Opsomenorrhea is an elongation of the menstrual cycle, in which its duration is more than 35 days. The violation is cyclical, menstruation is repeated at least 3 months later. Menstruation can occur both in the form of hypooligomenorrhea and in the form of hypermenorrhea. The probability of pregnancy in patients with opsomenorrhea is reduced. The examination for this violation includes a standard gynecological examination, ultrasound of the pelvic organs, hormonal blood tests, colpocytology, according to indications – SDC. The strategy of treatment of opsomenorrhea is determined taking into account the causes of menstrual cycle disorders; hormone therapy plays a leading role in it.
Opsomenorrhea (bradimenorrhea) is an increase in the interval between menstruation from 36 days to 3 months (with a norm of 21-35 days). Along with oligomenorrhea, hypomenorrhea and spaniomenorrhea, it refers to variants of hypomenstrual syndrome. Opsomenorrhea can have a primary (congenital) or secondary (acquired) character. The primary variant of bradymenorrhea in practical gynecology is spoken of if rare menstruation is noted from the very beginning of menstrual function. The secondary variant is characterized by a decrease in menstruation after a period when the woman had a normal menstrual rhythm. Like other menstrual cycle disorders, opsomenorrhea negatively affects the reproductive function, which is primarily due to a change in the phase of the cycle, inferiority or lack of ovulation.
Primary opsomenorrhea is formed as a result of malformations of the genitals, delayed sexual development, general and genital infantilism, asthenia during puberty. In this case, menarche usually comes late, and in the future the rhythm of menstruation becomes rare. Various acquired pathological conditions that negatively affect menstrual function lead to the development of secondary opsomenorrhea. It can be alimentary dystrophy, psychoemotional trauma, hard physical labor, severe intoxication. A change in the rhythm of menstruation by the type of opsomenorrhea can be associated with surgical operations – abortions, SDC, ovarian resection, oophorectomy, adnexectomy.
Sometimes opsomenorrhea develops against the background of endocrine disorders (often polycystic ovaries, hypothyroidism, Sheehan syndrome), autoimmune, parasitic diseases, brain tumors, sluggish infectious processes, including the genitourinary system. In addition to pathological opsomenorrhea, there is a physiological decrease in menstruation – for example, during puberty and the formation of the cycle, in the premenopausal period due to the gradual extinction of ovarian function.
Clinically, opsomenorrhea occurs in the form of rare menstruation. The intermenstrual interval is over 35 days, but not more than 3 months. The intensity of menstrual bleeding is usually insignificant (smears or drops of blood), the duration is short. The change in the phase of the menstrual cycle causes the inferiority of ovulation or anovulation, so many patients with opsomenorrhea suffer from infertility. In some cases, opsomenorrhea passes into secondary amenorrhea. Along with rare periods, there are symptoms of the underlying disease.
Opsomenorrhea can have 2 different types of flow: with the presence of a prolonged two-phase or monophasic menstrual cycle. With an elongated two-phase cycle, the delay of menstruation is due to the prolonged process of maturation of the follicle. In the first phase of the cycle, the follicle either does not develop at all, or undergoes atresia at one of the stages of development. The secretion of estrogens in this case is low, the basal temperature is single–phase, colpocytology indicates a low degree of epithelial proliferation. In the future, after the growth delay, the follicle still matures, but ovulation can occur on the 20-30 day of the menstrual cycle. The duration of the yellow body phase is shortened or not changed. The level of sex hormones does not differ from that of a normal menstrual cycle, the basal temperature in the second phase becomes higher than 37 ° C, the cytology of vaginal smears reflects secretory changes in the endometrium.
Opsomenorrhea on the background of a monophasic cycle is less common – in 22-24% of cases, usually in patients with hypoplasia of the genitals. The state of the endometrium remains without dynamics and corresponds to the beginning of the proliferative phase. Another cause of opsomenorrhea in a monophasic cycle can be the persistence of the follicle. In this case, the phase of the corpus luteum does not occur, and the persistent follicle creates conditions for endometrial hyperplasia. The reverse development of the follicle is accompanied by a sharp drop in estrogen levels and rejection of the functional layer of the uterus of the endometrium, which is clinically expressed by menorrhagia.
Establishing the causes of smallpox menorrhea requires a wide range of diagnostic measures. At the initial visit to the gynecologist, complaints, the nature of the menstrual cycle, gynecological and general somatic anamnesis are clarified. Examination on the chair allows you to identify anomalies in the development of reproductive organs, to take a smear for colpocytological examination (“hormonal mirror”). By means of ultrasound of the pelvic organs, anatomical abnormalities, inflammatory processes that served to develop opsomenorrhea are determined.
To examine the infectious status, gynecological smears are analyzed: microscopy, PCR, bacposev for flora. In order to identify hormonal disorders, the level of FSH, LH, prolactin, estradiol, progesterone is studied. In some cases, the determination of adrenal and thyroid hormones is indicated. If extragenital pathology is suspected as the cause of opsomenorrhea, the patient is referred for consultation to an endocrinologist, a neurosurgeon.
The directions and scope of therapeutic measures are determined by the underlying pathology, age and reproductive plans of a woman. Congenital anatomical defects, severe forms of sexual infantilism are difficult to correct. In these cases, the tactics of treating opsomenorrhea are developed together with geneticists and endocrinologists. Some types of pathology (brain tumors, PCOS) may require surgical intervention.
Hormone therapy plays a leading role in the regulation of the menstrual cycle. It allows you to restore the normal rhythm of menstruation. If this is not enough for pregnancy, they resort to ovulation stimulation. If inflammatory gynecological diseases are the cause of opsomenorrhea, antibiotic therapy, vitamin therapy, and immunostimulation are performed. They use natural factors treatment (balneotherapy, mud therapy), collar zone electrophoresis, gynecological massage, acupuncture. In case of weight deficiency, an individual diet with a complete diet is developed. A patient with opsomenorrhea is recommended to avoid physical exertion and psychoemotional shocks.