 2-3 minutes, the liquid is removed. Baths are done in 2-3 days. 

With relapses and chronic gonorrhea, treatment is necessarily carried out and prescribed by the dermatovenereologist.

In pregnancy, gonorrhea is subject to compulsory treatment. Usually use ceftriaxone, sometimes – macrolides.

In candidal vaginitis (for acute thrush or fungal vagitis ), treatment begins with the use of antifungal drugs:  

  • miconazole in vaginal suppository 100 mg at night, one per week;
  • fluconazole 150 mg orally once;
  • Introconazole tablets 200 mg twice a day, take 3 days;
  • clotrimazole 100 mg each (for the night of 7 days, 1 candle is administered vaginally).

Pregnant women can, starting with the first trimester of pregnancy, use candles with pimafucine , starting with the second trimester of pregnancy – candles “ terzhinan ”, “ gino-pevaril ”, candles with clotrimazole .

Thrush ( candidal vaginitis) bothers women more often than other specific vaginitis and it is characterized by chronic course and constant relapses.

In chronic thrush, the combined use of vaginal suppositories (for example, with ketoconazole ) for 14 consecutive days and taking a systemic antifungal drug (for example, fluconazole in 150 mg capsules once for 3 consecutive days) is recommended.

After treatment of chronic thrush, it is also recommended to continue the prophylactic administration of antifungal drugs to prevent recurrence of thrush: you need to take 150 mg of fluconazole orally on the first day of menstruation once during 6 menstrual cycles (six months).

Atrophic Vaginitis

Treatment of atrophic ( postmenopausal ) vaginitis should include:

  • replenishment of hormonal deficiency with the help of hormone replacement therapy or phytoestrogens (which can be applied in each case the doctor decides),
  • candles in the vagina or cream with wound healing and softening effect (candles with sea buckthorn, calendula, string), tampons with aloe juice at home,
  • antibacterial vaginal suppositories for vaginitis with the identification of pathogenic flora.

Recommendations gynecologist

  • The treatment of a male partner is necessary for specific vaginitis, since even in the absence of complaints of microorganisms (for example, Trichomonas), the man can be contained in the body of a man in the prostate and in the seminal vesicles, cause chronic inflammation and lead to prostatitis and infertility. In addition, there is no point in treating a woman if the sexual partner after treatment re-rewards her with germs. In the case of non-specific vaginitis in a partner, the man should be treated only if he has complaints (itchy genitals, discharge, painful urination, pain in the lower abdomen).
  • During the treatment of vaginitis, it is recommended to exclude alcohol, limit sweet
  • It is strongly recommended to exclude sex life.
  • If the patient is more worried about itching of the vulva in the region of the labia minora, then you can use a cream with the same preparation instead of vaginal suppositories (for example, cream with clotrimazole , clindamycin ).
  • Douching with vaginitis is auxiliary, for example, you can douche with chamomile solution, calendula, chlorhexidine solution, but antibacterial and antifungal drugs in vaginal suppositories, tablets, creams will have the main therapeutic effect. It will be useful to apply the spray ” epigen “, it is worth mentioning it separately, as it has an immunostimulating effect. It helps fight nonspecific vaginitis, candidal vaginitis, in cases of genital warts and herpes.
  • For severe itching and painful sensations in the vagina, local anesthetic ointments ( emla , kamistad ) can be recommended for a short time.
  • In the treatment of vaginitis, you can visit the pool and swim. To infect someone or to become infected with vaginitis yourself is possible only if you do not just swim, but have sex in the water.

Restoration of microflora

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At the second stage of treatment, biopreparations with bacteria are used to restore normal microflora in the vagina. It is necessary to make a pause in 3-4 days between taking antibacterial agents and biologics.

Preparations of this series can be divided into:

  • containing only lactobacilli (acylact, acipol , lactogen , lactobacterin ),
  • containing only bifidumbacterium ( bifidumbacterin , probifor ),
  • kombirirovannye ( lineks , bifiform et al.).

Biologics are best used in vaginal suppositories, and inside for systemic exposure.

Control after treatment

After treatment of acute vaginitis, smear monitoring is carried out a week after the end of therapy, and again after the end of the next menstruation. With a normal microscopic smear and no recurrence, the prognosis for recovery is favorable.

Bartholinite

Forms

The reasons

Symptoms of Bartholinitis

Bartholinitis during pregnancy

Diagnostics

Bartholinitis treatment

Consequences and prognosis

Bartholinitis is said to be inflamed when the large gland vestibular gland is inflamed (aka bartholin gland), which is a paired organ and is located in the labia majora. Bartholinitis mainly affects women of childbearing age.

Forms

Bartholinitis is divided into acute and chronic form. In turn, in the acute process a false abscess is distinguished, it is also a canaliculitis and a true one.

Chronic process often recurs. Also a manifestation of chronic Bartholinitis is a Bartholin gland cyst. 

The reasons

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Typically, the disease is caused by pathogens of genital infections (gonococci, trichomonas, chlamydia , mycoplasma ). But most often there is an association of pathogens. Not so often Bartholinitis can be caused by nonspecific flora (staphylococci, streptococci), which penetrate the gland duct from the inflamed urethra and / or vagina.  

A number of factors contribute to the development of the disease:

  • reduced immunity;
  • the presence of chronic foci of infection in the body (inflamed tonsils or carious teeth);
  • the period of menstruation or the second phase of the cycle;
  • treatment with certain drugs (antibiotics, hormones, cytostatics);
  • promiscuous sex life;
  • too tight underwear;
  • hypothermia;
  • injuries, including micro-in the perineum;
  • operative interventions (abortions, etc.);
  • lack of vitamins;
  • neglect of personal hygiene.

Symptoms of Bartholinitis

The disease begins with canaliculitis – inflammation of the external duct of the gland. Local symptoms are mild: there is a slight swelling in the area of ​​the labia majora and a small reddened spot. At this stage, many patients are still in no hurry to see a doctor and take inflammations for a pimple, trying to squeeze it out (in this case, a drop of purulent discharge appears).

With no further treatment, the external duct becomes clogged, and the secret of the Bartholin gland accumulates in its thickness. Then the local phenomena become more pronounced, the labia swollen, reddens, and symptoms of general intoxication appear (low-grade fever – up to 38 ° C, fatigue, decreased appetite). The inflamed gland spreads the tissues of the labia, in addition there are signs of local inflammation, which provokes pain in the patient when walking.

With a true Bartholin gland abscess, its parenchyma and surrounding fiber is melted. There is a pronounced hyperemia, a significant increase in the size of the gland, pain at the slightest movement. In such cases, patients cannot even walk. Phenomena of general intoxication increases, the temperature “jumps” up to 38.5 – 39 ° C. Dyspeptic symptoms, lack of appetite, headache and fatigue, emotional lability join.

Chronic bartholinitis tends to worsen frequently, but local inflammatory reactions and signs of general intoxication are not very pronounced. With a long-existing chronic Bartholinitis, exudate accumulates in the gland and a capsule is formed – the Bartholin gland cyst.

Bartholinitis during pregnancy

Bartholinitis during gestation threatens spontaneous abortion, preterm delivery, intrauterine infection of the fetus, and the risk of postpartum complications increases many times over.

If possible, a false abscess during pregnancy is treated conservatively. A true abscess is opened immediately. If acute Bartholinitis was diagnosed during labor, the autopsy of the abscess is delayed for the postpartum period. In order to avoid spontaneous opening of an abscess during attempts, an episiotomy is performed on the healthy side (to relieve head pressure on the abscess). In the case of spontaneous opening in the sore period of the abscess, it is prohibited to conduct a vaginal examination (only rectal).  

A Bartholin cyst during pregnancy is not an indication for urgent removal. Surgery postponed for the postpartum period.

Diagnostics

Differential diagnosis of bartholinitis should be carried out

  • with suppuration of the labia majora (when pararectal and paravaginal fiber is infected) during rectal and vaginal examination, seals in the vagina and rectum are determined;
  • with perineal furunculosis (the focus of inflammation is not one and in the center of the abscess one can see rod hair).

To diagnose the disease is quite simple, already on the first examination, the gynecologist makes the correct diagnosis. But in any case, an additional examination is appointed:

  • complete blood count (leukocytosis, monocytosis, accelerated ESR);
  • urinalysis (to detect signs of inflammation of the bladder and urethra: leukocyturia, cylindruria, microhematuria is possible);
  • tests of vaginal and cervical smears;
  • swab of the gland discharge;
  • bakposev on microflora at the opening of the abscess and the determination of sensitivity to antibiotics;
  • PCR diagnostics for genital infections;
  • blood for HIV infection and syphilis.

Bartholinitis treatment

The sooner treatment is started, the better the prognosis of the disease. When canaliculitis (the initial stage of Bartholinitis), applications with antiseptics (Miramistin, chlorhexidine, furacilin) ​​or with infusions of medicinal herbs (chamomile, calendula, and coltsfoot) are prescribed. Also as a local therapy using medicinal ointment (Levomekol, Vishnevsky). Antibiotics are prescribed orally (amikacin, ceftriaxone, kefzol, sumamed), together with metronidazole. The course of such therapy is 7 days, the process begins resorbed.

In case of false and true abscesses of the Bartholin gland, it is necessary to open the abscess with subsequent drainage (3-5 days). The wound is washed with hydrogen peroxide and drainage is introduced. Ligation is carried out daily. In parallel, intramuscular antibiotics (fluoroquinolones, cephalosporins, penicillins) are administered. The whole process of treatment lasts no more than 10 days. In addition, a course of multivitamins and immunostimulants is prescribed.

Bartholin gland cyst is removed only by surgery during the “cold” period. There are 2 types of operations: marsupalization or removal (extirpation) of the gland. During marsupalization, a new false duct of the gland is formed.

Consequences and prognosis

Bartholinitis is dangerous by frequent relapses, the formation of a fistula at the site of the gland and the transfer of infection to nearby organs (vagina and urethra). With severe and late treatment of the disease may be complicated by sepsis . 

The prognosis for the correct and timely treatment of Bartholinitis is favorable.

Bacterial vaginosis

Manifestations of bacterial vaginosis

Diagnostics

Bacterial Vaginosis Treatment

Forecast

Bacterial vaginosis is a violation of the vaginal microecology. This is the most common condition in women of childbearing age.

The predisposing factors leading to the development of bacterial vaginosis include the following:

  • use of antibacterial drugs;
  • long-term use of intrauterine contraceptives;
  • use of preformed contraceptives;
  • previous inflammatory diseases of the urogenital tract;
  • violation of the hormonal status, accompanied by violation of the menstrual cycle;
  • changing the state of local immunity;
  • exposure to low doses of ionizing radiation;
  • stressful effects on the body.

In 60% of women suffering from bacterial vaginosis, violations of the microecology of the colon are detected (dysbiosis intestine).

Manifestations of bacterial vaginosis

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The main symptom is complaints about discharge with an unpleasant smell, which are noted by only 50% of women. Discharge is more often moderate, less often – plentiful, in some cases they may be absent altogether. Secretions in bacterial vaginosis grayish-white, uniform, without lumps, have a specific “fishy smell”, which can be permanent, absent, appear during menstruation and sexual intercourse.

The duration of these symptoms can be calculated for years. With a long current process discharge they acquire a yellowish-green color, become thicker, often resemble a curd, have the property of foam, are slightly friable and sticky, and are evenly distributed along the walls of the vagina.

Other complaints, mainly of itching and urination disorders, are rare: they may be completely absent or appear periodically. Often women with bacterial vaginosis complain of heavy menstrual bleeding, pain in the lower abdomen, adnexitis .

At the same time, in some cases in some patients do not reveal any manifestations of the disease.

Vaginal and vaginal irritation is rarely observed, which distinguishes bacterial vaginosis from candida and trichomoniasis, which are usually accompanied by severe itching.

Diagnostics

A preliminary diagnosis of bacterial vaginosis can be made already during a gynecological examination. After the inspection, a discharge of the vaginal discharge from the back of the body is taken.

The diagnosis can be made in the presence of 3 out of 4 listed symptoms:

  • the specific nature of the discharge;
  • acidity> 4.5 (normal 3.8-4.5);
  • positive aminotest ;
  • the presence of “key” cells. The so-called “key cells” are mature epithelial cells (surface layer of the vaginal epithelium), over the entire surface of which microbes are tightly and in large numbers attached.

Performing one of the 4 tests is not enough for a diagnosis.

Bacterial Vaginosis Treatment

In case of bacterial vaginosis, local therapeutic measures are considered optimal. A good therapeutic effect is indicated for drugs from the group of nitroimidazoles ( metronidazole , trichopolum , metrogyl , etc.), which are administered intravaginally in the form of tablets, tampons, or suppositories.

There are various schemes of complex treatment of bacterial vaginosis, consisting in the use of nitroimidazoles , prescribed by tablet and topical agents (1% hydrogen peroxide, antiseptic solution of tomicid , benzalkonium chloride compounds , etc.), which irrigate the vagina.

In case of tablet administration of nitroimidazoles, it is necessary to take into account the possibility of side effects such as dysfunction of the gastrointestinal tract, dizziness and headache.

In severe cases of bacterial vaginosis, the underlying principle of treatment is the use of broad-spectrum antibiotics for the purpose of general sanation of the vaginal mucosa ( clindamycin , oleandomycin , cephalosporins).

When prescribing broad-spectrum antibacterial drugs, a large number of side effects may occur, including dysbacteriosis of other cavities (intestines, etc.).

The effectiveness of the treatment of bacterial vaginosis is assessed by the disappearance of subjective manifestations, the dynamics of the clinical symptoms of the disease, the normalization of laboratory parameters. The first follow-up clinical and laboratory examination should be carried out a week after the completion of therapy, repeated – after 4-6 weeks.

During treatment and follow-up, the use of barrier methods of contraception (condoms) should be recommended.

Currently, one of the effective drugs for the treatment of bacterial vaginosis is dalacin vaginal cream, applied once a day for 3 days. The course of treatment is 3 days. One full applicator corresponds to a single dose of the drug.

Among the most frequent complications in the application of the above drugs should be noted vaginal candidiasis. For its prevention it is necessary to prescribe antifungal drugs – nystatin 2000 mg per day inside, simultaneously with the start of treatment. The most effective drug for non-pregnant women is fluconazole.At the same time, for the treatment of vaginal candidiasis during pregnancy, drugs such as clotrimazole , pimafucine , gino – mevoril , dafnedzhin , etc. are widely used .

Another effective remedy for bacterial vaginosis is the antiseptic drug Povidone – iodine ( Betadine ).

Forecast

With all of the above methods of treatment, there may be relapses that occur at different times after treatment. Apparently, this is due to the fact that antibiotic therapy, eliminating pathogens, often does not create the conditions for a sufficiently rapid recovery of beneficial bacteria.

In this regard, the complex treatment within 10 days after the main course of treatment must include such biological products as acylact, bifikol , bifidum – and lactobacterin , because of their specific action, aimed at restoring the normal ratio of lactobacilli in the vagina, and thereby preventing the frequency of recurrences of this diseases.

Primary Amenorrhea

How often it occurs

Types of primary amenorrhea

Why does

When to go to the doctor

Survey

Treatment

Possible complications

Prognosis and prevention

ICD-10 Code N91.0

Synonyms: amenorrhea, absence of menstruation. 

Primary amenorrhea is the initial absence of a girl’s period after 16 years. The disease can be caused by both anatomical disorders and hormonal disruptions. Symptoms vary according to the original cause of the disease. Treatment in most cases is based on hormone replacement therapy.

Primary amenorrhea differs from secondary primarily in the fact that a girl suffering from this disease has no menstrual bleeding, including menarche (first menstrual periods) in her life.

How often it occurs

The prevalence of primary amenorrhea varies, according to various sources, from 1.5 to 2%. At the same time, the disease together with its secondary form takes 10-15% in the structure of diseases associated with disorders of reproduction. This means that in 10-15% of girls and women who go to doctors because of the inability to conceive and bear a child, reveal the absence of menstruation for six months or more, or the complete absence of menstruation from the age of 16.

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Types of primary amenorrhea

There are two classifications of primary amenorrhea. First of all, there are:

  • the true form of pathology, in which there is no functional connection between the hypothalamus, pituitary, ovaries and the uterus and, as a result, there are no cyclic changes in these organs, sex hormones are not enough to make cyclic changes in the endometrium.
  • a false form of the disease in which there is a functional connection between organs and cyclical changes, but blood and rejection of the endometrium cannot for some reason go outside, for example, due to developmental defects of the cervix, vagina, and the hymen. These conditions require the intervention of a physician and are well treatable.

The second classification divides the primary amenorrhea into:

  • pathology with delayed sexual development – in this case, a delay in the development of secondary sexual characteristics is detected;
  • disease without signs of delayed sexual development – a violation of the development of secondary sexual characteristics in this case is absent.

Why does

Primary amenorrhea is a disease that is experienced at a young age. In most cases, the causes of violations leading to the emergence of a complex of symptoms are the result of malformations still in the womb.

Amenorrhea with delayed sexual development

Delayed sexual development is manifested by the lack of growth of the mammary glands and body hair of the female type at the age of more than 14 years. A girl constitutionally may not correspond to the height and weight set for her peers. When taking pictures of bones, the bone age lags to the true one too.

The main causes of primary amenorrhea in this case are two:

Malformations of the gonads

The cause of malformations with the absence of ovaries are genetic abnormalities. This congenital abnormality is called gonadal dysgenesis syndrome.

  • gonadal dysgenesis is a malformation in which a girl has no hormonally active tissue in the ovaries, which is why estrogen is insufficient in the body or they are completely absent. In the study of the chromosome set in the genetic laboratory, various chromosomal abnormalities are determined. Instead of ovarian tissue in the body, ultrasound or laparoscopy can show connective tissue strands. They do not emit hormones and there is no egg supply in them. Private and classic case of gonadal dysgenesis – Shershevsky-Turner’s chromosomal syndrome, in which the second X chromosome is missing;
  • testicular feminization syndrome is a malformation in which the girl has a male genotype (XY), but the appearance is typically feminine.

Disturbances in the hypothalamic-pituitary system

A distinctive feature of this type of amenorrhea is a decrease in the level of hormones (gonadotropins) produced in the brain. This can be detected by analysis of blood for FSH and LH.

No gonadotropins – no ovaries are stimulated – no sex hormone secretions in the ovaries – delayed sexual development – no menstruation.

Disturbances in the pituitary-hypothalamus system are divided into 2 groups:

  • functional disorders, they can be the result of malnutrition, frequent stress, infectious diseases, intoxication, many chronic diseases;
  • organic disorders – the presence of congenital abnormalities in the structure of the hypothalamic-pituitary system or tumors, due to which a complex of organs is no longer able to perform its functions. Also the cause of such violations may be the consequences of meningitis or encephalitis.

Amenorrhea without delayed sexual development

The cause of primary amenorrhea without delayed sexual development is various malformations of the genitals. For example, there may be a complete absence of the uterus (aplasia of the uterus) or ginatresia – the absence of natural openings in the hymen.

There are also developmental defects when there are ovaries and a sufficient amount of sex hormones are released, but the girl does not have a uterus or a vagina is not formed.

The absence of the uterus in the girl’s body is called Meyer-Rokitansky-Kyustner syndrome. The ovaries in this disease secrete sex hormones as usual, and outwardly the girl develops normally, in accordance with age. At the age of 16 years or more, parents usually bring a girl to the reception, concerned about the lack of menstruation. During the examination revealed the absence of the uterus; the vagina is usually short, sometimes absent, and in this case, in order for the girl to have a normal sex life, plastic surgery is required.

When to go to the doctor

Features in the absence of menstruation in young girls

When the mother and the child watching the doctor should be concerned about the absence of menstruation and assume the presence of the disease:

  • A girl is 16 years old, and her period does not come;
  • The girl is 14 years old, but there are no signs of the onset of puberty (growth of the mammary glands, growth of pubic hair, armpits);
  • Three years have passed since the growth of the mammary glands and the appearance of sexual hair growth, but there is no menstruation; 
    A noticeable lag in growth and weight indicators from the norm at this age and from peers.
  • The girl after the onset of signs of puberty at the beginning of menstruation (11–16 years old) appeared not cyclic bleeding from the genital tract, but cyclic pains in the lower abdomen.

The pains can be painful, with fever, with a feeling of pressure on the rectum, with difficulty urinating. Cyclic pain syndrome may be due to the monthly appearance of menstruation, the accumulation of blood in the uterus and fallopian tubes, and the inability to flow out during malformations of the vagina, cervix, and the hymen. After diagnosing such a condition, it is successfully amenable to surgical treatment.

Depending on the cause of the irregularity in the menstrual cycle, it can also be observed:

  • virilization of the external genital organs (unnatural enlargement of the clitoris, for example);
  • increased growth or active growth of individual limbs (with an excess of somatotropic hormone);
  • neurological symptoms (migraines, headaches, visual disturbances) – for tumors;
  • impaired hair growth (complete absence of hair in the pubic and axillary areas);
  • lower abdominal pain during menstruation (in the absence of holes in the hymen).

Shereshevsky-Turner syndrome is characterized by a number of symptoms. Among them:

  • low birth weight of the child;
  • the presence of edema of the hands and feet of lymphatic origin;
  • the presence of pterygoid folds in the neck;
  • high upper sky (gothic);
  • long distance between nipples;
  • a sharp decrease in estrogen and testosterone levels, increased levels of FSH and LH.

Survey

In the diagnosis of great importance is given to the collection of anamnesis, as well as examination of the patient.

Examination by a gynecologist. Just on examination, you can see signs of delayed sexual development and malformations of the vagina and hymen.

Vaginoscopy: examination of the vagina at full depth and cervix through a physiological hole in the hymen. It is performed in case of suspected malformations of the genital organs. The procedure is painless for the girl, does not damage the natural hymen, can be performed on an outpatient basis. Inspection is carried out using a vaginoscope: a thin tube with a video camera.

Mandatory set of surveys:

  • hormone level assessment ( testosterone, estrogen , LH and FSH );     
  • in addition, thyroid hormones, prolactin, cortisol, etc. are investigated.
  • hormonal tests (with estrogen, ACTH, progesterone, dexamethasone, etc.) – consist in maintaining the hormone in the body for several days and observing the reaction of the organism (menstrual bleeding will start or not);
  • X-ray, CT – and MRI examination of the skull to determine the status of the pituitary gland, identify the pathologies of the development of the Turkish saddle, exclude tumor processes;  
  • Laparoscopy allows you to specify the diagnosis in the presence of malformations and gonadal dysgenesis; 
  • An ultrasound examination of the pelvic organs can help identify the absence of the uterus; the accumulation of blood in the uterus or in the upper part of the vagina with malformations of the cervix or lower parts of the vagina; the absence of ovaries with follicles and their replacement by connective tissue strands with gonadal dysgenesis; a decrease in the size of the uterus and ovaries (“baby” uterus); 
  • MRI of the pelvis is performed for differential diagnosis between various forms of uterine malformations, and also helps to clarify the presence or absence of the genital organs in the pelvis. 
  • Examination of the genetics and the study of the chromosomal set in a girl will reveal the genetic cause of amenorrhea. Definition of karyotype and sex chromatin (used for reliable diagnosis of Shereshevsky-Turner syndrome);
  • Examination of the oculist and assessment of visual fields (perimetry) is carried out to exclude a pituitary tumor and intracranial hypertension.

Treatment

The disease is treated by an endocrinologist-gynecologist or gynecologist with a mandatory consultation of an endocrinologist.

When abnormalities in the pituitary-hypothalamic system are detected and sexual development is delayed, a sample with an analogue of gonadotropin-releasing hormone (GnRH) is used. If the girl’s body has a positive response to a sample with a GnRH analogue, then treatment can be non-hormonal. They begin with the use of neurotropic and vitamin complexes in order to improve the connection between the cerebral cortex, the structures of the hypothalamus and the pituitary gland. In some cases (especially if the cause of amenorrhea are nerve disorders) this has an effect. In the absence of a reaction to a sample with a GnRH analogue, hormone preparations are immediately prescribed for replacement purposes.

If a pituitary tumor is detected, it is removed. The girl with the introduction of hormones from the outside will catch up with their peers in development and the menstrual cycle will be adjusted. The prognosis for childbirth is favorable, the use of IVF is possible.

When determining genetic chromosomal abnormalities and the absence of ovaries in the girl’s body (gonadal dysgenesis), it is necessary to immediately begin hormone replacement therapy so that the girl outwardly develops in accordance with age. If there is an extra Y-chromosome in the girl’s chromosome set, then before the start of HRT, it is necessary to remove the connective tissue strands that replace the ovaries. This is done in order to prevent the growth of malignant tumors from connective tissue cords, often developing with such a chromosomal set.

With genetic chromosomal abnormalities and the absence of normal ovaries in a girl, hormone replacement therapy is indicated for a long time, until the age of middle menopause. To conceive and give birth to the girl herself, of course, can not.

Malformations of the vagina successfully operated. Girls menstruate, live sex and conceive a child after plastic surgery. When fusion of the hymen and the presence of a septum in the vagina is their dissection.

Plastic surgery to create an artificial vagina in its absence requires hospitalization in central clinics and high qualifications of the operating gynecologist.

In the absence of the uterus (Rokitansky-Kyustner syndrome), sometimes plastic surgery to lengthen the vagina is necessary for full sexual life. Ovaries in this situation work according to age, hormone replacement therapy is not indicated. Plastic surgery to create an artificial uterus is not currently used. If you want to have a baby, the woman’s egg cell is fertilized with IVF, and the surrogate mother bears the pregnancy.

Possible complications

Primary amenorrhea, which is ignored for a long time, can lead to:

  • infertility (reproductive impairment is observed in most cases, it is difficult or not at all amenable to correction, often the only way out is IVF or surrogate motherhood);
  • osteoporosis – a condition in which the destructive processes in the bone tissue prevail over the recovery processes and, as a result, the bones lose their strength; 
  • atherosclerosis – deposition of lipid plaques on the walls of blood vessels, which lead to a narrowing of the vessel lumen and, as a consequence, impaired blood flow; 
  • Obesity – violation of the hormonal balance in the body often leads to weight gain, in which diets are ineffective.

Prognosis and prevention

Due to the fact that primary amenorrhea is a consequence of mainly congenital disorders, the means of its effective prevention have not yet been developed. Much depends on the initial state of health of the mother at the time of pregnancy, her lifestyle. The prognosis for timely treatment in most cases favorable. A woman may not be able to conceive or bear a child, but the symptoms of primary amenorrhea will not affect the quality of her life.

Amenorrhea secondary

The reasons

Signs of secondary amenorrhea

Analyzes and surveys

Treatment of amenorrhea

Prognosis and prevention

ICD-10 Code N91.1 

Synonyms: amenorrhea, prolonged absence of menstruation. 

Secondary amenorrhea – the absence of menstruation for six months or more in women who are of reproductive age, as well as having an established menstrual cycle. 
The prevalence of the disease in a population ranges from 3 to 10%. 
In addition to the absence of menstruation, depending on the cause, there may be additional symptoms, such as hirsurtism (excessive hair growth), obesity, infertility, acne, hypertension. 
Treatment is based mainly on the use of hormonal drugs.

The reasons

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There are two classifications of secondary amenorrhea.

The first is the division into two groups: physiological and pathological.

  • Physiological amenorrhea is possible during pregnancy, during menopause, while breastfeeding a child.
  • Pathological secondary amenorrhea is all other options associated with improper functioning of the body.

The second classification is based on the causes of the development of secondary amenorrhea.

Who is at risk

Among the risk factors contributing to the development of secondary amenorrhea, are called:

  • the presence of excess weight
  • chronic diseases of the genital or endocrine organs;
  • uncompensated chronic diseases
  • strict diets
  • acute infections not only of the genital organs, but also of the organism as a whole.

Causes of the brain (central)

Psychogenic Amenorrhea

  • It develops as a result of strong nervous shocks, regular stresses, and is also associated with severe stress, a depressive state. For example, for many women, menstruation stopped during the war. This was called the term “wartime amenorrhea.” The body in the conditions of danger to life put the sexual instinct in the background. In the pituitary-hypothalamic system, the proper amount of gonadotropins did not stand out, the ovaries did not receive proper stimulation and did not function.

Pathological changes in the hypothalamus

  • Loss of body weight due to debilitating diets, chronic or acute illness, anorexia. Menstruation stops when the amount of adipose tissue drops below a critical minimum. Adipose tissue is normally an extravagant source of a small amount of estrogen. In addition, with fasting and adherence to a rigid diet, there is always psychological stress, stress, and neurosis. As a result, less ovarian-stimulating gonadotropic hormones are produced in the brain. Without proper stimulation, the ovaries do not produce enough sex hormones. 
  • Overly intense exercise.
  • Neuroexchange-endocrine syndrome (a disease with presumably genetic predisposition, characterized by impaired functioning of the adrenal glands and ovaries against the background of obesity).

Pathological changes in the pituitary gland

  • Hyperprolactinemia (excessive pituitary synthesis of the hormone prolactin due to hormone-active tumor or functional impairment). Prolactin is responsible for the growth of the mammary glands and the production of breast milk. Excess prolactin can occur with a tumor or damage to the pituitary gland, after neuroinfections, with thyroid pathology and other endocrine disorders, and with severe stress. With an excess of prolactin, suppression of gonadotropin production in the brain occurs. Further along a typical pattern: no gonadotropins – no ovarian stimulation – the ovaries do not synthesize enough sex steroids – no menstruation. 
  • The effect of tumor formations on the production of pituitary hormones.
  • Sheehan syndrome (pituitary cell death due to impaired blood flow in it during complicated labor or abortion).
  • Traumatic brain injury with damage to the pituitary gland.

Adrenal Disorders

  • Adrenogenital syndrome characterized by congenital adrenal hyperplasia.
  • Adrenal tumors that can synthesize male sex hormones (virilizing).
  • Syndrome or Itsenko-Cushing’s disease (long-term treatment with systemic glucocorticosteroids or increased secretion of adrenal cortisol).

Pathology in the ovaries

Exhausted Ovary Syndrome

  • cessation of ovarian function in women whose age has not reached the age of 40 years. Syndrome of depleted ovaries develops with the depletion in the ovaries of the stock of follicles and eggs. It is the follicle tissue during the maturation of the egg and in the process of ovulation secrete sex steroids in the ovaries every month. Normally, the stock of follicles ends at 45-55 years (time of menopause). With ovarian depletion, this happens prematurely. The reserve of follicles in this disease can be initially reduced (for example, genetically small is laid, or during prenatal development of a girl, toxins, poisons, adverse environmental effects have affected the pregnancy of the mother). When cysts are large in the ovaries, normal ovarian tissue can be replaced and the ovarian reserve is lost. The supply of eggs also decreases after operations with the removal of part of the ovary.

Resistant ovary syndrome

  • ovarian insensitivity to hormones produced by the hypothalamic-pituitary system. In the tissues of the ovary a sufficient number of follicles and eggs, but the ovary is not sensitive to stimulation by gonadotropins. There are assumptions about the autoimmune nature of this syndrome. The ovaries are resistant to the stimulation of their function by gonadotropins. Breakdown occurs at the receptor level for gonadotropins.

Polycystic Ovary Syndrome ( PCOS )

  • the presence on the ovaries of a large number of varying in size cysts that disrupt their normal function. It is characterized by a violation of ovulation (its absence or rare ovulation), scanty rare menses or amenorrhea, hyperandrogenism (an increase in the content of male sex hormones in a woman’s blood). Often (in about half the cases), polycystic ovary syndrome is accompanied by overweight and hyperinsulinemia. At the same time there are many follicles in the ovaries, but their maturation and release of the egg does not occur. In the primary form of PCOS, an excess of male sex hormones and insulin is a violation in the formation cycle of these hormones (breakdown and deficiency at the level of enzymes). In the secondary form of PCOS, an excess of male sex hormones cause other diseases of the endocrine organs (hypothyroidism, obesity, brain tumors with increased production of the hormones prolactin and ACTH, adrenal gland disease).

Gonad hyper retardation syndrome

  • develops after taking hormone drugs. Sometimes menstruation stops after the abolition of combined oral contraceptives, after treatment with hormonal drugs of certain groups in order to suppress active endometriosis and uterine fibroids. Usually, amenorrhea after hormone drugs are self-cured after a few months.

Other violations:

  • ovarian tumors and cysts , both benign and malignant;  
  • effects on chemotherapy or radiation therapy on the ovaries, consequence of surgery, artificially created menopause.

From the side of the uterus

Pathology of the uterus:

  • endometritis,
  • frequent abortive interventions
  • atresia of the cervical canal,
  • the presence of intrauterine adhesions.

Fusion (synechia) in the uterus – Asherman syndrome

  • In this case, the inner menstrual layer of the uterus is damaged. Women with Asherman’s syndrome always have a previous traumatic or inflammatory factor: traumatic abortion, frequent abortions, curettage, infectious complications after surgical manipulations with the development of endometritis.

Cervical Canal Fusion (atresia)

  • Occur after abortions, operations on the cervix (plastic, cervical amputation according to Sturmdorf), electroconization of the cervix with damage to the basal layer of the mucous membrane of the cervical canal. There are adhesions, the overgrowth of the cervical canal and the violation of the outflow of menstrual blood from the uterus. Menstruation can be scanty, smearing at the beginning and stop altogether with complete atresia of the canal.

Signs of secondary amenorrhea

The main symptom of secondary amenorrhea is the absence of menstruation for 6 months or more. However, often menstrual dysfunction is supplemented by other complaints, including:

  • decreased libido – sexual desire – a sign of androgen deficiency;
  • oily skin, acne, excessive hairiness, fat deposition on the abdomen and shoulder girdle are signs of excess androgens (male sex hormones);
  • a decrease in the size of the uterus and ovaries, a pale and dry mucous membrane in the vagina – signs of estrogen deficiency;
  • “Flushes” (as in menopause), sweating, palpitations, irritability, fatigue, skin aging – with a deficit of sex steroids;
  • galactorrhea – the appearance of discharge from the mammary glands, although the woman is not pregnant and does not breastfeed – with an excess of prolactin;
  • weight gain or, on the contrary, excessive weight loss in a short time without significant changes in diet and lifestyle (weight gain is observed in polycystic ovary syndrome, hyperprolactinemia and dysfunction of the thyroid gland);
  • the appearance on the skin of stretch marks (“stretch marks”);
  • depressions, mood swings;
  • fatigue, sleepiness or, on the contrary, worsening of sleep quality or insomnia;
  • puffiness of the face, dull and falling hair;
  • bouts of tachycardia, increased blood pressure;
  • headaches;
  • lower abdominal pain
  • in case of PCOS on examination by the gynecologist, the ovaries are palpated enlarged in volume, dense;
  • violation of visual fields and color perception – with a pituitary tumor.

Analyzes and surveys

Diagnosis of the presence of secondary amenorrhea is not difficult. It is much more difficult for doctors to determine the cause of the development of the disease in order to select the optimal correction options. The following tests and tests are usually assigned:

External and gynecological examination

Red Flags:

  • excess weight,
  • acne
  • girsurtism,
  • male figure with broad shoulders and narrow hips, etc.

For a complete diagnosis, a detailed history of the patient is important (the time of the first menarche, the regularity and duration of the cycle, the history of gynecological diseases, abortions, STDs).

Blood tests

Pregnancy testing (determination of the level of hCG in serum) is always performed with menstruation delays and irregular cycles.  

Evaluation of the hormonal status of the blood test:

  • LH,
  • FSH,
  • estradiol,
  • progesterone,
  • prolactin,
  • ACTH,
  • cortisol,
  • 17-OH progesterone,
  • DHEA-S,
  • testosterone.

Determining the concentration of thyroid hormones:

  • thyroxin (T4), 
  • thyroid stimulating hormone (TSH); 

The list of recommended hormones for evaluation may expand or narrow depending on the clinical picture in each particular case.

Additional methods:

  • Perform pharmacological tests (with progesterone, clomiphene, estrogen and gestagens). It consists in administering to the body certain doses of hormones with subsequent evaluation of the body’s response to them. The method helps to determine which hormones are lacking and at what level the deficit has arisen. In the case of a negative test, a menstrual-like reaction to the administration of the hormone does not occur. When positive, the patient responds to the introduction of hormones by bleeding from the uterus.
  • Analysis of genital infections (gonorrhea, trichomoniasis, syphilis, etc.).
  • Determination of blood glucose, test glucose tolerance if indicated, for example, polycystic ovary syndrome and obesity;   

Surveys

  • Hysteroscopy is a manipulation aimed at examining the uterus. Helps diagnose the presence of non-functioning endometrium. 
  • Ultrasound of the pelvic organs – allows you to identify synechia in the uterus, hematometer, reducing the size of the uterus and ovaries, cysts, no follicles in the ovaries, no endometrial growth in the uterus, no ovulation, polycystic and enlarged ovaries with a dense capsule. 
  • Diagnostic laparoscopy is an operation performed for diagnostic purposes, and is particularly informative in cases of secondary amenorrhea of ​​ovarian origin. Also, laparoscopy is indicated to clarify the diagnosis of emaciated or resistant ovarian syndrome, in case of infertility in a woman, and preparation for IVF.  
  • CT or MRI of the pituitary gland in case of suspected pathological changes in the work of this organ;
  • X-ray examination of the “Turkish saddle” with suspected pituitary tumor – prolactin.
  • Ultrasound of the kidneys , according to indications in / intravenous urography, is necessary for all patients with malformations of the reproductive system, often combined with kidney abnormalities.  
  • Ultrasound of the adrenal glands and thyroid gland.

Treatment of amenorrhea

Gynecologist-endocrinologist or gynecologist in tandem with an endocrinologist deals with amenorrhea therapy.

Treatment of a secondary form of amenorrhea depends on its origin. The main goal is to restore menstruation and, if possible, reproductive function.

Treatment may be directed to the immediate cause of the absence of menstruation, when it is known. If the cause of the disease is not clear or the disease itself is incurable, symptomatic therapy is prescribed.

If amenorrhea is caused by any chronic disease, first seek compensation for it, and then normalize the menstrual cycle.

The important points of treatment of amenorrhea also include:

  • Psychotherapy;
  • Physiotherapy
  • Healthy lifestyle, normalization of sleep and rest;
  • For weight loss, a high protein diet, counseling with a psychotherapist or psychiatrist with anorexia;
  • Amenorrhea caused by obesity is corrected with a low-carb diet, increased physical exertion;
  • In the psychogenic form – reducing stress effects, counseling with a psychologist, the use of sedatives.

Treatment methods

Medicamentous

Here, the gynecologist and the patient need to clearly know the purpose of the treatment:

  • restoration of menstrual function and normal hormonal levels in the absence of the desire to conceive or
  • recovery of menstruation, ovulation and childbirth.

Drugs and treatment tactics will be different in these situations.

Hormone replacement therapy

With resistant or ovarian syndrome

  • hormone replacement therapy (HRT) is shown. One of the easiest drugs to use for HRT in this case is femoston. The treatment is carried out before the age of the average menopause, according to indications and longer.

Hypothyroidism

  • hormone replacement therapy with thyroid hormones.

With hyperprolactinemia

  • “Bromkriptin”, “dostineks.”

Anti-androgenic drugs for PCOS and hyperandrogenism

Again, talking about two treatment goals.

  • reducing the severity of excess male sex hormones androgen
  • restoration of the ability to continue the race.

Achieving the first goal (for example, contraceptives) may precede the achievement of the second. KOC is divided into groups, including by the presence of anti-androgenic effect. To reduce the signs of excess androgens: oral contraceptives with antiandrogenic gestagens – ethinyl estradiol + cyproterone (“Diane-35”), ethinyl estradiol + dienogest (“Janine”), cyproterone (with the ineffectiveness of oral contraceptives).

Glucocorticoid drugs, for example, “dexamethasone” in a dose of 0.5 mg at night and the diuretic “spironolactone” or “veroshpiron” (100 mg 1–2 p. / Day) also have an antiandrogenic effect.

The effects of hormone therapy in relation to unwanted hair growth on the face and body, improving the condition of the skin and hair rarely occur quickly (improvement is observed no earlier than after 3-6 months). Often it is necessary to artificially remove hair: shaving, electrolysis, chemical hair removal.

Preparations for the stimulation of ovulation in the ovaries (for example, with PCOS)

  • Special schemes for the use of drugs “clomiphen” and “puregon” are used.

Stimulation of ovulation is used when the presence of menstruation and the absence of obesity. These drugs allow the follicle to mature in the ovaries. In some cases, pregnancy occurs independently after the induction of ovulation, and in other cases, stimulation makes it possible to pick up a mature egg for IVF.

Preparations for increasing insulin sensitivity in PCOS with obesity and hyperinsulinemia

  • “Siofor”, “metformin”

These drugs help patients with hyperinsulinemia in the fight against weight loss, reduce the density of the ovarian capsule. Weight loss and insulin levels in PCOS are necessary for a more favorable prognosis for conception and childbirth, as well as for the prevention of insulin-dependent diabetes mellitus.

Surgical treatment method

Surgical intervention is necessary in the case of synechiae in the uterus and fusion in the cervical canal.

The patient is dilated and dilated in the cervical canal in the hospital.

Synechias are destroyed by hysteroscopy and hysteroresectoscopy. These are vaginal surgeries, performed in the hospital under general anesthesia. After surgical removal of adhesions, a course of anti-inflammatory therapy (antibiotics, NSAIDs, means for preventing adhesive disease, enzymes, physical therapy) and hormone replacement therapy is prescribed.

Surgical treatment is also used in the absence of the effect of conservative treatment of PCOS. An operative laparoscopy is performed, and a dense capsule is made on the ovaries.

With hypertecosis and ovarian tumors secreting male sex hormones, excision of the ovaries is indicated.

Surgical treatment is also used in the case of growing hormone-producing pituitary tumors (for example, prolactinomas).

Assisted Reproductive Technology Method

(including IVF) – is in some cases the only way to become a mother to a woman.

Prognosis and prevention

Secondary amenorrhea with timely diagnosis and early treatment has a favorable prognosis. It is possible to restore both the menstruation and the reproductive function of the woman. The main complication of neglect is infertility, which can be difficult to correct and require the use of methods of reproductive technology.

The course and prognosis depend on the cause of amenorrhea. In hypothalamic-pituitary-related amenorrhea, the appearance of menstruation within 6 months was noted in 99% of patients, especially after the correction of body weight.

With appropriate timely correction of endocrine abnormalities in the body, the prognosis for the restoration of menstrual function is favorable. However, it must be remembered that treatment usually takes a long period, usually not less than six months.

The prognosis for childbirth depends on the cause of amenorrhea. Childbearing is not possible with advanced stages of ovarian depletion syndrome.

Independent conception and childbirth occur in patients after correction of hyperprolactinemia, hyperandrogenism, and thyroid hormones. With the help of ovulation stimulation, it is possible to induce pregnancy with PCOS and to take an egg cell for in vitro fertilization procedure with resistant ovary syndrome (with the cycle still saved). IVF with donor ovum and surrogate motherhood can help women with ovarian depletion syndrome.

Given the many factors that can provoke amenorrhea secondary type, specific prevention has not been developed.

Adnexitis

Types of adnexitis

The reasons

Symptoms of adnexitis

Diagnostics

Adnexitis treatment

Complications and prognosis

Adnexitis is an inflammation of the appendages of the uterus, which include the fallopian tubes and ovaries.

Translated from Latin, salpinx means the fallopian tube, and ovarium means the ovary; therefore, another name for adnexitis is salpingoophoritis.

Adnexitis, as a rule, women of reproductive age (20-35 years) are ill.

Types of adnexitis

Acute, subacute and chronic adnexitis are distinguished by the nature of the course.

Depending on the involvement in the pathological process of appendages on both or on one side, adnexitis can be one-sided or two-sided.

For the reason that led to the occurrence of the disease, distinguish between non-specific and specific (for example, gonorrheal) adnexitis.

The reasons

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The cause of the development of adnexitis are pathogenic microorganisms.

Specific adnexitis is caused by gonococci, tubercle bacillus, and pathogens of diphtheria.

Nonspecific adnexitis develops when streptococci, staphylococci, Escherichia coli, mycoplasma, and other bacteria penetrate the uterine appendages.  

The infection can spread in an ascending way in case of inflammation of the vagina, cervix or uterus, and in a descending way from other organs located above (for example, appendicitis).

Predisposing factors for adnexitis include:

  • weakening of immunity;
  • hypothermia;
  • stress;
  • frequent and indiscriminate change of sexual partners;
  • unprotected sex during menstruation;
  • non-compliance with personal hygiene;
  • transferred infectious disease;
  • chronic common, including endocrine, diseases;
  • abortion and diagnostic curettage of the uterus;
  • intrauterine device;
  • uterus hysteroscopy and metrosalpingography. 

Symptoms of adnexitis

Manifestations of the disease depend on its course.

Signs of acute form

Acute adnexitis and exacerbation of chronic adnexitis is characterized by

  • a sharp increase in body temperature to 38 – 39 degrees,
  • signs of intoxication (nausea, vomiting, weakness, lack of appetite),
  • pain in lower abdomen.

Pain in acute adnexitis are cutting, can give the lower back and rectum.

Perhaps the addition of symptoms of urination disorders (pain during urination, increased frequency).

On palpation there is a sharp pain and tension of the abdominal muscles.

In advanced cases, signs of peritoneal irritation may appear ( Shchetkin-Blumberg sign ), which indicates peritonitis. 

In severe cases, purulent fusion of the uterine appendages ( tubo-ovarian formation) develops, which requires urgent surgical intervention.

In case of late or inadequate treatment, acute adnexitis becomes chronic.

Symptoms of the chronic form

Chronic adnexitis is characterized by periodic aching or pulling pains in the abdomen and lower back, which radiate to the vagina, rectum and lower extremity.

A characteristic symptom of a chronic process is dyspareunia (pain during intercourse).

In addition, due to the formation of adhesions in the pelvic area and changes in ovarian function, menstrual irregularities of the oligomenorrhea type (rare and scanty periods) and amenorrhea (absence of menstruation for 6 months or more) develop.    

Also, with chronic adnexitis, menses become painful. Pain in the chronic course of the disease is aggravated after hypothermia, stressful situations, before the onset of menstruation.

During a vaginal examination, in case of acute or acute adnexitis in the region of the uterus, painful, enlarged ovaries and tubes are palpated (due to the accumulation of fluid in them).

Chronic adnexitis without exacerbation is characterized by the presence of tightness in the uterine appendages, dense stationary ovaries, shortening of the vaginal arches.

Diagnostics

Diagnosis of adnexitis is based on the collection of anamnesis, complaints, gynecological examination. The following laboratory tests are also shown:

  • general blood and urine analysis;
  • biochemical blood test ( C-reactive protein , blood sugar, total protein, etc.);
  • smear of vaginal secretions on flora, tank. seeding and antibiotic susceptibility studies;
  • Ultrasound of the pelvic organs ;
  • laparoscopy (in difficult cases);
  • tuberculin test (for suspected tuberculous infection).

Differential diagnosis of adnexitis is performed with ovarian cysts, external endometriosis, appendicitis, and lumbar osteochondrosis.     

Adnexitis treatment

The treatment of adnexitis is performed by a gynecologist.

Acute treatment

Patients with acute and acute exacerbation of chronic adnexitis are hospitalized. Calm, hypoallergenic diet and cold on the lower abdomen (to limit the inflammatory process and relieve pain) are prescribed.  

First of all, it is recommended to carry out therapy with a broad-spectrum antibiotic:

  • cephalosporins ( kefzol, ceftriaxone ),
  • penicillins ( ampioks, ampicillin),
  • fluoroquinolones (ciprofloxacin),
  • tetracyclines ( doxycycline ),
  • aminoglycosides (gentamicin) and others.

Antibacterial treatment is carried out within 7-10 days.

Additionally assigned disintoxication therapy (intravenous phys. Saline, glucose), and anti-inflammatory drugs locally (in rectal suppositories) and orally ( indomethacin, diclofenac).

Also shown is the intake of vitamins, anti-allergic and antifungal drugs.

Chronic treatment

Chronic adnexitis and rehabilitation after an acute process provides

  • receiving absorbable drugs (trypsin, wobenzym ),
  • receiving immunity stimulants ( Taktivin, vitreous body, aloe extract)
  • physiotherapy.

Physical therapy includes medicinal electrophoresis (with lidaza, aloe, plasmol and other drugs), UV irradiation, UHF and ultrasound on the lower abdomen.  

In case of chronic adnexitis, therapeutic mud, paraffin therapy, therapeutic baths and irrigation with mineral waters are effective, and sanatorium-resort therapy is recommended.

Complications and prognosis

Untreated or inadequately treated acute adnexitis leads to a chronic process. Possible complications of chronic adnexitis:

  • infertility (developed due to obstruction of the fallopian tubes and chronic anovulation );
  • the development of adhesions up to intestinal obstruction; 
  • ectopic pregnancy;
  • the threat of miscarriage and miscarriage;
  • inflammation of neighboring organs ( pyelonephritis, cystitis, colitis ).  

The prognosis for acute and chronic adnexitis is favorable for life. In the chronic process, infertility occurs in 50% of patients.

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