Abundant menstruation mcb 10. What is algomenorrhea in women

Algodysmenorrhea is a pain syndrome that occurs monthly in the first days of the menstrual cycle. The nature of the pain differs depending on the personal characteristics of the woman's body, as well as on the causes of painful menstruation. Algodysmenorrhea syndrome can be a symptom of a more serious disease, therefore, when pathological condition you need to get a consultation in the gynecological office. An individual clinical picture will allow the doctor to prescribe an adequate treatment for a woman or suggest a standard of care for pain during menstruation.

Classification

Algomenorrhea (ICB code 10 - N94.4, N94.5, N94.6, in Latin - algomenorrhea) is one of the most common diseases in gynecology. The disease is classified according to the causes of appearance, which provoke a deterioration in well-being during menstruation. The importance of classification is reflected in the treatment tactics that the gynecologist will take to combat painful periods. Types of pathology:

Primary algomenorrhea . Almost all young gynecological patients know what it is in women. The onset of pain is observed in adolescents during the first year and a half of menstruation. The syndrome develops as a result of psychogenic, endocrine, constitutional disorders. At the same time, there are no signs of organic pathologies of the pelvic organs. Primary dysmenorrhea is not associated with gynecological diseases, but often speaks of other dysfunctions of body systems. This type of disease has a strong association with young girls' individual perceptions of pain.

Secondary algomenorrhea . The form of the disease is directly related to the disruption of work internal organs reproductive system. In this case, pain during menstruation should be considered as a sign of other pathologies. The diagnosis of algomenorrhea of ​​a secondary kind is made after examinations and the determination of the underlying disease. In addition to pain in this form of the disease, there are symptomatic manifestations of a causative anomaly.

Causes of pathology

The pathogenesis of the disease develops under the influence of various factors. Primary and secondary algomenorrhea is caused by different reasons. The first type of pathological pain appears as a result of an increase in the level of prostaglandins in the endometrium. At the same time, the activity of muscle contraction increases, the vessels spasm, and cellular hypoxia begins. Nerve endings are irritated, causing pain. The primary disease is explained by the presence of the following disorders:

1. Mechanical. These include pathological development genitals, incorrect position of the uterine organ. Pain during menstruation can be triggered by the accumulation of blood in the uterine cavity.
2. Hormonal. Characterized by the predominance of estrogen hormones over progesterone.
3. Constitutional. Insufficient development of muscle tissues and their poor stretching as a result of infantilism, asthenic physique.
4. Psychogenic. Algodysmenorrhea is a common disease in women with a weak psyche, vegetative disorders. In women with low pain threshold sensitivity to cramps during menstruation is much higher.

If a secondary pain syndrome is diagnosed during menstruation, it is necessary to determine what kind of disease causes malaise. This type of algomenorrhea is more common in older women. The main causes of pain:

• Endometriosis. In pathology, endometrial tissue extends into the uterus, causing intrauterine contractions. Pain occurs a week before menstruation and stops completely in the middle of the cycle.
• Myoma. Uterine nodules lead to an unhealthy contraction of the muscles, which can continue not only during menstruation, but also in other phases of the cycle.
• Soldering process. Inflammatory fluid (exudate) limits the internal genital organs in mobility, which is why menstruation is accompanied by pain.

Algodysmenorrhea is often detected in female infertility, after abortion, as a result of the placement of the spiral.

Symptoms and signs of the disease

The clinic of the pathological condition is quite characteristic for all variants of the disease. The main symptom of algomenorrhea is pain in the lower abdomen, which can radiate to the lower back, hips, can be felt in the ovaries, uterus, or completely cover the abdominal region.

The type of pain is pulling, cramping, pressing, aching, arching. How intense the pain syndrome depends on the individual state of the body.

In some cases, the course of the disease is complicated: body temperature rises, general weakness, sweating, headaches, dizziness, fainting appear, and physical ability to work is lost. Some women suffer from nausea and vomiting, diarrhea, and bloating. Possible itching of the genital organs, the release of a large amount of blood.

Pain is very intense, which requires an ambulance call medical care with possible hospitalization. Doctors fill out a call card, which indicates personal data and the reason for feeling unwell.

Diagnostics

Diagnosis of patients with algomenorrhea begins with an examination by a gynecologist and anamnesis. By outward signs the doctor determines the type of physique, anomalies in the development of the skeleton, reveals the presence of vascular networks and varicose veins. If there is a history of vegetative-vascular dystonia, mitral canal prolapse, scoliosis and other disorders, this may be due to primary view diseases. After that, the material is taken for analysis in the form of smears, cultures, and the hormonal background is checked.

If organic disorders are suspected, additional diagnostic procedures. Hysteroscopy allows you to assess the condition of the uterine walls, ultrasound makes it possible to determine the structure of internal organs and detect the presence of neoplasms. In rare cases, the examination includes laparoscopy. According to indications, other diagnostic measures are also used.

Treatment of algomenorrhea

How algodysmenorrhea is treated depends on the individual case. For primary and secondary forms are used different methods therapy. Treatment of algomenorrhea of ​​the second type is expressed in getting rid of the underlying disease and symptomatic restoration of working capacity, if the stomach hurts too much during menstruation. How to treat the primary form of pathology:

1. Painkillers and antispasmodics. Analgesics act directly on the muscle tissue of the uterus, which causes a decrease in pain and greatly alleviates the condition during menstruation.
2. Non-steroidal anti-inflammatory drugs. Provide a change in the amount of prostaglandins after their administration. Their level becomes lower, which anesthetizes and improves the general condition. Such drugs can be preventive in nature and taken a few days before menstruation.
3. Oral contraceptives with gestagens. Eliminate the increased amount of estrogens, which can moderate the pain of algomenorrhea.
4. Folk remedies. Recipes for infusions with dandelion, yarrow, eucalyptus flowers can significantly alleviate algomenorrhea.
5. Medicines containing magnesium. Help to deal with functional disorders muscle tissue and resist its intense contractions.
6. Vitamins. Increase immunity, strengthen the body and improve overall health.

Many women are interested in whether the disease can be cured at home. It is recommended to use painkillers, antispasmodic or hormonal drugs from the list only after consulting a doctor. Many agents have unwanted side effects therefore, the treatment regimen should be selected individually. How long the treatment should last and how to relieve pain, the doctor should determine after the tests.

Prevention

Prevention of dysmenorrhea is a healthy active lifestyle, in which the disease is much easier, the absence bad habits. Preventive recommendations include exercising at least a few hours a week, eating healthy foods that affect the normal distribution of hormones in the body. With constitutional primary algomenorrhea, it is important to monitor posture and correct pathological changes in the skeleton in time, treat systemic diseases, control hormonal levels and visit a gynecologist at least once a year.

Bleeding from the genital tract is considered normal, which appears at intervals of 21-35 days and lasts from three to six days. If the regularity or volume changes, then there must be a pathological reason for the cycle to fail. Metrorrhagia is the occurrence of bleeding from the genital tract outside the time of normal menstruation. This symptom can appear at any age - in adolescents, women of reproductive age, during menopause.

The ICD-10 code for metrorrhagia corresponds to several headings. N92 includes profuse, irregular, and frequent menstruation, and N93 other abnormal bleeding from the uterus, which may occur after intercourse (N93.0) or unspecified (N93.8-9).

What is metrorrhagia, causes of pathology

Most common causes metrorrhagia are hormonal disorders, inflammatory diseases and problems with the blood coagulation system. But each age has its own characteristics.

Teenagers

The appearance of bleeding that is not associated with menstruation in adolescents is called juvenile uterine bleeding. Often it is explained by the immaturity of hormonal structures, but groups of factors have been identified that can contribute to the appearance of an unpleasant symptom.

• Antenatal period. During fetal development, the girl's genital organs and several million eggs are laid. Some of them will be atrezed in the future, and the rest will form an ovarian reserve for life. Unlike men, who constantly produce sperm, women do not produce new eggs. Therefore, any negative influences during fetal development can lead to pathology. reproductive system further.
• mental trauma. stress and heavy physical exercise affect the production of hormones along the hypothalamus-pituitary-adrenal cortex chain. This leads to a violation of the secretion of gonadotropic hormones, the persistence of the follicle and a change in the synthesis of sex hormones.
• Hypovitaminosis. It affects the lack of vitamins C, E, K, which leads to fragility of blood vessels, impaired hemostasis and secretion of prostaglandins, as well as a decrease in the process of gluing platelets during the formation of blood clots.
• Infections. In girls with NMC of the type of metrorrhagia, chronic tonsillitis, influenza, acute respiratory infections and other infections are often observed. Tonsillogenic infectious processes have a special effect on the hypothalamic region.
• Increased function of the pituitary gland. The secretion of FSH and LH in girls with bleeding is erratic. The maximum release can occur at intervals of one to eight days, and the concentration is several times higher than that in healthy people. Bleeding at this age is more often anovulatory.
• Blood coagulation disorders. Often this hereditary pathologies hemostasis systems. With them, juvenile bleeding is observed in 65% of cases. Often these are thrombocytopathy, von Willebrand syndrome, idiopathic thrombocytopenic purpura.

Bleeding in adolescents can be of three types:

• hypoestrogenic;
• normoestrogenic;
• hyperestrogenic.

In this case, there are characteristic changes in the ovaries and endometrium on ultrasound. With hypoestrogenism, the thickness of the endometrium is reduced, and small cystic changes in the ovaries. With the hyperestrogenic type, the endometrium can grow up to 2.5 cm, which is much higher than the norm. At this time, cystic formations from 1 to 3.5 cm are visualized in the ovaries.

For potential mothers

Metrorrhagia in the reproductive period may be associated with the following conditions:

• hormonal pathologies;
• tumors;
• pathological conditions of the cervix;
• with pregnancy complications.

Hormonal pathologies include non-inflammatory diseases of the reproductive organs:

• endometrial hyperplasia;
• myoma;
• endometriosis.

At the same time, a state of relative hyperestrogenism is noted. The thickness of the endometrium increases significantly, and in case of malnutrition, bleeding can begin in the middle of the cycle. With endometriosis, the cause of bleeding may be the emptying of endometrioid foci, which form cavities in the body of the uterus.

Dysfunctional bleeding often occurs during the reproductive period. They occur when the hormonal functions of the ovaries are disturbed. Trigger factors can be:

• infection;
• stress;
• injury;
• unfavorable environment;
• metabolic syndrome.

Metrorrhagia usually appears after a long delay in menstruation, sometimes up to three months. The bleeding itself can last up to seven days, is allocated a large number of clotted blood, leading to anemia.

The release of blood during ovulation can be physiological in nature. It is also called "breakthrough" and is explained by a sharp jump in sex hormones. Also, spotting bleeding sometimes appears in women who have started taking combined oral contraceptives. However, it is considered the norm only during the period of adaptation to the drug in the first three months.

Erosion of the cervix may be accompanied by postcoital bleeding. Also, bleeding may appear with endometritis.

A woman may not be aware of her pregnancy at the initial stage. Especially if she has an irregular menstrual cycle, delays often occur. Therefore, metrorrhagia may be associated with miscarriage early term. But even with a diagnosed pregnancy, bleeding from the genital tract speaks in favor of an abortion that has begun.

On the late term metrorrhagia is a sign of bleeding from a placenta previa or detachment of a normally located placenta. This may cause pain in the lower back, lower abdomen. In each of these cases, emergency medical attention is required. The consequences of delay in such a situation are intrauterine fetal death.

Over 45 years old

Climacteric metrorrhagia can be cyclic and acyclic. Its origin may be different:

• organic - associated with the pathology of the cervix, endometrium, myometrium, ovaries or vagina;
• inorganic - in connection with atrophic processes in the endometrium and anovulation;
• iatrogenic - due to taking drugs for replacement therapy;
• extragenital- associated with pathology of other organs.

Metrorrhagia in premenopause is more often associated with endometrial polyps. For women aged 45-55 main reason- endometrial hyperplasia. According to structural changes, it can be without cell atypia and atypical, which can turn into oncology.

Women aged 55-65 account for the peak incidence of endometrial cancer. Therefore, postmenopausal metrorrhagia always makes you think about the tumor.

Pre- and postmenopause are characterized by bleeding against the background of fibroids located submucosally (in the muscular layer of the uterus), myosarcomas. Before menopause, adenomyosis may be the cause. Pathology of the ovaries, cervix, atrophic processes in the vagina lead to metrorrhagia less often.

In postmenopausal women, metrorrhagia often occurs with total absence menstruation and in women not taking hormone replacement therapy.

Diagnostic methods

When examining a teenager, the conversation is conducted with her mother. The doctor pays attention to the course of pregnancy and childbirth, the presence of diabetes, endocrine pathologies that can affect the health of the girl. External examination reveals the following signs that are associated with hypothalamic dysfunction:

• light stretch marks on the skin;
• excessive hair growth;
• hyperpigmentation in the armpits, on the neck and elbows.

Girls are often obese or overweight.

Laboratory studies include:

• blood chemistry- reflects the state of metabolism of proteins, fats and carbohydrates;
• fasting blood glucose- susceptibility to diabetes;
• sex steroids in urine- analysis of hormone metabolism;
• blood hormones - LH, FSH, estriol, progesterone, testosterone, EDGEA, cortisol.

Additionally, TSH, T3 and T4 are examined. Antibodies to thyroid peroxidase are also determined. In some cases, registration of daily rhythms of LH, prolactin, cortisol is used.

Methods instrumental diagnostics for teenagers:

• Ultrasound through the vagina;
• MRI of the pelvis;
• radiograph of the brain;
• osteometry of the hands;

When choosing a diagnostic method in women of reproductive age, the doctor starts from the existing clinical picture. With metrorrhagia caused by an interrupted pregnancy, determination of the level of sex or pituitary hormones is not necessary. In such a situation, general clinical blood tests, ultrasound of the small pelvis are sufficient.

In older women, bleeding can be a symptom of many gynecological diseases. Diagnosis is aimed at establishing not only the cause, but also the place of bleeding: from the uterus, vagina, ovaries, cervix. The following examination methods are used:

• collection of anamnesis;
• assessment of blood loss from words;
• in premenopause, the determination of beta-hCG;
• blood chemistry;
• general blood analysis;
• coagulogram;
• hormones: LH, FSH, estriol, progesterone;
• thyroid hormones;
• markers CA-125, CA-199;
• Ultrasound of the small pelvis transvaginally;
• Doppler mapping;
• MRI of the pelvis;
• smear for oncocytology;
• endometrial biopsy;
• hysteroscopy;
• separate diagnostic curettage.

It is not necessary for every woman to use the entire list of diagnostic techniques. Some of them are performed when indicated.

Tactics for choosing therapy

Treatment of metrorrhagia depends on the age of the patient, her general condition and causes of bleeding. Therapeutic measures can be conservative and surgical.

For young girls

AT adolescence more often resort to conservative hemostatic therapy during the bleeding present at the time of treatment. For this, combined hormonal contraceptives are used, but they are not taken one tablet per day, but according to a certain scheme, which can include from four tablets per day. To avoid recurrence of bleeding, COCs continue to be used even after it has stopped, but already in the usual mode.

Curettage of the uterine cavity in girls is not used. Manipulation is allowed only in case of severe endometrial hyperplasia or polyp. In this case, the hymen is cut off with lidase, and all manipulations are carried out with special children's mirrors.

In mature women

To properly stop bleeding, the main thing is to identify the cause. If it's an abortion or dysfunctional uterine bleeding, endometrial hyperplasia, then the main method of treatment is curettage.

Drugs to stop bleeding can also be used:

• "Dicinon";
• aminocaproic acid;
• calcium gluconate.

Hormonal hemostasis is rarely used, only in women under 30 with minor bleeding due to ovarian dysfunction. Subsequently, they are recommended to take monophasic hormonal contraceptives Yarina, Janine, Marvelon.

Against the background of existing endometriosis and fibroids, as well as endometrial hyperplasia, women who do not plan children in the coming years are recommended to install the Mirena hormonal system.

Removal of the uterus as a method of stopping bleeding in reproductive age is used extremely rarely. Usually only when combined with fibroids, severe endometriosis, with pronounced contraindications to hormonal therapy.

During the menopause

The first step in treatment is to stop bleeding. For this, curettage, hysteroscopy, resectoscopy are used. In severe cases, especially if there is oncology, a hysterectomy is performed.

Treatment tactics

Treatment goals: timely diagnosis menstrual irregularities (NMC), taking into account the classification and age factor, etiology; identification of complications (secondary anemia, infertility, etc.).

It is necessary to exclude the organic genesis of NMC, and then examine the hormonal status of the patient in order to determine the level of damage. In parallel, symptomatic therapy, hormonal hemostasis is carried out (A). In the presence of signs of inflammation, an infectious lesion should be excluded. If there is an IUD in the uterine cavity, remove it. In the absence of the effect of conservative therapy, recurrence of the disease, therapeutic and diagnostic curettage of the endometrium with histological examination(C). For perimenopausal bleeding, endometrial ablation (A).

Indications for curettage of the uterine cavity:

Prolonged bleeding with metrorrhagia;

The woman's age is over 35;

In women under 35 years of age with the ineffectiveness of conservative therapy for up to 3 days.

Non-drug treatment

A diet rich in proteins and vitamins fractional nutrition. Limitation of physical activity (increased rest time). Physiotherapy: endonasal electrophoresis with Ca ++, collar according to Shcherbak. Phytotherapy (decoctions of nettle, shepherd's purse).

Medical treatment:

Etamzilat 250 mg x 2-3 times a day for 2-3 days;

NSAIDs (non-acetylsalicylic acid), mefenamic acid, naproxen, tolfenamic acid, ibuprofen;

Combined oral contraceptives (Regulon, Novinet) and transdermal therapeutic system (contraceptive patch);

Combined hormone therapy estrogen (for example, estradiol at a dose of 1 mg) and progestin for 7-10 days leads to the cessation of dysfunctional bleeding, however, such treatment has no effect on bleeding caused by organic causes. Immediately after discontinuation hormonal drugs“withdrawal bleeding” occurs, about which the patient should be warned in advance;

Treatment continues with cyclic progestins (norethisterone 5 mg x 3 times a day; linestrol 10 mg x 2 times a day) in a cyclic mode from 15 to 25 days of the menstrual cycle;

Menadione sodium bisulfide 0.0015 mg x 3 times a day, 3-5 days;

Oxytocin 5 IU / m x 2-3 times a day, 3-5 days;

In the absence of effect up to 3 days and moderate spotting, with endometrial hyperplasia - ethinyl etraradiol 30 mcg + desogestrel 150 mcg according to the scheme.

Preventive actions(prevention of complications):

1. Prevention of infectious complications.

2. Prevention of relapses.

3. Preservation of reproductive function.

Further management:

1. Observation in the antenatal clinic.

2. Symptomatic therapy.

CLASS XIV. DISEASES OF THE URINARY SYSTEM (N00-N99)

This class contains the following blocks:
N00-N08 Glomerular diseases
N10-N16 Tubulointerstitial kidney disease
N17-N19 kidney failure
N20-N23 Urolithiasis disease
N25-N29 Other diseases of the kidney and ureter
N30-N39 Other diseases of the urinary system
N40-N51 Diseases of the male genital organs
N60-N64 Diseases of the mammary gland
N70-N77 Inflammatory diseases of the female pelvic organs
N80-N98 Non-inflammatory diseases of the female genital organs
N99 Other disorders of the genitourinary system

The following categories are marked with an asterisk:
N08* Glomerular lesions in diseases classified elsewhere
N16* Tubulointerstitial lesions of the kidneys in diseases classified elsewhere
N22* Urinary tract stones in diseases classified elsewhere
N29* Other disorders of the kidney and ureter in diseases classified elsewhere
N33* Defeats Bladder in diseases classified elsewhere
N37* Disorders of the ureter in diseases classified elsewhere
N51* Disorders of the male genital organs in diseases classified elsewhere
N74* Inflammatory lesions of the pelvic organs in women with diseases classified elsewhere
N77* Ulceration and inflammation of the vulva and vagina in diseases classified elsewhere

GLOMERULAR DISEASES (N00-N08)

If necessary, identify an external cause (Class XX) or if renal failure is present ( N17-N19) use two's complement code.

Excludes: hypertension with primary renal involvement ( I12. -)

Rubrics N00-N07 the following fourth characters classifying morphological changes may be used. Subcategories.0-.8 should not be used unless specific investigations have been performed to identify the lesions (eg, biopsy or autopsy of the kidneys). Three-digit rubrics are based on clinical syndromes.

0 Minor glomerular disorders. Minimum Damage
.1 Focal and segmental glomerular lesions
Focal and segmental:
hyalinosis
sclerosis
Focal glomerulonephritis
.2 Diffuse membranous glomerulonephritis
.3 Diffuse mesangial proliferative glomerulonephritis
.4 Diffuse endocapillary proliferative glomerulonephritis
.5 Diffuse mesangiocapillary glomerulonephritis. Membranoproliferative glomerulonephritis (type 1 and 3 or NOS)
.6 Dense sludge disease. Membranoproliferative glomerulonephritis (type 2)
.7 Diffuse crescentic glomerulonephritis. Extracapillary glomerulonephritis
.8 Other changes. Proliferative glomerulonephritis NOS
.9 unspecified change

N00 Acute nephritic syndrome

Included: acute:
glomerular disease
glomerulonephritis
nephritis
kidney disease NOS
Excludes: acute tubulointerstitial nephritis ( N10)
nephritic syndrome NOS ( N05. -)

N01 Rapidly progressive nephritic syndrome

Included: rapidly progressive(s):
glomerular disease
glomerulonephritis
nephritis
Excludes: nephritic syndrome NOS ( N05. -)

N02 Recurrent and persistent hematuria

Includes: hematuria:
benign (familial) (children's)
with a morphological lesion specified in c.0-.8
Excludes: hematuria NOS ( R31)

N03 Chronic nephritic syndrome

Included: chronic(s):
glomerular disease
glomerulonephritis
nephritis
kidney disease NOS
Excludes: chronic tubulointerstitial nephritis ( N11. -)
N18. -)
nephritic syndrome NOS ( N05. -)

N04 Nephrotic syndrome

Includes: congenital nephrotic syndrome
lipoid nephrosis

N05 Nephritic syndrome, unspecified

Includes: glomerular disease)
glomerulonephritis) NOS
jade)
nephropathy NOS and renal disease NOS with morphological lesion specified in c.0-.8
Excludes: nephropathy NOS of unknown cause ( N28.9)
kidney disease NOS of unknown cause ( N28.9)
tubulointerstitial nephritis NOS ( N12)

N06 Isolated proteinuria with specified morphological lesion

Includes: proteinuria (isolated) (orthostatic)
(persistent) with morphological lesion specified
v.0-.8
Excludes: proteinuria:
NOS ( R80)
Bence-Jones ( R80)
caused by pregnancy O12.1)
isolated NOS ( R80)
orthostatic NOS ( N39.2)
persistent NOS ( N39.1)

N07 Hereditary nephropathy, not elsewhere classified

Excludes: Alport syndrome ( Q87.8)
hereditary amyloid nephropathy ( E85.0)
syndrome (absence) (underdevelopment) of the nail-patella ( Q87.2)
hereditary familial amyloidosis without neuropathy ( E85.0)

N08* Glomerular lesions in diseases classified elsewhere

Includes: nephropathy in diseases classified elsewhere
Excludes: renal tubulointerstitial lesions in diseases classified elsewhere ( N16. -*)

Includes: pyelonephritis
Excludes: cystic pyeloureteritis ( N28.8)

N10 Acute tubulointerstitial nephritis

Spicy:

pyelitis
pyelonephritis
B95-B97).

N11 Chronic tubulointerstitial nephritis

Included: chronic:
infectious interstitial nephritis
pyelitis
pyelonephritis
B95-B97).

N11.0 Non-obstructive chronic pyelonephritis associated with reflux
Pyelonephritis (chronic) associated with (vesicoureteral) reflux
Excludes: vesicoureteral reflux NOS ( N13.7)
N11.1 Chronic obstructive pyelonephritis
Pyelonephritis (chronic) associated with:
anomaly) (pelvic-ureteral
inflection) (connections
obstruction) (pelvic segment of the ureter
structure) (ureter
Excludes: calculous pyelonephritis ( N20.9)
obstructive uropathy ( N13. -)
N11.8 Other chronic tubulointerstitial nephritis
Non-obstructive chronic pyelonephritis NOS
N11.9 Chronic tubulointerstitial nephritis, unspecified
Chronic:
interstitial nephritis NOS
pyelitis NOS
pyelonephritis NOS

N12 Tubulointerstitial nephritis, not specified as acute or chronic

Interstitial nephritis NOS
Pyelitis NOS
Pyelonephritis NOS
Excludes: calculous pyelonephritis ( N20.9)

N13 Obstructive uropathy and reflux uropathy

Excludes: kidney and ureteral stones without hydronephrosis ( N20. -)
congenital obstructive changes in the renal pelvis and ureter ( Q62.0-Q62.3)
obstructive pyelonephritis ( N11.1)

N13.0 Hydronephrosis with ureteropelvic junction obstruction
Excluded: with infection ( N13.6)
N13.1 Hydronephrosis with ureteral stricture, not elsewhere classified
Excluded: with infection ( N13.6)
N13.2 Hydronephrosis with obstruction of the kidney and ureter by a stone
Excluded: with infection ( N13.6)
N13.3 Other and unspecified hydronephrosis
Excludes: with infection ( N13.6)
N13.4 Hydroureter
Excluded: with infection ( N13.6)
N13.5 Kinking and stricture of the ureter without hydronephrosis
Excludes: with infection ( N13.6)
N13.6 pyonephrosis
Conditions listed under headings N13.0-N13.5, with infection. Obstructive uropathy with infection
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N13.7 Uropathy due to vesicoureteral reflux
Vesicoureteral reflux:
NOS
with scarring
Excludes: pyelonephritis associated with vesicoureteral reflux ( N11.0)
N13.8 Other obstructive uropathy and reflux uropathy
N13.9 Obstructive uropathy and reflux uropathy, unspecified. Urinary tract obstruction NOS

N14 Tubulointerstitial and tubular lesions due to drugs and heavy metals

Use an additional code if necessary to identify the toxic substance. external causes(class XX).

N14.0 Nephropathy caused by analgesics
N14.1 Nephropathy caused by others medicines, medicines or biologically active substances
N14.2 Nephropathy due to unspecified drug, medicament and biologically active substance
N14.3 Heavy metal nephropathy
N14.4 Toxic nephropathy, not elsewhere classified

N15 Other tubulointerstitial kidney diseases

N15.0 Balkan nephropathy. Balkan endemic nephropathy
N15.1 Abscess of the kidney and perirenal tissue
N15.8 Other specified tubulointerstitial lesions of the kidneys
N15.9 Tubulointerstitial kidney disease, unspecified. Kidney infection NOS
Excludes: urinary tract infection NOS ( N39.0)

N16* Tubulointerstitial disorders of the kidneys in diseases classified elsewhere

leukemia ( C91-C95+)
lymphoma ( C81-C85+, C96. -+)
multiple myeloma ( C90.0+)
N16.2* Tubulointerstitial kidney disease in blood diseases and disorders involving the immune mechanism
Tubulointerstitial kidney disease in:
mixed cryoglobulinemia ( D89.1+)
sarcoidosis ( D86. -+)
N16.3* Tubulointerstitial kidney damage in metabolic disorders
Tubulointerstitial kidney disease in:
cystinosis ( E72.0+)
glycogen storage diseases E74.0+)
Wilson's disease ( E83.0+)
N16.4* Tubulointerstitial kidney damage in systemic connective tissue diseases
Tubulointerstitial kidney disease in:
dry syndrome [Sjögren] ( M35.0+)
systemic lupus erythematosus ( M32.1+)
N16.5* Tubulointerstitial kidney damage in graft rejection ( T86. -+)
N16.8* Tubulointerstitial kidney disease in other diseases classified elsewhere

RENAL INSUFFICIENCY (N17-N19)

If it is necessary to identify the external agent, an additional external cause code (class XX) is used.

Excludes: congenital kidney failure (P96.0)
tubulointerstitial and tubular lesions caused by drugs and heavy metals ( N14. -)
extrarenal uremia ( R39.2)
hemolytic-uremic syndrome ( D59.3)
hepatorenal syndrome ( K76.7)
postpartum ( O90.4)
prerenal uremia ( R39.2)
kidney failure:
complicating abortion, ectopic or molar pregnancy ( O00-O07, O08.4)
after childbirth and delivery O90.4)
after medical procedures N99.0)

N17 Acute renal failure

N17.0 Acute renal failure with tubular necrosis
tubular necrosis:
NOS
spicy
N17.1 Acute renal failure with acute cortical necrosis
Cortical necrosis:
NOS
spicy
renal
N17.2 Acute renal failure with medullary necrosis
Medullary (papillary) necrosis:
NOS
spicy
renal
N17.8 Other acute renal failure
N17.9 Acute renal failure, unspecified

N18 Chronic renal failure

Includes: chronic uremia, diffuse sclerosing glomerulonephritis
Excludes: chronic renal failure with hypertension I12.0)

N18.0 End-stage kidney disease
N18.8 Other manifestations of chronic renal failure
Uremic neuropathy+ ( G63.8*)
Uremic pericarditis+ ( I32.8*)
N18.9 Chronic renal failure, unspecified

N19 Renal failure, unspecified

Uremia NOS
Excludes: renal failure with hypertension ( I12.0)
uremia of the newborn P96.0)

STONE STONES (N20-N23)

N20 Kidney and ureter stones

Excludes: with hydronephrosis ( N13.2)

N20.0 Kidney stones. Nephrolithiasis NOS. Stones or stones in the kidney. Coral stones. kidney stone
N20.1 Stones of the ureter. Stone in the ureter
N20.2 Kidney stones with ureteral stones
N20.9 urinary stones unspecified. Calculous pyelonephritis

N21 Lower urinary tract stones

Includes: with cystitis and urethritis

N21.0 Stones in the bladder. Stones in the bladder diverticulum. bladder stone
Excludes: staghorn calculi ( N20.0)
N21.1 Stones in the urethra
N21.8 Other stones in the lower urinary tract
N21.9 Stones in lower urinary tract, unspecified

N22* Stones of the urinary tract in diseases classified elsewhere

N22.0* Urinary stones in schistosomiasis [bilharzia] ( B65. -+)
N22.8* Urinary tract stones in other diseases classified elsewhere

N23 Renal colic, unspecified

OTHER DISEASES OF THE KIDNEY AND URETER (N25-N29)

Excluded: with urolithiasis (N20-N23)

N25 Disorders resulting from renal tubular dysfunction

Excludes: metabolic disorders classified under headings E70-E90

N25.0 Renal osteodystrophy. Azotemic osteodystrophy. Tubular disorders associated with phosphate loss
Renal(th):
rickets
dwarfism
N25.1 Nephrogenic diabetes insipidus
N25.8 Other disorders due to renal tubular dysfunction
Lightwood-Albright Syndrome. Renal tubular acidosis NOS. Secondary hyperparathyroidism of renal origin
N25.9 Dysfunction of the renal tubules, refined

N26 Shriveled kidney, unspecified

Kidney atrophy (terminal). Renal sclerosis NOS
Excludes: shriveled kidney with hypertension ( I12. -)
diffuse sclerosing glomerulonephritis ( N18. -)
hypertensive nephrosclerosis (arteriolar) (arteriosclerotic) ( I12. -)
small kidney for unknown reason ( N27. -)

N27 Small kidney of unknown origin

N27.0 Small kidney unilateral
N27.1 Small kidney bilateral
N27.9 Small kidney, unspecified

N28 Other diseases of kidney and ureter, not elsewhere classified

Excludes: hydroureter ( N13.4)
kidney disease:
acute NOS ( N00.9)
chronic NOS ( N03.9)
kink and stricture of the ureter:
with hydronephrosis ( N13.1)
without hydronephrosis ( N13.5)

N28.0 Ischemia or infarction of the kidney
Renal artery:
embolism
obstruction
occlusion
thrombosis
Kidney infarction
Excludes: Goldblatt's kidney ( I70.1)
renal artery (extrarenal part):
atherosclerosis ( I70.1)
congenital stenosis ( Q27.1)
N28.1 Acquired kidney cyst. Cyst (multiple) (single) kidney acquired
Excludes: cystic kidney disease (congenital) ( Q61. -)
N28.8 Other specified diseases of the kidneys and ureter. kidney hypertrophy. Megaloureter. Nephroptosis
pyelitis)
Pyeloureteritis (cystic)
ureteritis)
ureterocele
N28.9 Diseases of the kidney and ureter, unspecified. Nephropathy NOS. Renal disease NOS
Excludes: nephropathy NOS and renal disorders NOS with morphological lesions specified in .0-.8 ( N05. -)

N29* Other disorders of kidney and ureter in diseases classified elsewhere

OTHER DISEASES OF THE URINARY SYSTEM (N30-N39)

Excludes: urinary tract infection (complicating):
O00 -O07 , O08.8 )
O23 . — , O75.3 , O86.2 )
with urolithiasis N20-N23)

N30 Cystitis

If necessary, identify the infectious agent ( B95-B97) or corresponding external factor(class XX) use additional code.
Excluded: prostatocystitis ( N41.3)

N30.0 Acute cystitis
Excludes: radiation cystitis ( N30.4)
trigonite ( N30.3)
N30.1 Interstitial cystitis (chronic)
N30.2 Other chronic cystitis
N30.3 Trigonite. Urethrotrigonitis
N30.4 Radiation cystitis
N30.8 other cystitis. Bladder abscess
N30.9 Cystitis, unspecified

N31 Neuromuscular dysfunction of bladder, not elsewhere classified

Excludes: spinal bladder NOS ( G95.8)
due to defeat spinal cord (G95.8)
neurogenic bladder associated with cauda equina syndrome ( G83.4)
urinary incontinence:
NOS ( R32)
specified ( N39.3-N39.4)

N31.0 Uninhibited bladder, not elsewhere classified
N31.1 Reflex bladder, not elsewhere classified
N31.2 Neurogenic bladder weakness, not elsewhere classified
Neurogenic bladder:
atonic (motor disturbances) (sensory disturbances)
autonomous
non-reflex
N31.8 Other neuromuscular bladder dysfunctions
N31.9 Neuromuscular dysfunction of bladder, unspecified

N32 Other disorders of bladder

Excludes: bladder stone ( N21.0)
cystocele ( N81.1)
hernia or prolapse of the bladder in women ( N81.1)

N32.0 Obturation of the bladder neck. Bladder neck stenosis (acquired)
N32.1 Vesico-intestinal fistula. Vesicocolonic fistula
N32.2 Vesical fistula, not elsewhere classified
Excludes: fistula between bladder and female genital tract N82.0-N82.1)
N32.3 Bladder diverticulum. Bladder diverticulitis
Excludes: bladder diverticulum stone N21.0)
N32.4 Bladder rupture non-traumatic
N32.8 Other specified lesions of the bladder
Bladder:
calcified
wrinkled
N32.9 Bladder disorder, unspecified

N33* Bladder disorders in diseases classified elsewhere

N33.0* Tuberculous cystitis ( A18.1+)
N33.8* Bladder disorders in other diseases classified elsewhere
Bladder lesions in schistosomiasis [bilharzia] ( B65. -+)

N34 Urethritis and urethral syndrome

If necessary, identify the infectious agent
use additional code ( B95-B97).
Excludes: Reiter's disease ( M02.3)
urethritis in diseases transmitted predominantly sexually ( A50-A64)
urethrotrigonitis ( N30.3)

N34.0 urethral abscess
Abscess:
Cooper's glands
Littre's glands
periurethral
urethral (glands)
Excludes: urethral caruncle ( N36.2)
N34.1 Nonspecific urethritis
Urethritis:
non-gonococcal
non-venereal
N34.2 Other urethritis. Urethral meatitis. Ulcer of the urethra (external opening)
Urethritis:
NOS
postmenopausal
N34.3 Urethral syndrome, unspecified

N35 Urethral stricture

Excludes: urethral stricture after medical procedures ( N99.1)

N35.0 Post-traumatic stricture of the urethra
Urethral stricture:
postpartum
traumatic
N35.1 Postinfectious stricture of the urethra, not elsewhere classified
N35.8 Other urethral stricture
N35.9 Urethral stricture, unspecified. Outer opening NOS

N36 Other disorders of urethra

N36.0 Urethral fistula. False urethral fistula
Fistula:
urethroperineal
urethrorectal
urinary NOS
Excludes: fistula:
urethroscrotal ( N50.8)
urethrovaginal ( N82.1)
N36.1 Urethral diverticulum
N36.2 Urethral caruncle
N36.3 Prolapse of the mucous membrane of the urethra. Prolapse of the urethra. Urertocele in men
Excludes: female urethrocele N81.0)
N36.8 Other specified diseases of the urethra
N36.9 Disease of urethra, unspecified

N37* Urethral disorders in diseases classified elsewhere

N37.0* Urethritis in diseases classified elsewhere. candidal urethritis ( B37.4+)
N37.8* Other disorders of the urethra in diseases classified elsewhere

N39 Other diseases of the urinary system

Excludes: hematuria:
NOS ( R31)
recurrent and persistent N02. -)
N02. -)
proteinuria NOS ( R80)

N39.0 Urinary tract infection without established localization
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N39.1 Persistent proteinuria, unspecified
Excludes: complicating pregnancy, childbirth and the puerperium ( O11-O15)
with refined morphological changes ( N06. -)
N39.2 Orthostatic proteinuria, unspecified
Excluded: with specified morphological changes ( N06. -)
N39.3 Involuntary urination
N39.4 Other specified types of urinary incontinence
overflow)
reflex) urinary incontinence
upon awakening)
Excludes: enuresis NOS ( R32)
urinary incontinence:
NOS ( R32)
inorganic origin ( F98.0)
N39.8 Other specified diseases of the urinary system
N39.9 Urinary tract disorder, unspecified

DISEASES OF THE MALE GENITAL ORGANS (N40-N51)

N40 Prostatic hyperplasia

adenofibromatous hypertrophy)
Adenoma (benign)
Enlargement (benign) of the prostate
Fibroadenoma) glands
fibroma)
Hypertrophy (benign)
Myoma
Adenoma of the median lobe (prostate)
Obstruction of prostate duct NOS
Excluded: benign tumors, except adenoma, fibroma
and prostate fibroids D29.1)

N41 Inflammatory diseases of the prostate

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N41.0 Acute prostatitis
N41.1 Chronic prostatitis
N41.2 prostate abscess
N41.3 Prostatocystitis
N41.8 Other inflammatory diseases of the prostate
N41.9 Inflammatory disease of the prostate gland, unspecified. Prostatitis NOS

N42 Other diseases of the prostate

N42.0 Prostate stones. prostatic stone
N42.1 Stagnation and hemorrhage in the prostate gland
N42.2 prostate atrophy
N42.8 Other specified diseases of the prostate
N42.9 Prostate disease, unspecified

N43 Hydrocele and spermatocele

Includes: dropsy of spermatic cord, testicle, or testicular sheath
Excludes: congenital hydrocele ( P83.5)

N43.0 Hydrocele encysted
N43.1 Infected hydrocele
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N43.2 Other forms of hydrocele
N43.3 Hydrocele, unspecified
N43.4 Spermatocele

N44 Testicular torsion

Twisting:
epididymis
spermatic cord
testicles

N45 Orchitis and epididymitis

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N45.0 Orchitis, epididymitis and epididymo-orchitis with abscess. Abscess of the epididymis or testis
N45.9 Orchitis, epididymitis and epididymo-orchitis without mention of an abscess. Epididymitis NOS. Orchitis NOS

N46 Male infertility

Azoospermia NOS. Oligospermia NOS

N47 Excessive foreskin, phimosis and paraphimosis

close-fitting foreskin. tight foreskin

N48 Other disorders of the penis

N48.0 Leukoplakia of the penis. Kraurosis of the penis
Excludes: carcinoma in situ of the penis ( D07.4)
N48.1 Balanoposthitis. Balanitis
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N48.2 Other inflammatory diseases of the penis
abscess)
Furuncle)
Carbuncle) cavernous body and penis
cellulite)
Cavernitis of the penis
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
N48.3 Priapism. painful erection
N48.4 Impotence of organic origin
Use an additional code if necessary to identify the cause.
Excludes: psychogenic impotence ( F52.2)
N48.5 ulcer of the penis
N48.6 Balanitis. Plastic induration of the penis
N48.8 Other specific diseases of the penis
atrophy)
Hypertrophy) of the cavernous body and penis
thrombosis)
N48.9 Disease of the penis, unspecified

N49 Inflammatory diseases of the male genital organs, not elsewhere classified

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
Excludes: inflammation of the penis ( N48.1-N48.2)
orchitis and epididymitis ( N45. -)

N49.0 Inflammatory diseases of the seminal vesicle. Vesiculitis NOS
N49.1 Inflammatory diseases of the spermatic cord, vaginal membrane and vas deferens. Vazit
N49.2 Inflammatory diseases of the scrotum
N49.8 Inflammatory diseases of other specified male reproductive organs
N49.9 Inflammatory diseases of unspecified male genital organ
abscess)
Furuncle) unspecified male
carbuncle) penis
cellulite)

N50 Other diseases of male genital organs

Excludes: testicular torsion ( N44)

N50.0 testicular atrophy
N50.1 Vascular disorders of the male genital organs
Hematocele)
Hemorrhage) male reproductive organs
thrombosis)
N50.8 Other specific diseases of the male genital organs
atrophy)
Hypertrophy) seminal vesicle, spermatic cord,
Edema - testicles [except for atrophy], vaginal ulcer - vulva and vas deferens
Chylocele vaginalis (nonfilarial) NOS
Fistula urethroscrotal
Structure:
spermatic cord
vaginal membrane
vas deferens
N50.9 Disease of the male genital organs, unspecified

N51* Disorders of the male genital organs in diseases classified elsewhere

N51.0* Disorders of the prostate gland in diseases classified elsewhere
Prostatitis:
gonococcal ( A54.2+)
caused by Trichomonas A59.0+)
tuberculosis ( A18.1+)
N51.1* Affections of the testis and its appendages in diseases classified elsewhere
Chlamydial:
epididymitis ( A56.1+)
orchitis ( A56.1+)
Gonococcal:
epididymitis ( A54.2+)
orsite ( A54.2+)
mumps orchitis ( B26.0+)
Tuberculosis:

• epididymis ( A18.1+)

• testicles ( A18.1+)

N51.2* Balanitis in diseases classified elsewhere
Balanitis:
amoebic ( A06.8+)
candidiasis ( B37.4+)
N51.8* Other disorders of the male genital organs in diseases classified elsewhere
Filarious chylocele of the vaginal membrane ( B74. -+)
Herpes infection of the male genital organs A60.0+)
Tuberculosis of seminal vesicles ( A18.1+)

BREAST DISEASES (N60-N64)

Excludes: breast disease associated with childbearing ( O91-O92)

N60 Benign breast dysplasia
Includes: fibrocystic mastopathy
N60.0 Solitary cyst of the mammary gland. breast cyst
N60.1 Diffuse cystic mastopathy. cystic mammary gland
Excludes: with proliferation of epithelium ( N60.3)
N60.2 Fibroadenosis of the mammary gland
Excludes: breast fibroadenoma ( D24)
N60.3 Fibrosclerosis of the mammary gland. Cystic mastopathy with epithelial proliferation
N60.4 Ectasia of the mammary ducts
N60.8 Other benign breast dysplasias
N60.9 Benign dysplasia of mammary gland, unspecified

N61 Inflammatory diseases of the mammary gland

Abscess (acute) (chronic) (not postpartum):
areola
mammary gland
Breast carbuncle
Mastitis (acute) (subacute) (not postpartum):
NOS
infectious
Excludes: infectious mastitis of the newborn ( P39.0)

N62 Breast hypertrophy

Gynecomastia
Breast hypertrophy:
NOS
massive puberty

N63 Mass in mammary gland, unspecified

Nodule(s) in breast NOS

N64 Other disorders of breast

N64.0 Fissure and fistula of the nipple
N64.1 Fatty necrosis of the mammary gland. Fat necrosis (segmental) of the breast
N64.2 Atrophy of the mammary gland
N64.3 Galactorrhea not associated with childbearing
N64.4 Mammalgia
N64.5 Other signs and symptoms of the breast. Breast induration. Discharge from the nipple
inverted nipple
N64.8 Other specified diseases of the breast. Galactocele. Subinvolution of the mammary gland (post-lactational)
N64.9 Breast disease, unspecified

INFLAMMATORY DISEASES OF THE FEMALE PELVIC ORGANS (N70-N77)

Excluded: complicating:
abortion, ectopic or molar pregnancy ( O00 -O07 , O08.0 )
pregnancy, childbirth and the postpartum period O23. — ,O75.3 , O85 , O86 . -)

N70 Salpingitis and oophoritis

Included: abscess:
fallopian tube
ovary
tubo-ovarian
pyosalpinx
salpingoophoritis
tubo-ovarian inflammatory disease
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N70.0 Acute salpingitis and oophoritis
N70.1 Chronic salpingitis and oophoritis. hydrosalpinx
N70.9 Salpingitis and oophoritis, unspecified

N71 Inflammatory diseases of uterus other than cervix

Includes: endo(myo)metritis
metritis
myometritis
pyometra
uterine abscess
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N71.0 Acute inflammatory disease of the uterus
N71.1 Chronic inflammatory disease of the uterus
N71.9 Inflammatory disease of uterus, unspecified

N72 Inflammatory disease of cervix

cervicitis)
Endocervicitis) with or without erosion or ectropion
exocervicitis)
If necessary, identify the infectious agent
use additional code ( B95-B97).
Excludes: erosion and ectropion of the cervix without cervicitis ( N86)

N73 Other inflammatory diseases of female pelvic organs

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

N73.0 Acute parametritis and pelvic cellulitis
Abscess:
broad ligament ) specified as
parametrium) acute
Pelvic phlegmon in women)
N73.1 Chronic parametritis and pelvic cellulitis
N73.0, specified as chronic
N73.2 Parametritis and pelvic phlegmon, unspecified
Any state in a subheading N73.0, not specified as acute or chronic
N73.3 Acute pelvic peritonitis in women
N73.4 Chronic pelvic peritonitis in women
N73.5 Pelvic peritonitis in women, unspecified
N73.6 Pelvic peritoneal adhesions in women
Excludes: pelvic peritoneal adhesions in women postoperative ( N99.4)
N73.8 Other specified inflammatory diseases of female pelvic organs
N73.9 Inflammatory diseases of female pelvic organs, unspecified
Infectious or inflammatory diseases of female pelvic organs NOS

N74* Inflammatory diseases of female pelvic organs in diseases classified elsewhere

N74.0* Tuberculous infection of the cervix ( A18.1+)
N74.1* Inflammatory diseases of the female pelvic organs of tuberculous etiology ( A18.1+)
Tuberculous endometritis
N74.2* Inflammatory diseases of the female pelvic organs caused by syphilis ( A51.4+, A52.7+)
N74.3* Gonococcal inflammatory diseases of the female pelvic organs ( A54.2+)
N74.4* Inflammatory diseases of the female pelvic organs caused by chlamydia ( A56.1+)
N74.8* Pelvic inflammatory disease in other diseases classified elsewhere

N75 Diseases of Bartholin's gland

N75.0 Bartholin gland cyst
N75.1 Bartholin gland abscess
N75.8 Other diseases of the Bartholin's gland. Bartholinitis
N75.9 Bartholin gland disease, unspecified

N76 Other inflammatory diseases of the vagina and vulva

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
Excludes: senile (atrophic) vaginitis ( N95.2)

N76.0 Acute vaginitis. Vaginitis NOS
Vulvovaginitis:
NOS
spicy
N76.1 Subacute and chronic vaginitis

Vulvovaginitis:
chronic
subacute
N76.2 Acute vulvitis. Vulvit NOS
N76.3 Subacute and chronic vulvitis
N76.4 Abscess of the vulva. Furuncle of the vulva
N76.5 Vaginal ulceration
N76.6 Ulceration of the vulva
T76.8 Other specified inflammatory diseases of the vagina and vulva

N77* Ulceration and inflammation of the vulva and vagina in diseases classified elsewhere

NON-INFLAMMATORY DISEASES OF THE FEMALE GENITAL ORGANS (N80-N98)

N80 Endometriosis

N80.0 Endometriosis of the uterus. Adenomyosis
N80.1 ovarian endometriosis
N80.2 Fallopian tube endometriosis
N80.3 Endometriosis of the pelvic peritoneum
N80.4 Endometriosis of the rectovaginal septum and vagina
N80.5 intestinal endometriosis
N80.6 Skin scar endometriosis
N80.8 Other endometriosis
N80.9 Endometriosis, unspecified

N81 Female genital prolapse

Excludes: genital prolapse complicating pregnancy, childbirth or delivery ( O34.5)
prolapse and hernia of the ovary and fallopian tube ( N83.4)
prolapse of the stump (vault) of the vagina after hysterectomy ( N99.3)

N81.0 urethrocele in women

Excludes: urethrocele with:
cystocele ( N81.1)
uterine prolapse ( N81.2-N81.4)
N81.1 Cystocele. Cystocele with urethrocele. Prolapse of wall (anterior) of vagina NOS
Excludes: cystotele with uterine prolapse ( N81.2-N81.4)
N81.2 Incomplete prolapse of the uterus and vagina. Cervical prolapse NOS
Vaginal prolapse:
first degree
second degree
N81.3 Complete prolapse of the uterus and vagina. Prosidence (uterus) NOS. Third degree uterine prolapse
N81.4 Prolapse of uterus and vagina, unspecified. Uterine prolapse NOS
N81.5 Vaginal enterocele
Excludes: enterocele with uterine prolapse ( N81.2-N81.4)
N81.6 Rectocele. Prolapse of the posterior wall of the vagina
Excludes: rectal prolapse ( K62.3)
rectocele with uterine prolapse N81.2-N81.4)
N81.8 Other forms of female genital prolapse. Insufficiency of the pelvic floor muscles
old ruptured pelvic floor muscles
N81.9 Prolapse of female genital organs, unspecified

N82 Fistulas involving female genital organs

Excludes: vesico-intestinal fistula ( N32.1)

N82.0 Vesico-vaginal fistula
N82.1 Other fistulas of the female urinary tract
Fistulas:
cervical-vesical
ureterovaginal
urethrovaginal
uteroureteral
utero-vesical
N82.2 Fistula vaginal-intestinal
N82.3 Fistula vaginal-colonic. Rectovaginal fistula
N82.4 Other enterogenital fistulas in women. Intestinal fistula
N82.5 Fistulas genital-skin in women

Fistula:
utero-abdominal
vagina-perineal
N82.8 Other fistulas of the female genital organs
N82.9 Fistula of female genital organs, unspecified

N83 Non-inflammatory lesions of ovary, fallopian tube and broad ligament of uterus

Excluded: hydrosalpinx ( N70.1)

N83.0 Follicular ovarian cyst. Graafian follicle cyst. Hemorrhagic follicular cyst (of the ovary)
N83.1 Cyst corpus luteum. Hemorrhagic cyst of the corpus luteum
N83.2 Other and unspecified ovarian cysts
retention cyst)
Simple cyst) of the ovary
Excludes: ovarian cyst:
associated with a developmental anomaly Q50.1)
neoplastic ( D27)
polycystic ovary syndrome ( E28.2)
N83.3 Acquired atrophy of the ovary and fallopian tube
N83.4 Prolapse and hernia of the ovary and fallopian tube
N83.5 Torsion of the ovary, ovarian stalk, and fallopian tube
Twisting:
additional pipe
morgagni cysts
N83.6 Hematosalpinx
Excludes: hematosalpinx with:
hematocolpos ( N89.7)
hematometer ( N85.7)
N83.7 Hematoma of the broad ligament of the uterus
N83.8 Other non-inflammatory diseases of the ovary, fallopian tube and broad ligament of the uterus
Broad ligament rupture syndrome [Masters-Allen]
N83.9 Non-inflammatory disease of ovary, fallopian tube and broad ligament of uterus, unspecified

N84 Polyp of female genital organs

Excludes: adenomatous polyp ( D28. -)
placental polyp ( O90.8)

N84.0 Polyp of the body of the uterus
Polyp:
endometrium
uterus NOS
Excludes: polypoid endometrial hyperplasia ( N85.0)
N84.1 Polyp of the cervix. Polyp of the mucous membrane of the cervix
N84.2 Vaginal polyp
N84.3 Vulvar polyp. Polyp of the labia
N84.8 Polyp of other parts of the female genital organs
N84.9 Polyp of female genital organs, unspecified

N85 Other non-inflammatory diseases of uterus, excluding cervix

Excludes: endometriosis ( N80. -)
inflammatory diseases of the uterus N71. -)

non-inflammatory diseases of the cervix ( N86-N88)
uterine body polyp N84.0)
uterine prolapse N81. -)

N85.0 Glandular hyperplasia of the endometrium
Hyperplasia of the endometrium:
NOS
cystic
glandular cystic
polypoid
N85.1 Adenomatous hyperplasia of the endometrium. Atypical endometrial hyperplasia (adenomatous)
N85.2 Uterine hypertrophy. Large or enlarged uterus
Excludes: postpartum uterine hypertrophy ( O90.8)
N85.3 Subinvolution of the uterus
Excludes: postpartum uterine subinvolution ( O90.8)
N85.4 Incorrect position of the uterus
anteversion)
Retroflection) of the uterus
retroversion)
Excludes: as a complication of pregnancy, childbirth or postpartum period ( O34.5, O65.5)
N85.5 Eversion of the uterus
O71.2)
postpartum uterine prolapse N71.2)
N85.6 Intrauterine synechia
N85.7 Hematometer. Hematosalpinx with hematometra
Excludes: hematometra with hematocolpos ( N89.7)
N85.8 Other specified inflammatory diseases of the uterus. Acquired uterine atrophy. Uterine fibrosis NOS
N85.9 Non-inflammatory disease of the uterus, unspecified. Uterine lesions NOS

N86 Erosion and ectropion of the cervix

Decubital (trophic) ulcer)
Eversion) of the cervix
Excludes: with cervicitis ( N72)

N87 Cervical dysplasia

Excludes: carcinoma in situ of cervix ( D06. -)

N87.0 Mild dysplasia of the cervix. Cervical intraepithelial neoplasia grade I
N87.1 Moderate cervical dysplasia. Cervical intraepithelial neoplasia II degree
N87.2 Severe cervical dysplasia, not elsewhere classified
Severe dysplasia NOS
Excludes: cervical intraepithelial neoplasia grade III, with or without mention
D06. -)
N87.9 Cervical dysplasia, unspecified

N88 Other noninflammatory diseases of cervix

Excludes: inflammatory diseases of the cervix ( N72)
polyp of the cervix N84.1)

N88.0 Leukoplakia of the cervix
N88.1 Old ruptures of the cervix. Adhesions of the cervix
O71.3)
N88.2 Stricture and stenosis of the cervix
Excluded: as a complication of childbirth ( O65.5)
N88.3 Cervical insufficiency
Evaluation and care for (suspected) isthmic-cervical insufficiency outside of pregnancy
Excludes: complicating the condition of the fetus and newborn ( P01.0)
complicating pregnancy O34.3)
N88.4 Hypertrophic elongation of the cervix
N88.8 Other specified non-inflammatory diseases of the cervix
Excludes: current obstetric injury ( O71.3)
N88.9 Non-inflammatory disease of the cervix, unspecified

Excludes: carcinoma in situ of vagina ( D07.2), inflammation of the vagina ( N76. -), senile (atrophic) vaginitis ( N95.2)
whites with trichomoniasis ( A59.0)
N89.0 Mild dysplasia of the vagina. Intraepithelial neoplasia of the vagina I degree
N89.1 Moderate vaginal dysplasia. Vaginal intraepithelial neoplasia II degree
N89.2 Severe vaginal dysplasia, not elsewhere classified
Severe vaginal dysplasia NOS
Excludes: grade III vaginal intraepithelial neoplasia with or without mention
about pronounced dysplasia ( D07.2)
N89.3 Vaginal dysplasia, unspecified
N89.4 Leukoplakia of the vagina
N89.5 Stricture and atresia of the vagina
Vaginal:
adhesions
stenosis
Excludes: postoperative adhesions of the vagina ( N99.2)
N89.6 Thick hymen. Rigid hymen. Tight virgin ring
Excluded: hymen overgrown ( Q52.3)
N89.7 Hematocolpos. Hematocolpos with hematometra or with hematosalpinx
N89.8 Other non-inflammatory diseases of the vagina. Beli NOS. Old rupture of the vagina. Vaginal ulcer
Excludes: current obstetric injury ( O70. — , O71.4,O71.7-O71.8)
an old tear involving the pelvic floor muscles ( N81.8)
N89.9 Non-inflammatory disease of the vagina, unspecified

N90 Other non-inflammatory diseases of vulva and perineum

Excludes: carcinoma in situ of the vulva ( D07.1)
current obstetric trauma ( O70. — , O71.7-O71.8)
inflammation of the vulva N76. -)

N90.0 Mild dysplasia of the vulva. Vulvar intraepithelial neoplasia grade I
N90.1 Moderate vulvar dysplasia. Intraepithelial neoplasia of the vulva II degree
N90.2 Severe vulvar dysplasia, not elsewhere classified
Severe vulvar dysplasia NOS
Excludes: grade III vulvar intraepithelial neoplasia with or without mention
about pronounced dysplasia ( D07.1)
N90.3 Vulvar dysplasia, unspecified
N90.4 Leukoplakia of the vulva
dystrophy)
kraurosis) vulva
N90.5 Atrophy of the vulva. Stenosis of the vulva
N90.6 Hypertrophy of the vulva. Hypertrophy of the labia
N90.7 Vulvar cyst
N90.8 Other specified non-inflammatory diseases of the vulva and perineum. Spikes of the vulva. Clitoral hypertrophy
N90.9 Noninflammatory disease of vulva and perineum, unspecified

N91 Absence of menstruation, scanty and infrequent menstruation

Excludes: ovarian dysfunction ( E28. -)

N91.0 primary amenorrhea. Menstrual disorders during puberty
N91.1 Secondary amenorrhea. Missing periods in women who have had them before
N91.2 Amenorrhea, unspecified. Absence of menses NOS
N91.3 Primary oligomenorrhea. Scanty or infrequent periods from the beginning of their appearance
N91.4 Secondary oligomenorrhea. Scanty or infrequent periods in women with previously normal periods
N91.5 Oligomenorrhea, unspecified. Hypomenorrhea NOS

N92 Abundant, frequent and irregular menstruation

Excludes: bleeding after menopause ( N95.0)

N92.0 Abundant and frequent menstruation with a regular cycle
Periodically profuse menstruation NOS. Menorrhagia NOS. Polymenorrhea
N92.1 Abundant and frequent menstruation with an irregular cycle
Irregular bleeding in the intermenstrual period
Irregular, shortened intervals between menstrual bleeding. Menometrorrhagia. metrorrhagia
N92.2 Heavy menstruation during puberty
Profuse bleeding at the beginning of the menstrual period. Pubertal menorrhagia. Pubertal bleeding
N92.3 ovulatory bleeding. Regular menstrual bleeding
N92.4 Heavy bleeding in the premenopausal period
Menorrhagia or metrorrhagia:
climacteric
in menopause
premenopausal
premenopausal
N92.5 Other specified forms of irregular menses
N92.6 Irregular menstruation, unspecified
Irregular:
bleeding NOS
menstrual cycles NOS
Excludes: irregular menstruation due to:
prolonged intervals or scanty bleeding ( N91.3-N91.5)
shortened intervals or heavy bleeding ( N92.1)

N93 Other abnormal bleeding from uterus and vagina

Excludes: neonatal bleeding from the vagina ( P54.6)
false menstruation ( P54.6)

N93.0 Postcoital or contact bleeding
N93.8 Other specified abnormal bleeding from the uterus and vagina
Dysfunctional or functional uterine or vaginal bleeding NOS
N93.9 Abnormal uterine and vaginal bleeding, unspecified

N94 Pain and other conditions associated with the female genital organs and the menstrual cycle

N94.0 Pain in the middle of the menstrual cycle
N94.1 Dyspareunia
Excludes: psychogenic dyspareunia ( F52.6)
N94.2 vaginismus
Excluded: psychogenic vaginismus ( F52.5)
N94.3 Premenstrual tension syndrome
N94.4 Primary dysmenorrhea
N94.5 Secondary dysmenorrhea
N94.6 Dysmenorrhea, unspecified
N94.8 Other specified conditions associated with the female genital organs and the menstrual cycle
N94.9 Conditions related to the female genital organs and the menstrual cycle, unspecified

N95 Menopausal and other perimenopausal disorders

Excludes: profuse bleeding in the premenopausal period ( N92.4)
postmenopausal:
osteoporosis ( M81.0)
with pathological fracture M80.0)
urethritis ( N34.2)
premature menopause NOS ( E28.3)

N95.0 Postmenopausal bleeding
N95.3)
N95.1 Menopause and menopause in women
Symptoms associated with menopause such as hot flashes, insomnia, headaches, impaired attention
Excludes: associated with artificial menopause ( N95.3)
N95.2 Postmenopausal atrophic vaginitis. Senile (atrophic) vaginitis
Excluded: associated with induced menopause ( N95.3)
N95.3 Conditions associated with artificially induced menopause. Syndrome after artificial menopause
N95.8 Other specified menopausal and perimenopausal disorders
N95.9 Menopausal and perimenopausal disorders, unspecified

N96 Recurrent miscarriage

Examination or provision of medical care outside the period of pregnancy. Relative infertility
Excludes: current pregnancy ( O26.2)
with current abortion O03-O06)

N97 Female infertility

Includes: inability to conceive
female sterility NOS
Excludes: relative infertility ( N96)

N97.0 Female infertility associated with the absence of ovulation
N97.1 Female infertility of tubal origin. Associated with congenital malformation of the fallopian tubes
Pipe:
obstruction
blockage
stenosis
N97.2 Female infertility of uterine origin. Associated with congenital anomaly of the uterus
Oocyte implantation defect
N97.3 Female infertility of cervical origin
N97.4 Female infertility associated with male factors
N97.8 Other forms of female infertility
N97.9 Female infertility, unspecified

N98 Complications associated with artificial insemination

N98.0 Infection associated with artificial insemination
N98.1 ovarian hyperstimulation
Ovarian hyperstimulation:
NOS
associated with induced ovulation
N98.2 Complications associated with an attempt to implant a fertilized egg after in vitro
fertilization
N98.3 Complications associated with attempted embryo implantation
N98.8 Other complications associated with artificial insemination
Complications of artificial insemination:
donor sperm
husband's sperm
N98.9 Complications associated with artificial insemination, unspecified

OTHER DISEASES OF THE URINARY SYSTEM (N99)

N99 Disorders of the genitourinary system after medical procedures, not elsewhere classified

Excludes: radiation cystitis ( N30.4)
osteoporosis after surgical removal of the ovary ( M81.1)
with pathological fracture M80.1)
conditions associated with artificially induced menopause ( N95.3)

N99.0 Postoperative renal failure
N99.1 Postoperative stricture of the urethra. Urethral stricture after catheterization
N99.2 Postoperative adhesions of the vagina
N99.3 Vaginal prolapse after hysterectomy
N99.4 Postoperative adhesions in the pelvis
N99.5 Dysfunction of the external stoma of the urinary tract
N99.8 Other disorders of the genitourinary system after medical procedures. Residual ovary syndrome
N99.9 Disturbance of the genitourinary system after medical procedures, unspecified