Menstrual function disorders
Menstrual cycle disruptions are one of the most frequent reasons for visiting a gynecologist. They are classified according to the nature of the bleeding and its relationship to the phases of the cycle.
- Amenorrhea is the complete absence of menstruation. It can be physiological (before puberty, during pregnancy and lactation) or pathological (against the background of gynecological and somatic diseases).
- Hypomenstrual syndrome refers to scanty cycle manifestations. It includes hypomenorrhea (decreased blood volume), oligomenorrhea (shortened bleeding days), and opsomenorrhea (infrequent cycles).
- Menorrhagia is heavy or prolonged bleeding strictly related to the cycle. It manifests as hypermenorrhea (large volume), polymenorrhea (prolonged bleeding), or proiomenorrhea (rhythm disturbance). It occurs due to decreased uterine contractility (myoma, endometritis) or ovarian dysfunction.
- Metrorrhagia is acyclic bleeding unrelated to menstruation. It is characteristic of submucosal myoma, cervical and uterine cancer, and hormonally active tumors.
- Menometrorrhagia is heavy menstruation that does not stop and continues into the intermenstrual period.
- Algodismenorrhea is painful menstruation. It often accompanies infantilism, endometriosis, inflammation, and abnormal uterine positions.
Uterine displacement anomalies
Normally, the uterus has a certain degree of mobility, but a persistent change in its position leads to pelvic organ dysfunction.
Hyperanteflexion of the uterus A pathological forward bend in which the angle between the body and the cervix becomes acute (less than 70°). It most often develops against the background of sexual infantilism or previous inflammation. Examination reveals a small uterus sharply deviated anteriorly, an elongated conical cervix, and flattened vaginal fornices. The main complaints are primary infertility and algodismenorrhea. Treatment aims to eliminate the cause, and to relieve pain 2–3 days before menstruation, antispasmodics (drotaverine) and anti-prostaglandin drugs (indometacin) are prescribed.
Retroflexion of the uterus Deviation of the uterine body posteriorly and the cervix anteriorly (the angle is open posteriorly).
- Movable form occurs due to weakness of the ligamentous apparatus (after childbirth, in asthenic women) and is easily reduced during a manual examination.
- Fixed form is a consequence of adhesions in endometriosis or inflammation; it cannot be manually reduced.
In retroflexion, the bladder loses the protection of the uterus. Constant pressure of intestinal loops on these organs eventually provokes their prolapse or descent.
Pathological discharge (Leukorrhea)
Leukorrhea can indicate both a local infection and systemic pathologies. When taking a medical history, the physician must detail its characteristics:
- Quantity: from scanty to profuse.
- Color: milky, yellowish, green, gray, or "dirty" (tinged with blood).
- Consistency: thick, viscous, curdled, frothy, or creamy.
- Odor: from completely absent to sharp and unpleasant.
Key questions for the patient: whether the discharge is related to a change in sexual partner, whether it intensifies on certain days of the cycle, and what preceded its first appearance.
Infertility diagnosis
Infertility evaluation requires a comprehensive approach. It begins with taking a medical history: menstrual and sexual function, contraception methods, history of STIs, abdominal surgeries, and extragenital diseases (diabetes, thyroid pathologies) are evaluated.
An objective examination includes measuring BMI, assessing skin condition (acne, striae) and the mammary glands. Laboratory minimums include smears for flora, and PCR and bacterial cultures as indicated. Functional diagnostic tests (basal body temperature, karyopyknotic index) are performed over three menstrual cycles.
A general practitioner consultation is mandatory for all patients to rule out contraindications to pregnancy. An endocrinologist, geneticist, and psychiatrist are involved only when specific indications are present.
The role of laparoscopy in gynecology
Laparoscopy is a crucial tool for both elective diagnosis (for PCOS, endometriosis, malformations, unexplained pelvic pain) and emergency care (ectopic pregnancy, ovarian apoplexy, twisted tumor pedicle).
Absolute contraindications to surgery:
- Hemorrhagic shock.
- Cardiovascular and respiratory decompensation.
- Uncorrectable coagulopathy.
- Acute hepatorenal failure.
- Conditions where the Trendelenburg position is prohibited (e.g., trauma and cerebral vascular lesions).
Complications (gas embolism, vascular or intestinal injury) directly depend on the surgeon's qualifications, which is why strict patient selection is required.
To avoid confusing the types of hypomenstrual syndrome, remember the rule "H-O-O": Hypomenorrhea (low volume), Oligomenorrhea (few days), Opsomenorrhea (few cycles — infrequent).
Class and exam questions
What is the fundamental difference between menorrhagia and metrorrhagia?
Menorrhagia is always cyclic, meaning it is related to the menstrual cycle (e.g., excessively heavy or prolonged periods). Metrorrhagia is acyclic bleeding that starts suddenly and does not depend on the phase of the cycle.
Why is uterine retroflexion dangerous if left untreated?
When the uterus is deviated posteriorly, the bladder remains anatomically unprotected. Intestinal loops constantly press on the uterus and bladder, which over the long term leads to pelvic organ prolapse or complete descent.
Why is a general practitioner consultation mandatory for infertility?
The general practitioner evaluates the woman's general somatic condition to identify potential extragenital diseases and absolute contraindications to carrying a pregnancy.
What else to study on this topic
- Functional diagnostic tests (FDT): rules for measuring basal temperature, assessment of the "pupil" symptom, and calculation of the karyopyknotic index.
- Differential diagnosis of acute gynecological and surgical pathologies in the presentation of an "acute abdomen."
- Mechanisms of antisperm antibody formation in immune infertility.
- Specific complications of laparoscopy: pathogenesis of gas embolism and mediastinal emphysema.
- The impact of extragenital pathologies (diabetes mellitus, tuberculosis) on the female reproductive system.
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