On the classification of menstrual disorders and their clinical manifestation

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The establishment of specific reasons and mechanism of development of this or that irregular periods (dysmenorrhoea) in each case represents a difficult task. This is because the etiology and pathogenesis of dismenorei are very complex, as in the menstrual cycle is involved in a number of senior centers and peripheral glands. External, the most visible manifestation of dismenorei is a change of pace and the number of breeding rootdelay, and the reason for this may depend on violations arising in any segment of the complex neurohormonal chain. In addition, pathological focus in itself may be terminated and cease to serve the immediate cause dysmenorrhea, and as a direct cause it will be a violation of the functions of the body, which reacted to the former initial pathological focus. The complexity is determined more by the fact that in the origin and development disorders of the menstrual cycle always involve multiple organs and systems within a particular functional interdependence.
Many of the causes leading to the disorder of menstrual function, can be divided into groups due to: a) vegetative dysfunctional; b) endocrine-dysfunctional and C) General health reasons.
The complexity of the pathogenesis led to the fact that by now generally accepted classification, which would give into the hands of practitioners ways lightweight find the cause of a violation of the cycle, its diagnosis and choice of treatment method, no.
Existing classification to some extent complementary, based either on the external manifestations of violations of the cycle, or to violations that occur in one of effector organs (ovaries)or theoretical approaches for the diagnosis external disturbances to create a picture of pathogenetic chain.
In this respect, we see a need to consider a few sentences.
Following the classification of K. N. Jmakina (1966) is a pathogenetic and built on the principle of determination of the level of destruction in complex neurohumoral chain (table. 3).

TABLE 3. Classification of menstrual cycle on K. N. Makino
The level of impairment of neurohumoral regulation The nature of the violations Painful form, functional and morphological changes Menstrual irregularities
Cortical-hypothalamic Functional disorder, organic (tumor, neuroinfection) Amenorrhea wartime, Psychogenic amenorrhea. Adipose-genital dystrophy. Chiari Syndrome-Frommel. Anorexia nervosa. False pregnancy Amenorrhea
Pituitary-hypothalamic Functional disorder, organic (tumor) The Syndrome Itsenko-Kushinga Hypo-, oligo-, opto-amenorrhea
Pituitary Panhypopituitarism Syndrome Simmonds-Shihan Hypo-, oligo-, opto-amenorrhea
Partial hypopituitarism (hypogonadotropic), and simultaneously the hyperproduction of somatotropic hormone Gigantism
The same
Partial hypopituitarism (hypogonadism) Pituitary infantilism "
Ovaries Hypoestrogenism

A. two-phase cycle:

Violation of follicular phase
Hypo-, oligo-, opto-amenorrhea
Hypolycaena The lack of yellow body, premature ripening yellow body with short-term existence of his Polimenoreya, protomedeia
Hyperlattices Persistent yellow body Hyper, polimenoreya (after a short delay)

B. single-Phase cycle:

Premature atresia of the follicle
Hypo-, oligo-, amenorrhea with subsequent metrorragia
Hyperestrogenism Persistent follicle, a small cystic degeneration of the ovary Metrorragiya after a delay of menstruation
Hyperandrogenism Polycystic ovaries Hypo-, oligo-, opto-amenorrhea, metrorragia

Century Hormonesproduced tumors:

Granulation the tumor. TECOM
Hyper, polimenoreya, metrorragiya
Hyperandrogenism Arrhenoblastoma. The tumor from Ladyhawke cells. Lepidolite tumors Oligo-amenorrhea

, The Primary defect of development of the ovarian tissue:

Gonadal dysgenesis syndrome Shereshevsky - Turner and others Gonagala aplasia

Tuberculosis endometrium

Metrorragiya, amenorrhea
Atresia of the cervical canal Amenorrhea
Neurogenic dystrophy - a violation of uterine interoceptive Amenorrhea, oligomenorrhea
Thyroid gland Hypothyroidism Myxedema, cretinism Hypo-, oligo-amenorrhea, metrorragia
Hyperthyroidism Thyrotoxicosis Protomedeia, hiperproliferarea, rarely amenorrhea
Adrenal glands Gipokortitsizm Disease Adisson. Hypo-, oligo-amenorrhea
Hypercortisolism Adrenogenital syndrome (hyperplasia, a tumor of the adrenal cortex)

Classification has many benefits, the main of which is the classification of some diseases to a certain level of destruction of the hypothalamic-pituitary-ovarian-uterine chain, which contributes to the choice of pathogenetic therapy.
At the same time, in the present classification, there are some gaps. Apparently, these deficiencies are caused by the fact that in the classification did not find a clear separation of the disease, which should be related to the functional abnormalities of the menstrual cycle and those motologichesky clearly defined disease in which the disorders of menstruation act only as a symptom of the disease.
Indeed, in the rankings include diseases such as tuberculosis endometrium, hormonesproduced ovarian tumors and so on, which are known to be accompanied by violations of the menstrual cycle. Meanwhile, in our opinion, these States should not be made into the section of the anomalies of the menstrual cycle, as disorders of the loop here act only as a symptom of underlying disease. Apparently, the same should apply to such diseases as Chiari syndrome - Frommel, Sheehan, Stein - Leventhal, hyperplasia or a tumor of the adrenal cortex, and so on, where violation of menstrual function acts only as one of the symptoms along with others.
The range of diseases (or conditions)to be included in the classification anomalies of menstrual function, should be narrowed through the consideration only of such violations, which are characterized by primary functional changes in one of the links of neurohumoral regulation without the Express anatomical substrate, i.e. the States, where there are no structural and functional abnormalities.