Symptoms of gynecological diseases

Cycle disorders: deficiency and absence of menses

The absence or scantiness of bloody discharge combines several clinical conditions that require thorough differential diagnosis.

Amenorrhea is the complete absence of menstruation in a woman. In clinical practice, it is generally divided into two large groups. The physiological form is observed during strictly defined periods of life: before puberty, throughout pregnancy, and during lactation. The pathological form is diagnosed if the menstrual cycle had previously been established but then ceased. This occurs due to the development of various general systemic diseases or specific gynecological pathologies of various origins.

Hypomenstrual syndrome is a symptom complex that occurs in the same pathological conditions as pathological amenorrhea. It includes three main forms of disorders:

• Hypomenorrhea — a significant decrease in the total volume of blood loss.
• Oligomenorrhea — a pathological shortening of the duration of menstruation itself.
• Opsomenorrhea — a marked decrease in the frequency of menstruation.

Excessive and acyclic bleeding

Excessive uterine bleeding is classified according to its relationship with the normal rhythm. Often, various types of these disorders are combined with each other.

Menorrhagia is bleeding that remains related to the menstrual cycle and occurs cyclically. Menorrhagia includes:

• Hypermenorrhea — a significant increase in the volume of blood lost during menstruation.
• Polymenorrhea — an increase in the duration of bloody discharge.
• Proiomenorrhea — a disruption of the usual menstrual rhythm.

The etiology of menorrhagia includes two main factors. The first is a decrease in uterine contractility, which is characteristic of inflammatory processes (endometritis, myometritis) and tumors (uterine fibroids). The second factor is ovarian dysfunction, which includes improper maturation of follicles or the corpus luteum, as well as the complete absence of ovulation.

Metrorrhagia represents acyclic uterine bleeding that has no relation whatsoever to the menstrual cycle. Its etiology includes dysfunctional uterine bleeding (resulting from impaired ovulation processes), the presence of submucosal uterine fibroids, cancer of the uterine body and cervix, as well as hormonally active ovarian tumors.

A distinction is also made for menometrorrhagia — a condition in which bleeding begins as heavy menstruation but does not stop and smoothly transitions into the intermenstrual period.

Pain syndrome

Algodysmenorrhea is a pathological condition in which menstruation becomes painful. As a rule, pronounced pain accompanies the very beginning of bleeding, but in rarer cases, it can last throughout the entire menstruation, significantly reducing the patient's quality of life.

The etiology of this pain syndrome is quite diverse. The main causes include:

• Underdevelopment of the genital organs (infantilism).
• Incorrect anatomical position of the uterus in the small pelvis.
• Endometriosis.
• Various inflammatory diseases of the internal genital organs.

Pathological discharge (Leukorrhea)

Leukorrhea represents pathological discharge from the genital tract. It is important to understand that it can act as a symptom not only of purely gynecological diseases, but also of various pathological processes located outside the reproductive system.

When taking the history and performing a physical examination of the patient, the physician must evaluate a number of characteristics of leukorrhea in detail:

1. Quantity: the discharge can be scant, moderate, or heavy.
2. Color: ranges from milky and yellowish to green, yellow-green, gray, or even "dirty" (indicating an admixture of blood).
3. Consistency: can be thick, viscous, creamy, foamy, or curdled.
4. Odor: may be absent, simply pronounced, sharp, or extremely unpleasant.

When complaining of leukorrhea, the physician invariably asks specific questions: whether the amount of discharge increases during certain periods of the cycle (especially in direct relation to menstruation), whether it is associated with sexual intercourse or a recent change of partner, and when and why it first appeared.

Class and exam questions

What else to study on this topic

• Etiology and pathogenesis of dysfunctional uterine bleeding in ovulation disorders.
• Mechanisms of decreased uterine contractility against the background of myoma, endometritis, and myometritis.
• Hormonally active ovarian tumors as a cause of metrorrhagia.
• Extragenital diseases capable of provoking the appearance of pathological leukorrhea.
• Pathogenesis of pain syndrome in endometriosis, infantilism, and abnormal uterine position.

Other topics in the "Gynecology" section

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