Treatment of menstrual disorders

Introduction
Now for the treatment of women with menstrual disorders are conservative and surgical methods. This surgical methods have a limited use. The most frequently used operation - scraping of the uterus, has largely symptomatic interventions aimed mainly to achieve hemostasis and less pathogenic.
Conservative treatment of menstrual disorders play a leading role and include symptomatic, hormonal, physical therapy and complex therapy, which found the greatest distribution.
Symptomatic means, as a rule, are applied to stop bleeding, relieve pain and of themselves are not pathogenetic treatment, because they lead to the elimination (or intensity reduction) of the final manifestation of the disease.
In the light of modern views on the regulation of menstrual function, hormonal therapy should be built not on the principle of substitution (in respect of effector body), and on the principle of governing, i.e., including first of all the use neurosecretory hypothalamic Products (rilizing-factor), which would have a corresponding impact on the pituitary gland. However, so far not managed not only to get releasing factors synthetically (and only in this way will receive hormonal means possible their wide application), but also to identify their exact chemical nature and structure. Therefore the adoption releasing factors. apparently, is in the future.
The second way is the use of hormonal therapy, which at least partly could relate to the category of governing, is the use of pituitary genotype hormones: follicle-stimulating (FSH), luteinizing (LH) and luteotrophic (LTH). Of these three pituitary gonadal hormones known stimulating hormone, derived from the urine of women in menopause. However, it is not yet widely used.
As the second - luteinizing - hormone used chorionic gonadotropin-releasing hormone (horiogonin, human chorionic gonadotropin), principally non-pituitary substance LH, and only approaching its biological effect. It should be added that the horiogonin, being able to cause luteinization of granular cells of the follicles, as a rule, rarely leads to ovulation.
Consideration of the different types of menstrual disorders shows that the vast majority of them is related to either a complete lack of ovulation, or with disorders of this phenomenon. Thus, the treatment of women with abnormal menstrual cycle first need to find the means, which would be of influence on the process of preparation of the ovary (follicle) to ovulation, and on the phenomenon of ovulation and normal yellow body.
Due to the lack of real opportunities to a wide application of pituitary gonadotrophic hormones most prevalent today is the use of hormones peripheral cancer - ovarian. In this respect has an advantage over all the other hormones in connection with industrial production of synthetic drugs. Despite acquired in the application of ovarian hormones - estrogen and progesterone - effect in the form of normalization of menstrual function, this kind of treatment can only partly be attributed to the pathogenetic. Mostly these hormones have an impact only on the effector organs - the ovaries and the uterus. Thus, the use of ovarian hormones mainly aims not so much regulation (in the true sense of the term) menstrual function as the replacement of missing or cyclically wrong highlighting incretions ovary.
Themselves ovarian hormones can cause ovulation, because even when using low doses calculated on the action on the principle of "plus-minus interaction", they do not lead to sawtoothed rise allocation of FSH and LH, while only such a rise, and can provide the phenomenon of ovulation. Many years of clinical practice also indicates minor effectiveness of such treatment in relation to ovulation.
When applying ovarian hormones Clinician should always remember about their possible adverse effect on the hypothalamic-pituitary system. Such action is conditioned by the existence of the same principle of "plus-minus of interaction", the essence of which is in the inhibitory influence of hormones peripheral glands on the activity of the hypothalamic-pituitary system. This is especially evident in long-term use of estrogen and progesterone. As long as these substances are entered in the body, the effect in the form of periodic uterine rootdelay takes place, but as soon cease to enter these hormones, again are showing all the symptoms of the disease were before the start of treatment. It is possible that in such cases is so oppressed neurosecretory substance of the hypothalamus that in the future it becomes incapable of any rhythmic activity and maintained only at the level of basal activity.


In recent years revealed and another, at first sight paradoxical, the treatment of disorders of ovulation. It consists in applying for a relatively short period of time (3-4 cycles) funds that suppress ovulation - contraceptive progestins. Suppression of ovulation due to hormonal effects on the hypothalamic-pituitary system results in such cases to the fact that after the abolition of these substances removed the dampening effect and "animated" functional activity slowed down neurosecretory substances. Clinical observations show that such a choice seems appropriate in cases where there may defective, but still fundamentally rhythmic activity of the hypothalamic-pituitary system; in those cases, when it is completely absent, the effect cannot be obtained. In particular, it is reported I. A. Manuilov, and So I Pshenichnikova (1972).
Thus, we can state that the different ways of hormone therapy, the real opportunities which exist at present, most of them can not be attributed to mind truly regulating therapy.
Meanwhile in the body there are conditions and ways of acting are you in the right direction to change the impaired function of the gonads.
We are talking about results in recent years, data on the impact at the highest regulatory endocrine centers excitation various peripheral nervous formations, the impulses of which can affect the process of ovulation and partly to the process of folliculometry. It is also about the possibility of chemical or electric by changing the functional activity of the hypothalamic-pituitary system in the direction of promoting ovulation. Specific measures are limited to the impact on the cervix, upper cervical sympathetic ganglia, directly on the area of the hypothalamus and pituitary.
Accumulated in recent years, much evidence indicates that you have received numerous experimental data on the effect of effects attached to the abovementioned companies can be used in clinical practice in the treatment of women with ovulation disorders. At the same time without making outside of hormonal drugs, it becomes possible to implement a truly regulatory therapy, as it will change the functional activity of its own regulatory systems without any component substitution treatment. Consequently, to date, has created the preconditions for a broader and more targeted use non-hormonal effects, normalizes the function of the hypothalamic-pituitary system.
Consideration of different ways of non-hormonal effects in the pathology of menstrual function assumes first of all the different neuroreflectory impact on the peripheral and Central offices engaged in the regulation of the menstrual cycle. In addition, it is also possible and chemical (drug) impact on these same education.
Given the above is a clear need for detailed descriptions of the structural and functional relations in the hypothalamic-pituitary system and on the periphery, which provide the possibility of such influence. Therefore a significant part of this book is devoted to the anatomy, functions and relations, arising in norm and pathology between the highest regulatory and effector links, host a special part in the implementation of menstrual function.
Fifteen years of experience, supported by numerous favorable reports from various clinics, allows you already now a number neuroreflectory effects used in the treatment of women with menstrual disorders and menopause, to apply in daily practice gynecologist. Citing specific ways of influencing impaired menstrual function, we chose to present in this book only the ones that have an impact on the regulatory system. Numerous ways and means of providing local effect on the uterus (symptomatic hemostatic and increases contractions of the uterus assets) or directly influencing ovary (x-ray castration, electrophoresis with zinc, iodine, and so on)are not set out. Considering in summary, the proposed methods of treatment, we do not believe these are the only acceptable when treating disorders of the menstrual function and menopause, but only show one, yet little used the opportunity to get favorable results using non-hormonal influence as an independent or as an addition to traditional hormone treatments.