Metropolia

Metropolia - pathological condition of the uterus caused by hormonal disorders; characterized acyclic uterine bleeding (see Menstrual cycle) in the absence of organic changes in the sex organs. Frequent cause of metropolii is anovulatory cycle (see).
Bleeding of different duration and intensity normally comes after a delay monthly on average 2-8 weeks. Occurs most often during puberty and menopause (see).

Metropolia (from the Greek. metra - uterus and pathos - suffering, illness) is a pathological condition in terms of the strengthening of uterine bleeding in the absence of clear topograficheskikh changes in the sexual organs of a woman. Most often Metropolia observed at a young age and menopause.
No topograficheskikh changes in the sex organs is determined bimanual examination and inspection of mirrors, and microscopic examination of a scraping excludes the presence of endometrial tumours or inflammatory process.
The uterus may be reduced in size in the case of hemorrhagic Metropolia in combination with infantilism, and if metropolii menopausal uterus even atrophic. However, the uterus due to prolonged exposure to excess estrogen is often increased.
Increased production of estrogen (ovarian hormone) is usually observed at the persistence of follicles - a kind of violation of the development of the follicle in which he, upon reaching adulthood, continues to grow (live), not torn. Persistence of the follicles, and the absence of ovulation and education yellow body, ensure the normal course of the menstrual cycle, arise from reducing power gonadotropic luteinizing hormone, which in turn is in violation of the functions of podporoval areas of the brain. Under the influence of estrogen excessively grows endometrium. Histological examination of the mucous membrane of the uterus is found unevenly modified form glands, their enlargement and cyst formation. The mucous membrane under proliferation, is not transformed into a phase of secretion, as in the ovary does not occur ovulation and not formed a yellow body, without hormones (progesterone) does not occur in the endometrium phase of secretion. When long-term persistence of follicles are formed blood clots in the mucous membrane of the uterus, leukocytic infiltration in it, small hemorrhages; then develop necrosis and appear prolonged uterine bleeding, sometimes very intense and even life-threatening.
The most studied of the clinical forms of metropolii is hemorrhagic Metropolia, which in many cases is having persisting follicle. We cannot say that persistent follicle is the only cause of metropolii. Bleeding can sometimes happen when intact mucous membrane of the uterus. Atypical uterine bleeding is sometimes observed in the liver. Changes in the endometrium for functional bleeding is more of a companion than a causal factor. Diversity picture of the endometrium, the presence of mixed phases with different kind of changes of vessels in different parts cannot be explained only by the action of incretions ovary. Such changes can be attributed to non-uniform States vessels in different parts of the endometrium, and changes in the vessels. Cannot be identified haemorrhagic Metropolia with constant giperholesterinemia as giperholesterinemia may turn to a deficit of follicular hormones.
To establish a correct diagnosis is very important to collect in-depth history (migrated children's infections). You must determine the age, when it was first menstruation; special attention should be paid to patients who have menstrual period occurred later 16-18 years, indicating lability, and sometimes about the lack of ovarian function. One must also consider the disease of the endocrine glands, blood-forming organs and vascular diseases, and tuberculosis. The patient should be carefully screened bimanual and using mirrors. The diagnosis of help cytological examination and PAP test, determination of the title of estrogen and other Histological examination of scraping mucous membrane of the uterus gives the possibility to consider in the pathogenesis of the disease (an inflammatory process, tuberculosis) and timely diagnosing malignant neoplasms (cancer). It should be remembered that the glandular hyperplasia of the endometrium may develop due to hormonal effects granulation tumors of the ovary. Differential diagnosis it is necessary to bear in mind fibromatous of the uterus, endometriosis (adenomyosis).
Treatment should be directed to a stop uterine bleeding and normalization of menstrual function. To stop bleeding apply intramuscular administration of mamaykina (1 ml 1-2 times a day, 5-6 days in a row). Inside recommend menadione 0.01 g 3 times a day, 10% solution of calcium chloride on 1 table spoon 3-4 times a day; staticin 0.05 g 3-4 times a day. In severe cases, transfusion of donor blood - 250-500 ml intravenous and intramuscular injection of dry plasma 100 - 150 ml Good results re-injection (5-6 times) fractional doses (50 - 60 ml) of blood. To create a normal cyclical rhythm and fixing it is used hormonal drugs. In those cases, when the body is sick, there is a moderate amount of estrogen hormone that is set by the definition of estrogen or cytological examination of vaginal smear, appoint a relatively small dose of oestrogen hormone (500 - 1000 IU) a day 6-8 times. Then in 2-3 days to introduce 5000 ED follikulina with 5 mg of progesterone (in one sprite) and, finally, for 6-8 days daily for 5-10 mg of progesterone. If on the basis of hormonal analysis revealed a significant number of oestrogen hormones, start treatment progesterone without entering estrogen: starting from the 12th day of the cycle, daily enter 10-15 mg of progesterone or 3 times a day for 2-3 tablets pregnina sublingual within 8-10 days.
When the so-called functional uterine bleeding apply significant doses of progesterone (15 to 20 mg)in order to strengthen lack the natural ability of the diseased body for education secretory phase. Good results were obtained from the use of androgens (2-3 times a day for 10 mg methyltestosterone or metilandrostendiona in 10-12 days). With significant bleeding when you are unable to stop the bleeding conservative methods, resort to scraping mucous membrane of the uterus. In such cases, hormonal therapy is started at 10-12-th day after operation, and first impose progesterone (not the follikulina) within 8-10 days, then wait for the onset of menstruation, and on the 6th day launch a full three-phase scheme of treatment. Systematic treatment under strict plan not less than 4-5 cycles, leading in most cases to the normalization of menstrual function. Cm. also, Menstrual cycle disorders.