Bleeding in the middle of the cycle may be an indication of how rules and pathology. For example, normally considered short-term minor bleeding in the middle of the menstrual cycle, which are not accompanied by any more than other symptoms. Heavy intermenstrual bleeding mid-cycle - this is certainly not the norm.

Minor bleeding midcycle

Slight transient (usually within days) at mid-cycle bleeding normally associated with ovulation Ovulation - How to determine as accurately as possible?   - Follicle rupture (bubble), wherein the matured follicle. This is normal.

When combined oral contraceptives (COCs) when there is a transfer of the natural menstrual cycle on artificial bleeding may also occur in the middle of the cycle. This is because in the first three months of hormonal failures may occur, which manifest themselves in the form of minor bleeding at midcycle.

If you have an intrauterine contraceptive (IUD) is also quite possibly the appearance of small bleeding in the middle of the cycle, which is associated with a slight inflammation that cause the IUD in the uterine wall.

Why does heavy bleeding mid-cycle

Such bleeding can not be the norm. Excessive bleeding in the middle of the cycle can be a manifestation of dysfunctional uterine bleeding Uterine bleeding outside of menstruation - a sign of a serious breach   (MQM). Most often, the MQM develops in the transitional age periods - during puberty Puberty child - stages of a complex path   (juvenile bleeding), and during menopause.

The mechanism of DMK involves a violation of the rhythm of secretion of ovarian hormones, occurring in lesions of the hypothalamic - pituitary - ovary - uterus. The cause dysfunction of this system can be stress, exercise, change of climate, overwork, poor nutrition, hypovitaminosis, various acute and chronic diseases, surgery, trauma.

As a result of one or more of these factors lead to abnormalities in the hypothalamic-pituitary system, followed by the appearance of changes in the ovaries and uterus. Sometimes the opposite is true: changes in the ovaries and uterus (infectious-inflammatory processes, trauma, tumors, cysts) on the basis of feedback causes changes in the hypothalamic-pituitary system.

If MQM are three types of hormonal changes:

• High acyclic character release follicle stimulating hormone (FSH - a hormone 1 phase of the menstrual cycle) and luteinizing (LH - hormone 2 phase of the menstrual cycle) pituitary hormones;
• a moderate reduction in the secretion of FSH and LH from the acyclic nature of the allocation;
• a significant reduction in the secretion of FSH and LH.

Forms of dysfunctional uterine bleeding

MQM split into two types - ovulatory and anovulatory. If ovulatory MQM saved ovulation and possible conception, with anovulatory egg remains in the ovary, ovulation does not occur, so it is impossible to conceive.

The most rasprstranennymi are two types of anovulatory DUB: the type of persistence and the type of atresia. When the DMC-type persistence 1-2 follicles reach maturity and do not break, and continue to operate, allocating a large amount of estrogen. It causes changes in hormone-dependent organs - the uterus and vagina. After a long growths lining of the uterus (endometrium), or immediately rejected the whole (heavy bleeding) or rejected gradually (long, then decreased, or increased bleeding).

DMK on the type of atresia of the follicle is more common in adolescence. In the maturation stage it is several follicles, but the maturity they reach and are subject to atresia (a reversal). Atresia follicles manifested wavy release small amounts of estrogen with small fluctuations. Such prolonged exposure to even small doses of estrogen leads to proliferation of the endometrium. Once the amount of estrogen decreases, there is a long uneven rejection of the endometrium and the same long wavy bleeding.

How to manifest dysfunctional uterine bleeding

MQM for anovulatory type may occur only intermenstrual hemorrhage (severe bleeding mid-cycle), or only menstrual bleeding. But these violations in different cycles can alternate. Menstrual bleeding usually occurs after a considerable delay.

As a teenager on a background of a lack of estrogen may be a lag in physical development and in the development of secondary sexual characteristics.

How to treat dysfunctional uterine bleeding

Treatment MQM held only after a complete examination and detection of diseases which could affect the reproductive system. If such diseases detected, they are treated. The structure of the complex treatment of MQM should include hormonal correction, drugs that reduce the uterine smooth muscle (muscle cutting, squeezing the blood vessels and bleeding stops), restorative treatment, vitamin, healthy eating Healthy eating - do not limit yourself to eating   and a healthy lifestyle.

Galina Romanenko

Hyperplasia endometrial cancer develops when hormonal disorders of the menstrual cycle. Hormonal disorders lead to the fact that the lining of the uterus grows and forms a precancerous condition, so it is important to early detection and treatment of this condition.

Why can develop endometrial hyperplasia and its varieties

The endometrium of the uterus - is the inner mucosal layer of the uterus (mucosa), its overgrowth called hyperplasia Hyperplasia - do not be afraid . This happens in violation of the first half of the menstrual cycle, which occurs under the influence of female hormones estrogen. When a lot of estrogen, a female sex hormone the second half of the menstrual cycle, progesterone is small, the following changes:

• under the action of estrogen in the first half of the menstrual cycle, the endometrium grows rapidly (proliferation stage);
• lack of progesterone causes the increase in volume that endometrial continues indefinitely, whereas normal progesterone Progesterone - norm and pathology   should suppress the proliferation and stimulate the secretory activity of glands of the uterus;
• if estrogen lot, menstrual bleeding is a rare but strong, with significant blood loss; Estrogens are distinguished but sometimes wavy and long, in which case the bleeding is not strong, but the duration; possible and intermenstrual bleeding.

The mucous membrane of the uterus consists of a single-layer coating of columnar epithelium and stroma with its target it glands. Depending on what part of the endometrium grows, divided into glandular hyperplasia, glandulocystica, atypical (adenomatous hyperplasia) and focal (polyps). The latter two require careful observation woman gynecologist, as they tend to degenerate into a malignant tumor. Such a rebirth is possible with other types of hyperplasia, but it occurs much less frequently.

The disease develops due to various hormonal disorders, including in the human hypothalamus or pituitary gland, obesity, gynecological infectious-inflammatory processes, endometriosis Endometriosis - a serious problem with serious consequences , Uterine fibroids, polycystic ovaries, after gynecological operations, leading to hormonal disruptions, diabetes, hypertension, hepatitis and cirrhosis of the liver, and so on.

On what grounds can be suspected endometrial hyperplasia

The disease can be suspected in the menstrual cycle, which are accompanied by sudden or severe bleeding, or long (up to several weeks) minor blood loss. And then, and another creates the risk of iron deficiency anemia. The woman with the times there is a weakness, fatigue, decreased performance, pale skin, severe dizziness. But first, the disease may be asymptomatic.

Bleeding can be either cyclic, acyclic and character. In some cases, long-term maturation of follicles in the ovaries of menstruation may not be for several weeks or months, and then begin to bleed heavily. And vice versa may be too short menstrual cycles (two weeks).

The majority of patients with endometrial hyperplasia revealed a combination of menstrual disorders, bleeding and infertility with neuroendocrine disorders (obesity, diabetes, thyroid disease), as well as high blood pressure, and impaired liver function.

How can you identify endometrial hyperplasia

If you suspect a disease survey begins with ultrasound, including using a vaginal probe and blood tests for hormones. Ultrasound reveals abnormal proliferation of the mucous membrane of the uterus. The next stage of the survey - hysteroscopy Hysteroscopy - examination of the uterus inside   - Endoscopic examination using special equipment that allows a multiple increase in the well to consider the structure of the uterine mucosa and take a small piece of tissue from the most suspicious areas for histological examination. Histology taken tissue reveals a malignant tumor at the very beginning of its formation.

If necessary, also carried out hysterography (retgenologicheskoe study of the uterus) and radioisotope methods.

How we treat

Treatment depends on the results of the study and the age of the patient. In any case, first stop bleeding and iron deficiency anemia are treated and then subjected to a treatment aimed at suppressing the proliferation of mucous membrane of the uterus.

If a strong bleeding, treatment begins with scraping the mucous membrane of the uterus, and then attach hormone therapy. Depending on the results of the survey and the age of the patient, it may consist of synthetic analogues of estrogen and progesterone or a progesterone. If in the course of the survey there was a suspicion of a malignant tumor, the uterus is removed.

Galina Romanenko