When the rules go out of order!

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Numerous women see to approach with concern dates it of their rules, because they know that they are going to lose torrents of blood during eight or ten days. Others are embarrassed by bleedings outside of the rules. A woman out of five between 35 and 50 years would be concerned. How to treat these unrests?

At some women, the rules last more than seven days or are very abundant, one speaks then of ménorragies. At others, some hemorrhages occur during the cycle, outside of the rules , but sometimes the two unrests are associated. "One can say that it is a true problem of public health" underlines the Pr. Hervé Fernandez of the Béclère hospital in Clamart. To treat these unrests, several options are available.

Six or seven protections per day

The rules are judged abnormally abundant when they impose to use at least six or seven protections per day. But in the extreme cases, it can be about real menstrual "floodings", accommodating to use the score of daily protections. In these cases an anemia develops itself quickly. These ménorragies must be differentiated of simple abundant rules. The middle volume of the menstrual flux is of 35 ml, with important variations according to the women. One speaks of ménorragies from 80 ml.

In the same way the métrorragies must be distinguished of the simple spottings, small anarchical bleedings generally bound to the pill.

To search for a lesion

The metrorragies is the more often bound to a "organic" lesion of the uterus: fibroma, myoma, polyp or cancer, whose treatment is essentially surgical. On the other hand, in 80% of the cases, the ménorragies is due to an unbalance hormonal and qualified of "functional." This diagnosis cannot be kept however that after an attentive balance, to search for an uterine lesion. This balance must consist to the minimum of a gynecological exam with scan, of preference with a vaginal probe (scan endovaginale), possibly completed by other exams, as a hystéroscopie (endoscopic exam of the uterus).

The functional meno-merorragies doesn't constitute a serious illness, but they can drag an important hindrance in the daily life. To the demand of the Gynecare society, the Ipsos institute achieved an investigation by 150 women standing very abundant or anarchical rules and 101 medical gynecologists and obstetricians. The results reveal a non negligible attack of the life quality:

31% of these women don't dare to be going to bathe more;
28% never wear any clear clothes;
24% have the impression to be less desirable;
11% are embarrassed in their work.

Curiously, in spite of the caused hindrance, 42% of the women interrogated had not spoken of their unrests to their gynecologist and 66% declared not to follow any treatment.

A treatment first medicinal

The hold in charge of the functional meo-merorragies is in a first medical time. At the young woman, she rests on the pill progestative or combined, while respecting the usual contra-indications. To the approach of the menopause, the preference is given to a pill progestative normodosée, of the 8th on the 26th day of the cycle. However, this treatment often provokes some spottings (micro-bleedings). The rate of success doesn't pass 50%.

t is also possible to take the anti-inflammatory treatments or antihémorragiques the first three or four days of the rules. "These medicines are, in my opinion, more efficient than the progestatifs, without their inconveniences" esteem the Pr Fernandez.

The I.U.D.s to the progesteone (Mirena), seem to have a best efficiency, with 88% of results favorable to three months.

Of the too frequent curettages

When these treatments are inefficient and that the woman doesn't have desire of children anymore, the treatments that aim to reduce the mucous membrane of the uterus exist (endomètre), at the origin of the menstrual bleedings.

Achieved under general anesthesia, the curettage is intervention the most fluently practiced in France. Yet its efficiency is mediocre (50% of good results) and often transient. Otherwise some complications are possible (perforation).

The resection of the endomètre under hystéroscopie is a lot more efficient, with 85 to 95% of good results to 6 months, and 60 to 85% to two years, according to the cleverness and the surgeon's experience. Indeed, it is about a difficult technique, leading to 5%, about complications,: perforation, infection, hemorrhages... "One also observes poisonings bound to the liquid used for this surgery, the glycocol, that can pass in blood, note the Pr. Fernandez. These poisonings can be fatal. One counts one of it to three cases per year in France."

This risk, very weak but real, and the training necessary to the mastery of this method is sufficient to explain that the resection under hystéroscopie is used very little, in comparison of the curettage, although it was about an a lot more adapted treatment and efficient.

The surer small ball

Other simpler methods appeared in the years 1990. In France, the thermocoagulation by small ball is experimented since 1994. A small ball is introduced and swollen in the uterus, to paper the partition, then heated to 87°C, what permits to get the destruction of the endomètre. This method has the advantage to be simple, not requiring a complicated training, and not to give risks of perforation. Its efficiency approaches the 90% to five years. The thermocoagulation remains nevertheless little employee, because the material, to unique use, is not repaid. It is important to specify that this method is not able to, it either, to be used for the women who want more children.

Remain finally, the hysterectomy, that means the ablation of the uterus, whose efficiency is, evidently, radical, to the taken of a definitive mutilation and a heavy intervention. This method is often used in the Anglo-Saxon countries for functional pathologies. In France, 50% of the hysterectomies are practiced for benign pathologies, of which 25% for functional ménorragies, what seems again too much.

2009-05-09