Persistence of the follicle

Dysfunctional bleeding in the uterus includes a sufficiently large group of bleeding in the anovulatory cycle. They arise without ovulation, the yellow body is absent. Their approach is provoked by the persistence of the follicle. They also arise as a result of prolonged estrogenic action.

The persistence of the follicle is characterized by the attainment of one or more follicles of a certain maturation. However, there is no ovulation and formation of the yellow body. The duration of the follicle is several months and is accompanied by the production of a significant amount of estrogen hormones.

Achieving such a state can last from seven to eight days. After this, changes in the regressive nature and a decrease in the estrogen level in the body are revealed. Hormonal decline provokes destructive disorders of the endometrium and bleeding, similar to menstrual bleeding. The protracted persistence of the follicle occurs in combination with a delay in menstruation (in some cases up to several weeks) and severe bleeding for a long period. In addition, the condition is accompanied by a glandular-cystic hyperplasia in the endometrium. Bleeding of this type is most often detected in pre-menopausal and juvenile age.

Juvenile bleeding ranges from five to ten percent of all cases. They occur during incomplete maturation of the sexual nature with the instability of the menstrual cycle. For girls from twelve to fourteen years the cycle is characterized as anovulatory in 60% of cases, from fifteen to seventeen years - in 43% of cases and from 18 to 20 years - in 27%.

Follicular atresia is accompanied by prolonged production of estrogens. However, their number is relatively small. The constant estrogenic content, not characterized by peaks, provokes hyperplasia in the endometrium. This changes the vascular tone, which causes a violation in the circulation of the endometrium, the occurrence of bleeding and foci of necrosis. As a rule, cycle delays in this state are longer than those accompanying the follicle's persistence.

In both conditions, anovulatory bleeding occurs, usually after a menstrual delay, which can last for several days and up to six to eight weeks or several months. With persistence, there are more abundant bleedings, but they are less prolonged.

Diagnosis of anovulatory bleeding is carried out taking into account the clinical grounds and data of endocrinological studies. Persistence is characterized by the presence of basal temperature below 37º, high content (50-100 mcg / day) of estrogens. At the same time, a low content of pregnanediol is detected.

Atresia is accompanied by a low constant basal temperature. At the same time there is a moderate excretion of estrogens and reduced excretion of pregnanediol.

Differentiation of the diagnosis is made with uterine diseases of an organic nature (uterine myoma, cervical cancer and others), with common diseases (liver disease, blood, hemorrhagic diathesis and others). Patients who are diagnosed with a follicle persistence are treated for treatment aimed at stopping bleeding (the first stage of therapy) and restoring normal menstruation (the second stage of therapy). The task of the first stage is to provoke a secretory transformation in the hyperplastic endometrium. The second stage of therapy performs the task of preventing repeated bleeding and consists of restoring cycles and stimulating ovulation.