One of the main indicators of female health is the menstrual function of the body. Its violations can manifest itself in the form of oligomenogeni, which is one of the species (weakening of menstruation) of the syndrome and occurring in 2-3% of women.

Oryagnomorerian is a violation menstrual cycle (NMC) in the form of short, less than 2 days, regular spontaneous menstruation with an interval between them from 36 days to six months. Understanding the reasons for this syndrome is impossible without a general idea of \u200b\u200bthe physiological processes of the regulation of menstrual cycles.

The physiology of the regulation of menstrual cycles

Menstrual cycles are repetitive cyclic changes in women's bodyespecially in various departments of the reproduction system. The culminating external manifestation is menstruation, which are repeated with a certain interval during the entire reproductive period, except for pregnancy and lactation periods. The failure of these processes leads to the development of violations, including oligomenoria. After the first menstruation (menarche), which appears, as a rule, in 10-12 years, the regularity of cycles can be installed for 1-1.5 years.

The normal flow and cyclicality of these processes, accompanied by changes in the whole body, is provided by a single neurogormonal system consisting of central (unifying) and peripheral effector (executive) structures, as well as intermediate links. In the reproductive regulation mechanism, 5 levels, which interact with each other in accordance with the principles of positive and negative direct and feedbacks are distinguished.

Higher, or first level

Representation of the cerebral cortex and some other structures of the latter. They participate in perception and relevant influence on other departments of the reproductive system depending on the frequency, severity and duration of exposure to external (pronounced stresses, instability of the psycho-emotional sphere, etc.) and internal stimuli. In the latter case, this happens with specific receptors to estrogen, androgen and progesterone. In response to the effect of stimuli in these structures of the brain, biochemical transformation of biologically active substances that affect the corresponding function of other formation of the brain - hypothalamus are distinguished and undergoes.

Second level

The hypothalamus, as a neuroendocrine structure, is the second level of regulation. It has the properties of both neurons that reproduce electrical impulses and cells that are distinguished by the Liberin hormonal substances (stimulating) and statins (blocking). The activity of the hypothalamus depends on both the regulatory effect of the structures of the first level and on the content of genital hormones in the blood. Gonadotropic liberins of the hypothalamus are combined by the name Gonadotropin-Rilizing Hormone (GNV). Its secretion is programmed genetically and wears a circhoral (pulsating) character. The maximum activity of the hypothalamus lasts a few minutes, the intervals of activity range from 1 to 3 hours, which also affects the concentration of estradiol in the blood into the lutein or follicular phase of the menstrual cycle.

Third level

The front fraction of the pituitary is the third level of neuroendocrine regulation. This brain department secretes hormones:

• FSH (follicularitymuling), stimulating the growth and ripening of follicles in the ovaries;
• LH (luteinizing), which together with the first contributes to the development of progesterone;
• prolactin, controlling the release of progesterone with a yellow body into blood, as well as stimulating the growth of the mammary glands and regulating lactation;
• TSH (thyrotropic), STG (somatotropic) and ACTH (adrenocorticotropic).

Only with the balanced secretion of these hormones, it is possible to adequately functioning the reproductive system, the establishment of a regular menstrual cycle and the absence of such violations as oligomenorrhea, etc.

Fourth Level

It consists of peripheral endocrine organs, which include ovaries, thyroid gland and adrenal glands. The ovaries in which the follicles grow and ripen, the genital hormones are synthesized, a yellow body is formed, the main role is performed. The hormones synthesized in the ovaries are defining not only in the functional changes in the reproduction system itself, but they also have an active impact on the metabolism of substances in tissues and organs in which there are receptors for sex hormones, aminoptides, insulin and glucagon.

Fifth level

The mucous membrane of the vagina, the uterus, especially its mucous membrane (endometrium), in which cyclic processes are expressed maximum, uterine pipes and dairy glands. Cyclic changes in endometrials consisting of cell proliferation, secretion and directly menstruation depend on both the concentration of sex hormones and the condition of the fabric receptor apparatus to the sex hormones.

These levels form a hypothalamic-pituitary-ovarian axis. Principles of direct and inverse interaction through specific receptors to hormones at all levels provide cyclicality and adequate functioning of the reproductive system.

Under the "straight" bondability means the stimulating effect of the hypothalamic region of the brain into the pituitary gland, followed by the synthesis of sex hormones in the ovaries, under the "reverse" - the effect of the level of the concentration of genital hormones on the hypothalamus and pituitary gland.

One of the main generalizing indicators, which reflects the interaction of different levels of the axis of hypothalamus-pituitary-ovaries and the possibility of implementing the basic function of the body reproduction system is the menstrual cycle. Its nature makes it possible to clinically determine the level of the condition of the sexual system, due to the correct relationship in the system of hypothalamus-hypophysis-ovaries.

Thus, the NMC on the type of oligomenogenia, as well as other types of these disorders, can be provoked by factors causing disorders of interaction of the neuroendocrine systems at one or several levels.

Causes of the development of oligomenoria

Oligomenorrhea can be physiological and pathological nature. Physiological oligomenorrhea is a violation accompanying physiological conditions. It occurs in adolescence when the formation of the menstrual cycle occurs, and during the period of premopause, that is, the fuss of the functions of the reproductive system (what is and when the menopausal period occurs, read). In the latter case, it precedes menopausal amenorhea.

Pathological syndrome varies like:

1. Primary oligomenorrhea - It occurs during the formation of the menstrual cycle. In this case, it is an external sign of the start of development of the process, which in the fertile period determines the violation of the neuroendocrine function of the reproductive system of the body. By the end of the adolescence of the disorder in the system of hypothalamus-pituitary-ovarian, having a functional character initially acquire relative stability and retain their main traits already in childbearing age.
2. Secondary oligomenorrhea - develops after the established normal regular menstrual cycle.

Having an idea of \u200b\u200bthe levels of physiological regulation of the menstrual cycle, it becomes clear that any organic or functional disorder at one level can cause the cause of oligomenogenios at one level. These causes can be:

1. Anatomical changes in the brain due to injury, pituitary and other tumors of various nature, disease and syndrome of Itsenko Cushing.
2. Chronic negative psychogenic loads or pronounced stressful states.
3. Excessive long physical exercise and sharp change in climatic or temporary belt.
4. Sharp infectious diseases, complicated by neuroinfection, as well as transferred meningitis or encephalitis.
5. Diseases of endocrine organs (hypothyroidism, pancreatic diseases, adrenal tumors, some forms of climacteric and).
6. Family predisposition to violations of the reproduction function (read more about female infertility).
7. Congenital anomalies of the development of genital organs.
8. Metabolic disorders in obesity, rapid loss of body weight, unbalanced nutrition, body weight deficit for a long time.
9. Long-term receptions containing estrogen, opioid preparations, methoclopramid (anti-ansulic agent), hallucinogenic and some narcotic drugs, long or inadequate treatment with hormonal (glucocorticosteroids) drugs.
10. Ovarian diseases (,).
11. The cause of oligomenogenius may be frequent infectious diseases in childhood and in adulthood, including chronic inflammatory processes and high-inflammatory changes in endometrial, as well as tumors, operational interventions in the uterus and ovaries, injuries (abortions).
12. Liver diseases and cardiovascular systems (rarely).

IN International Classification Diseases (ICD-10) also introduced such a category as "Olygomenoria Uncomfortable". It belongs to the class of diseases of the genitourinary system, the "non-aggregative diseases of the female genital organs". This category includes oligomenore, which can be due to exhaustion syndromes, dysgenesis, ovarian hyperforms, or immune disorders covering humoral and cellular immunity units and manifested, possibly autoimmune ooforite or other disorders in the ovaries of an unclear reason.

Symptoms of oligomenoria

Changes in the nature of bleeding during menstruation and interval between them are often accompanied by violations fat Exchange in the form of excess body weight (in 80%), the appearance of acne on the face, on the skin of the front and rear surface chest, the development of acne, increased salinity, porosity and scar changes (stria) of the skin. In 25% of women with this syndrome there are phenomena of hirsutism, that is, excessive development of hair cover in the field of face, abdomen, mammary glands, chest.

Part of women have the development of the physique of male type and a decrease in sexual entry, headaches and dizziness, deviations from the norms of indicators arterial pressure, asymmetric indicators of blood pressure, numbness fingers, vegetative disorders, sleep disorders and appetite, fiscaliness, irritability, emotional instability.

Diagnostics

The diagnosis of the disease, which is the cause of the impairment of the menstrual cycle, is established on the basis of complaints and anamnesis, general objective and gynecological examinations, as well as assessing the state of the psycho-emotional sphere and neurological state.

Additional methods of diagnosis of oligomenogenius are the definition of basal temperature with the construction of the graph, the bonds and by means of a vaginal sensor, the magnetoresonance tomography of the skull. In addition, laboratory studies of the content in the blood serum hormones are carried out (prolactin, folliculic content and luteinizing hormones) and genital hormones (progesterone, estradiol, testosterone), as well as glucose and cholesterol, determine the content of 17-ketosteroids in the urine (to assess the adrenal function) .

Treatment

The treatment of oligomenoria is the treatment of diseases and the correction of pathological conditions, the consequence of which it is. In order to stimulate ovulation, clomiphene or gonadotropic agents are prescribed by certain schemes, oral combined contraceptives, urozhastan, parlorodel, etc.

Recommendations are given in terms of proper nutrition, Means are prescribed with sedative and, if necessary, antidepressant effect, physiotherapeutic treatment. When the brain tumors are detected, the adenoma of the pituitary and certain diseases of the ovaries can be recommended surgical treatment.

Timely correction functional disorders Neuroendocrine regulation is capable of slowing down their development or lead to complete recovery. In the case of late diagnosis and treatment, functional disorders become irreversible and lead to organic changes in reproductive organs.

Is it possible to get pregnant with an oligomenorium?

This largely depends on the reasons for the development of the syndrome. If hormonal disorders occur, there is no ovulation, disruption of rejection and restoration of the uterus mucous membrane, then naturally the pregnancy becomes impossible. In cases of infantilism, the possibility of pregnancy depends on the degree of hypoplasia of the uterus, the degree of hormonal functioning of the ovaries, from the presence of concomitant pathological conditions.

In accordance with the data of the World Health Organization for 1985, 14.7% are accompanied by this type of pathology. Among all the fruitless women suffering from any impaired menstrual cycle, the frequency of oligomenoria is 41.6%. An independent occurrence of pregnancy is observed about only 20% of women with this syndrome.

At a certain period of life, the cycle disorder happened, probably every woman. Disturbance which many ladies accustomed to consider something ordinary, are actually a signal about female health problems.

What is NMC in gynecology? This is a disturbed menstrual cycle, which is happening with women in different periods of their lives.

Irregular menstruation - delays or shorter cycle, indicate violations of physical or mental state women. The monthly cycle is peculiar biological clocks of the body. The crash of their rhythm should alert and cause the doctor to appeal to the disease to be identified in a timely manner. Below it will be about why the menstrual cycle fails, and what a woman should make in such a situation.

What is menstrual cycle

It is important to clearly know what kind of monthly cycle in women, and what should be the menstrual function in normal.

Menarche , that is, the first monthly, girls are coming from 12 to 14 years. At what age, girls begin with periods, depends on their residence. Than a teenager lives south, the earlier it takes a manarh. It is important to keep parents to follow when girls begin menstruation to understand whether the body is developing normally.

At the age of 45 to 55 years, the menstrual period ends. This period is customary to be called premanopausal.

During the period, the functional layer of the uterus mucous membrane is rejected as a result of a decrease in products in the body. The monthly cycle of a woman is divided into three phases.

• 1 phase , follicular, is characterized by developing, under the influence of which ripen follicles . Of all the follicles later stand out dominant follicleFrom which the matched egg is published later.
• 2 phase the menstruation cycle is the shortest phase that lasts about 1 day. At this time, the follicle bursts, and an egg cell is output. It is important to understand, speaking about the fact that the first phase of the menstruation cycle is distinct, which is the time when the egg is ready for fertilization. This is a fertilic phase when conception can occur.
• 3 phase , Luteinova - period when synthesis begins progesterone The yellow body arising on the site of a burst follicle. Progesterone provides endometrial preparation to subsequent implantation of a fertilized egg. But if the conception was never, there was a gradual death of the yellow body, the production of progesterone decreases, and the endometrium is gradually tightened, that is, menstruation begins.

If progesterone deficiency is noted, the products of estrogen are activated, and the cycle is repeated again. For the convenience of perception, the phase scheme is useful by day, where all the cycles phases are indicated and how these phases are called.

Thus, the menstrual cycle is cyclic changes that occur after a certain period of time. The duration of the normal cycle should be from 21 to 35 days. If a deviation is noted in a certain direction for 3-5 days, it cannot be considered pathology. However, if more substantial shifts are noted, then the woman should alert what the cycle of menstruation is reduced or it becomes longer.

If a woman has a normal menstruation cycle, how many days are the monthly period - a purely individual indicator. The norm of the length of menstruation is from three to seven days. It is important to consider paying attention to the duration that this condition should not be for a woman very difficult period. After all, an important characteristic is not only a duration value, but also the fact that menstruation should not deliver very strong uncomfortable sensations. During this period, about 100-140 ml of blood loss occurs. If there is an abundant blood loss or a woman notes that the delay rate is broken, it is important to immediately turn to the gynecologist.

Cycle regulation occurs at 5 levels.

In fact, the reasons for the disorders of the monthly cycle are very diverse, and there are many of them. Conditionally the causes provoking the impairment of the menstrual cycle can be divided into three groups:

• First - These are external factors that affect the normal cycle. That is, etiological factors affect the bark of the brain. A woman may noted that the cycle has decreased or, on the contrary, it is longer if it changed the climate sharply, stayed in a state of long stress, "sat down" on a rigid diet, etc.
• Second - a consequence of pathological conditions relating to not only the sexual system, but also the body as a whole. So, the causes of the failure of the menstruation cycle after 40 years are often associated with the beginning of the menopauscical period. However, it is possible that the reasons for the time failure of the cycle after 40 years are due to the presence of health problems in a middle-aged woman.
• Third - The effect of medicines. Often the answer to the question why the menstruation cycle fails, is the treatment of a number of drugs. The delay or another failure is possible both after the start of receiving certain drugs and after their cancellation. We are talking about hormonal contraceptives, anticoagulants, antiagregants, glucocorticoids, etc.

Pathological factors

• Pathology of ovarian - This is a violation of communication between the ovaries and, oncological diseases of the ovaries, the drug stimulation of ovulation, the insufficiency of the second phase of the cycle. Also irregular periods associated with the pathology of the ovaries may be a consequence of negative professional impacts, radiation, vibration, chemical influence. The causes of the irregular cycle of menstruation can be associated with the operational interventions on the ovaries, injuries of urinary organs, etc.
• Violated interaction between the hypothalamus and the pituitary - The irregular cycle may be associated with too active or insufficient release of gonadotropic hormones and rillation factors. Cycle disorders are sometimes a consequence of a pituitary tumor or brain, hemorrhages in the pituitary gland or necrosis.
• - If the woman develops endometriosis, both genital and extragnenital, hormonal nature of this disease leads to a violation of the hormone balance.
• Blood coagulation process - Hemophilia, other genetic pathologies.
• Scraping of the uterus - Endometrium is damaged if scraping after interrupting pregnancy or for the purpose of treatment. As a result, complications may develop - inflammatory processes of uterus and appendages. Algorically marked interregular periods after childbirth.
• Diseases of the liver and gallbladder .
• The appearance of hormonally-dependent tumors - oncological processes in the uterus, adrenal glands, breast, thyroid gland.
• in chronic form - There is no formation of a full endometrium.
• Polyps of mucous meter .
• Sharp "Racing" body weight - Like weight loss and provokes irregular periods in adolescents and in adult women, since the fatty tissue produces estrogens.
• Infectious diseases - can have a negative impact on the ovaries. Moreover, provoke a failure of menstruation, as infections that have been transferred in childhood, (for example, or) and sexual infections.
• The presence of anomalies of the uterus - Partition in the uterus, sexual infantilism, etc.
• Endocrine pathology - Often with it related causes of irregular periods after 40 years.
• Pathology of uterus - Tumors, hyperplasia.
• Mental diseases - epilepsy, etc.
• The presence of bad habits .
• , hypovitaminosis .
• Chromosomal anomalies.

What to do with a particular health problem, and how to normalize the cycle, the gynecologist will tell, who must be visited if the monthly "moved".

How can a cycle disorder manifest?

• Amenorrhea - Monthly missing for six months or more. With primary amenorbae Violations are noted from the moment when the beginning of menstruation girls occurred; In secondary - disorders were manifested after a certain period of normal cycles.
• Oligomenorrhea — monthly manifestations once a few months (3-4). After 45 years, such manifestations may be associated with.
• Obsenoria - Scooty monthly, ongoing no more than 1-2 days.
• Polymenorrhea - Long menstruation (more than 7 days) with a normal cycle.
• Hyperpolymenorye - Abundant allocations are noted, but the cycle is normal.
• Menorragia - abundant and long-term menstruation (more than 10 days).
• Metrragia - irregular appearance of bloody seals, sometimes they may appear in the middle of the cycle.
• Promigatory — frequent menstruationin which the cycle is less than three weeks.
• Algomenorrhea - Very painful periods, in which the woman becomes disabled. Algomenorrhea can also be primary and secondary.
• - so called any cycle impairment, under which there is pain during monthly and unpleasant vegetative disorders:, unstable mood, vomiting and nausea, etc.

The cause of frequent monthly, as well as other disorders described above may be related to the most diverse pathologies. A woman should alert any violations. For example, monthly, very frequent after 40 years may indicate the development of severe diseases.

Often, the cycle disorders are noted in adolescents when menstruation becomes becoming. This phenomenon is associated with physiological reasons. Girls have the formation of a hormonal background, and with it are associated both the causes of the short cycle of menstruation and causes of delays. In adolescents the duration of the cycle can be every time different.

The process of formation can continue for 1-2 years. But the girl should clearly know how to count the duration of the cycle of menstruation to track how many days the cycle lasts and whether its gradual becoming happens. This is important not only for those who already live in sex life, but also for girls who need to know the duration of the cycle and for hygiene purposes, and to track their state of health. Mom must necessarily explain the daughter, how to correctly count the cycle of menstruation. An example of such a calculation is also important for a teenager.

There are the following pathological factors affecting the regularity of menstruation in adolescents:

• infections of the brain and shells;
• card and brain injuries;
• frequent colds;
• sex infections;
• sclerokystous ovaries.

Negatively, the formation of a monthly cycle affects the fact that young girls practice hard diets, as a result of which there is not only excessive weight loss, but also hypovitaminosis, a breakdown of menstruation.

Interestingly, the regularity of menstruation is influenced by the characteristics of the character of adolescents.

Doctors highlight some more important factors that can affect the formation of a cycle:

• early start of sexual life, indiscriminate contacts;
• anomalies for the development of the sexual system;
• the presence of bad habits.

Due to the disturbed menstrual cycle, a teenager girl can occur so-called juvenile uterine bleeding . For such a condition, tightening periods are characterized. As a rule, prolonged and at the same time abundant monthly last year. It leads to anemia and a serious deterioration of the state in a teenager. As a rule, the causes of long-term periods are associated or with moral overvoltage, or with infections.

Cut cycle during premopause

Treatment of men's breakdowns in adolescents

If the teenage girl has a menstrual cycle, and at the same time the condition is complicated juvenile bleeding, two-stage therapy is carried out.

With pronounced pronounced bleeding when the girl is worried about weakness, dizziness, and it has lowered (up to 70 g / l), the doctor makes a decision to conduct scraping. Next, the histological examination of the scas.

Provided that the hemoglobin rate from 80 to 100 g / l is prescribed hormonal pills (,).

Also, if necessary, antianemic therapy (blood transfusion, erythrocyte mass, info-rope, refooliglucina) is carried out. Prescribed in the treatment scheme also iron preparations.

The teenager is prescribed hormonal funds for a period of no more than three months. The treatment of anemia lasts until the hemoglobin indicators are raised to the norm.

Treatment of cycle violations in women of childbearing age

Treatment of disruption of the menstruation cycle in this case, it seems like a scheme of therapy of such violations in adolescents. Both in twenty years and the treatment of disruption of the menstruation cycle in the 40 years during bleeding is carried out by scraping. It is carried out with diagnostic, and with a therapeutic goal.

It is important to fill the volume of circulating blood, for which colloidal solutions are used. Also practiced emergency treatment, symptomatic hemostasis. Provided that the scraping did not affect, the doctor may decide on hysterectomy or ablation (burning) endometrial.

It is also important to treat those accompanying diseases that could provoke a cycle disorder. So, with hypertension it is important to take appointed medicines, limit the consumption of saline, as well as fluids. In the pathology of the liver, adhere to the correct diet, take hepatoprotectors.

Some women are also practicing treatment folk remedies. However, such methods need to be practiced very carefully, since without consulting a doctor there is a risk of missing a serious pathology. And even the disruption of the menstruation cycle after 45 years, perceived by the woman, as the beginning of menopause, is the basis for applying to the doctor.

Since the cycle failures may cause women in childbearing, if necessary, prescribe Choriogonin and Pergonal - Medicines for stimulating the development of active follicles. In order to stimulate ovulation should be taken.

Bleeding during Cleese

When bleeding during the period of Klimaks, the patient must prescribe the scraping of the uterine cavity. After all, bleeding may indicate serious pathologies, in particular about the development atypical hyperplasia or endometrial adenocarcinoma . Sometimes the doctor may decide on holding hysterectomy .

Sometimes the patient in the period of menopause prescribed medications - Gestagens: Depot-provision , , 17-OPK .

In the process of treatment, anti-estrogenous means can be appointed - Danazol. , Gestrinone , 17A-Ethinyl Testosterone .

conclusions

If you violate a monthly question, how to restore the cycle of menstruation, it is necessary to immediately solve a woman of any age. Those who are interested in how to restore the menstruation cycle by folk remedies should be remembered that such manifestations are just a symptom of a major disease that must be treated correctly, according to a scheme appointed by a specialist.

Not always to eliminate such problems you need to take hormonal tablets to restore menstruation. Sometimes a woman for whom the question is relevant to how to restore the menstrual cycle without hormones, even changing the day of the day and singularities of nutrition. For example, women suffering from obesity helps normalization of weight. And those who practice very strict diets, it is enough to increase the caloric content of nutrition and overcome the exhaustion of the body. In any case, with "troublesholding" of the cycle and young girls, and women with a climax, it is important to consult with a gynecologist who will tell you how to act.

Different disorders of the menstrual cycle (NMC) are very frequent in our days, almost every second woman familiar with the problems of the irregular cycle. The diagnosis of NMC in gynecology is subject to:

• monthly scant (less than 50-80 ml) or abundant (more than 150 ml);
• the duration of the menstrual cycle is less than 21 days or more than 35 days;
• menstrual bleeding lasts less than 3 days or more than 7 days;
• menstruation accompanies a strong conching pain in the abdomen.

Causes and treatment of NMC

It is important to remember that the diagnosis of NMC in gynecology is just a symptom of a particular disease, the presence of which led to a failure in the work of the hormonal system.

The causes of the NMC are very diverse. The time disturbance of the cycle can be provoked by stress and unrest, longer - infectious, inflammatory and even tumor diseases of the genital and other internal organs, traumatic damage or endocrine disorders.

In gynecology, the trend is traced when the diagnosis of NMCs put those girls and women who possess hereditary predisposition to this disease. Congenital abnormalities of female genital organs are also possible.

To determine the cause and purpose of adequate treatment of the NMC, at least three diagnostic measures are needed:

• study of the hormonal profile of a woman;
• bacteriological;
• Ultrasound - Conducting an ultrasound with NMCs is necessary to exclude innate and acquired pathologies of small pelvis organs.

The treatment of NMCs is aimed at eliminating the root cause of violation. So, a woman may need hormone therapy, physiotherapy, nutritious and vitamin complexes, Reception of anti-inflammatory and antibacterial medicinal preparations And even surgery.

The NMC in the reproductive period is always a problem for the wishing to get pregnant women. Fortunately, with the help of modern techniques therapy, the nature of the course of the menstrual cycle is amenable to significant adjustment, even during the diagnosis of NMC, in most cases a pregnancy occurs.

Most often diagnosed types of menstrual disorders:

Determine the NMC Customer must already in terms of procurement schedule. If by the time of publication the purchase price is adjusted, changes are made in the schedule.

Justify the price of competitive purchases, and procurement at the only supplier. In art. 22 44-ФЗ described several methods for determining the NMC:

1. Market analysis method,
2. Regulatory method
3. Tariff method,
4. Design and estimate method,
5. POSSIBLE METHOD.

Let's look at them more carefully.

Method for analyzing the market for the calculation of the NMC

This is a priority method. The customer should always apply it if the 44-FZ does not provide for another. The customer compares prices for similar goods or services, and if there are no such, then for homogeneous. To calculate the NMC, the customer can:

• Use information from the Internet
• Request prices in EIS,
• Potential suppliers.

It is necessary to send no less than five requests, and to calculate the use of at least three price proposals to determine the NMC of similar purchases.

If you enter into a contract with the only supplier, it is not necessary to adhere to the level of the average price determined by the market analysis method. You can conclude a contract for less from the proposed prices.

An example of the substantiation of the NMC of the Treaty on the wholesale supply of petroleum products by analyzing the market

The average price per ton of gasoline is 45 000 rubles, it means the NMC of the entire purchase - 2 million 998 thousand 450 rubles.

Regulatory method Definition of NMC

There are separate types of goods, the purchases of which are normalized (for example, office, furniture, expendable medical materials). The customer purchases them at maximum prices. Resolutions in which there are costs of costs for various products for certain organizations are placed in EIS. The regulatory method can be applied together with the market analysis method, but the obtained NMC should not exceed the price set in the standard.

Tariff method for calculating NMC

The customer applies it if the price of the goods regulates the state or municipal authority. In this case, the NMC is determined by tariffs approved in decisions, orders, etc. In justifying the NMC, the customer refers to the regulatory document.

Design and estimate method for calculating NMC

Used when calculating prices for:

• Construction and reconstruction of buildings,
• Overhaul and ordinary repair of premises,
• Conducting works on the preservation of cultural heritage sites (monuments of history and culture) of the people of the Russian Federation, except for scientific and methodological guidance, technical and author's supervision.

POSSIBLE METHOD Definition of NMC

When you need to clarify the amount obtained by one of the listed methods, or other methods are not suitable, customers apply the cost method of calculating the NMC. To do this, list and summarize all possible costs of work or services, for example:

• Production costs or acquisition,
• Implementation, transportation, storage,
• Insurance and other costs.

Information on the usual profits for a certain field of activity The Customer can take from contracts posted in EIS or other sources.

Here is an example of calculating the NMC by the costly method of procurement to the retraining of medical staff:

You can use other methods, justifying why it is impossible to use the standard one. Recommendations for the rationale and application of other methods can establish the Government of the Russian Federation in its decrees.

Anxiety should cause too frequent monthly or, on the contrary, rare. Their absence over several months is a serious reason for concern. The poor is discharge, abundance, short-term (one or two days), prolonged duration - deviations from the norm. The following types of NMC in gynecology are most often diagnosed:

1. Hyperpolymenorius: A short menstrual cycle from 14 to 21 days is accompanied by a long period of abundant bleeding - from 7 to 12 days. It is fraught with blood loss, and this is a large load on the body and subsequently leads to violations of the adaptation mechanism. Such a NMC often testifies to serious female health issues.
2. Oryagnomorerian is found in 3% of cases. The interval between menstruation can last 40-180 days, they themselves proceed in two or three days. Diagnosed more often in young women fell fear of improving body weight, problems with conception.
3. Polymenia - common disorder. With the undisturbed duration of the cycle, there is plentiful and long-term blood loss: more than seven days.
4. Almost half of women under the age of 50 are diagnosed with algodismenorya. It is manifested by grapple-shaped pronounced or muted pain in the area of \u200b\u200bthe lower back, headache, nausea, ailment. Symptoms can go through a few hours, sometimes a day.

Over the course of several years, fluctuations in the duration of the cycle, changes in the number of selections in women after forty years. These are signals of the ovarian activity, which leads to a decrease in the efficiency of their work. In this case, the diagnosis of NMC indicates the occurrence of premanopause. The condition is considered physiological, natural and continues until entering the climax.

For some women, a long menstrual cycle is characterized by genetically. Very often, psychophysical factors become the cause of violations: overwork, moving to another place of residence with a time zone change, stress, excitement before the responsible exam, take some medicines and even extreme heat in summer.

Systematic lack of sleep has a powerful negative impact: in the preliminary clock, the woman's body actively synthesize the hormones-regulators of monthly cycles. A completely banal cause of the failure can be a urethrogenital infection: mycoplasma, chlamydia, uroplasm.

Combating anti-inflammatory treatment will save from problems. Uninterrupted to the diet causes the overall distortion of metabolism and entails NMC. The consequences of diabetes, obesity, diseases thyroid gland, hypertension, anorexia can be NMC.

Menstrual cycle violations may indicate serious gynecological diseases, and can only mean a feature of a particular body of a woman. The diagnosis of "NMC" is placed even when bleeding is accompanied by pain, and its duration and length of the cycle do not change.

Dysmenorrhea (spasms)

Almost half of the fair sex representatives suffer monthly from strong spasming pain at thenime of the abdomen, which indicates the beginning of the monthly. Pain can last from 12 hours to 32 hours, that is, more than a day. The character of pain can vary from periodic "fights" to the incessant unpleasant sensations, which can even cause disability.

Dysmenorrhea is primary and secondary. In primary spasms, they derive from anatomical cutting of the walls of the uterus, and this is a normal process. With secondary dysmanifier pain and spasms during menstruation (especially if there were no more than before) they are talking about the presence of any disease of the gynecological sphere (endometriosis, malignant diseases, cyst). In this case, immediately consult a doctor.

The cause of the dismensority can be a blood flow in the uterine arteries, the germination of endometrial outside the uterus (endometriosis), genetic predisposition to such pains.

Menorragia

The term "menorriage" in medicine is called long, too abundant, more than 80 ml., Menstruation and breakthrough bleeding between them. It may be a normal phenomenon for young girls who have a cycle recently, as well as small blood drops on the underwear in the middle of the cycle are found in young women during ovulation.

Amenorrhea

Amenorrheses are called the absence of menstruation, distinguish between primary and secondary amenorrhea. If the girl at 15-16 years have not yet begun monthly, then this is a reason to consult a doctor for the diagnosis of primary amenorrhea. If bleeding was, but disappeared and did not come within three months, such amenorrhea is called secondary.

Secondary amenorrhea, in particular, can overtake the too thin girls with a diagnosis of anorexia, as weight loss affects the production of hormone organism (namely they control the process of organizing the cycle).

Oligomenorrhea

Weak, rare monthly, the distance between which is more than 35 days, are called "Olygomenorrhea". Most often, such pathology happens in young girls with an unsteady monthly cycle.

PMS - premenstrual syndrome is one of the most common causes of NMC in gynecology. Elevated emotionality, federation, increased sensitivity to stressful situations - these symptoms are familiar, probably every woman. Approximately a week before the start of menstrual bleeding, some women begin the PMS, which should not be tolerated, since when accessing a doctor, some of its manifestations can be corrected, reduce.

Violation of the menstrual cycle is a fairly common disease in gynecology. Random failures caused by stress, according to statistics from each second woman. But should be alert if:

• delays frequent
• allocations during menstruation steel abundant or scanty,
• the number of days of bleeding increased or decreased,
• menstrual pain appeared.

The duration of the cycle is counted from the beginning of the previous menstruation before the beginning of the following. The minimum period between them is 21 days, the maximum - 35 days.

If your monthly cycle has been 22 days for many years, and then suddenly increased for several days - this is also a violation. An alarm can be the inverse situation.

As soon as you notice that the monthly changed, you need to make an appointment to the gynecologist to identify the cause of failures.

The impaired menstrual cycle appears due to the infections of the urogenital system and because of the failure in the hormonal system.

The NMC may occur for the following reasons:

• due to frequent stress,
• changes of hormonal background,
• infectious and noncommunicable diseases of the internal genitals,
• hereditary predisposition
• when taking drugs,
• due to the sharp change of place of residence,
• radiation and poisoning
• wrong power
• bad habits.

Most frequent cause Menstruation failures is a small pelvic infection. If, during the survey, the pathogens will not be detected, then sufficiently anti-inflammatory treatment, after which the normal cycle is restored.

Hormonal failures that violated the menstrual cycle arise in different links of the formation of hormones. An important role for their appearance plays genetic predisposition, mental injuries, avitaminosis.

Why should urgently treat the disorders of the monthly cycle? During the latency of the menstrual function, the hormones begin to work at a slow motion. For this reason, the increasing layer of endometrium does not go out in a timely manner, and hyperplasia is gradually formed in the uterus, polyps are growing. If they do not get rid of them, an oncological disease may appear.

Also because of the NMC, fibromyoma, ovarian cyst and other diseases may appear. They cause severe pain.

In connection with the defective mining of hormones with an irregular cycle, the threat of infertility appears. Eggs due to violations do not have time to mature, and even if you are able to get pregnant, the whole period of tooling the child will hang out the threat of miscarriage.

To identify the cause of the NMC, a doctor just talk to the patient. Sometimes he can assign a survey.

In gynecology there are four types of diseases associated with the wrong menstrual cycle:

Algodismenorye. This diagnosis is placed most often. If you have algodismenorrhea, you are experiencing new

Monthly may not be for various reasons, and it is not always connected with gynecological pathology, that is, the diagnosis of "NMC" is not always made. Consider the main causes of lack of menstruation.

• Pregnancy. At the occurrence of an interesting position, monthly ceased. That is, precisely on the lack of monthly ladies and may be suspected of pregnancy. Some argue that the monthly continues on them and during pregnancy, but this is not a menstruation itself, but bleeding, which can testify only about the threat of miscarriage or other problems with the fruit, such a state requires immediate appeal to a gynecologist.
• Breast-feeding. Three stages: pregnancy, childbirth and breastfeeding, is a single cycle of hormonal rearrangements in the body of a woman. The cultivated hormones during feeding the child warn the body that the new pregnancy can not yet come, and the periods do not begin, the cycle is not restored. But from each rule there are exceptions, and to build a system of protection against a new pregnancy on this fact is impossible. The gynecologist will advise to choose a barrier method of contraception after childbirth or take special hormonal contraceptives that will not affect the health of the baby.
• Monthly stops during menopause. This happens not immediately, gradually the cycle is lengthened, and at the age of 50-51, menopause comes. After her offensive, any bleeding from the uterus - the reason to urgently visit the doctor.

Methods of diagnosis and treatment

Based on the complaint of a woman, the doctor appoints a survey. At the same time, the impaired menstrual cycle itself is only a symptom. Diagnostic activities usually include:

• study of the hormonal state of the body;
• conducting an ultrasound examination in order to eliminate pathologies in the bodies of a small pelvis;
• laboratory analysis of vaginal smear.

The gynecologist will ask the patient in detail about the so-called obstetric history, namely: when there were last monthly, whether there were miscarriages and abortions, how many births were, at what age bleeding began and what character they wore, as well as much more. To clarify the causes of the disorders of the menstrual cycle, assign:

• Blood test is common and hormones (estrogen, progesterone, thyroid hormones, etc.);
• Ultrasound of a small pelvis, - helps to determine pregnancy, diseases of internal organs (uterus, ovarian), pathology of the structure of the reproductive system, etc.;
• Hysteroscopy (view the internal contents of the uterus using a small flashlight and camcorder);
• Diagnostic laparoscopy (inspection of the state of the internal organs through 3 punctures of the abdominal wall is usually carried out under general anesthesia);
• Endometrial biopsy (microscopic study of a tiny piece of the inner layer of the uterus for determination of various diseases).

Sometimes for the treatment of changes in the nature of the monthly cycle and disorders of the period cycle, it is enough to change the lifestyle, compliance with diet, caution when choosing sexual partners.

Day mode, sufficient sleep, healthy food rich in vitamins and useful substances - these factors affect women Health very much.

During menstruation, sexual contacts should be avoided, since during this period the woman's body is most vulnerable and less opposed to infections and diseases of the sexual sphere.

Since anemia may be a complication of the diagnosis of NMC (due to the large blood loss), the treatment will be aimed at preventing this, iron preparations are prescribed.

With pain during bleeding, unnecessary anti-inflammatory drugs can be assigned, painkillers.

The problem of irregular periods can be solved by destination oral contraceptives (OK), to select which can only a doctor, taking into account a variety of factors, including after blood tests per hormones.

If the cycle violations are secondary, then the main disease is initially treated, and gradually the problem goes.

The body of a woman is a complex system, the slightest changes in lifestyle or the presence of stress can lead to the disorders of the menstrual cycle. This diagnosis leads both an outpatient treatment and observation of a woman in the hospital.

NMC in gynecology: causes and treatment.

Adequate measures choose the attending physician, based on the survey results. In the arsenal of methods: therapy hormones, physiothereders, anti-inflammatory drugs, antibacterial. In some cases, operational intervention is possible. Often corrective effects have gentle techniques, for example, homeopathic agents.

Myoma uterus is a benign tumor. It is one of the most common (10-27%) tumors of the female reproductive system. Myomas of the uterus is currently found in women aged 30-40 years, often discover my comma in 20-30 months and younger. This tumor is detected from 15-20% of women over 30 years and almost 40% over 40 years. 80% of the testimony for surgical gynecological interventions appear due to the presence of uterine and its complications.

Mioma (Leiomioma, Fibromyoma) is formed from muscle and connective tissue uterus. To date, there is no consensus on the causes of the development of the Moma of the uterus. Most researchers give priority to hormonal disorders and hormone-dependence of the growth of myomatous nodes. Others talk about the impact of infection in the development of myoma (intrauterine contraceptives, abortions, inflammation, sexually transmitted infections).

Classification.

In cases where the submucous tumor is located mainly in the muscular layer (more than 1/3 of the volume of the node), use the term "intertensular mioma of uterus with centripetal growth." Among the sublifted nodes, Moma distinguish a special form - boring tumors whose growth in the uterine cavity occurs towards the internal zev.

The location of the mioma nodes in relation to the muscle layer of the uterus.