Dung blood
Introduction
Introduction to Gongxue Dysfunctional uterine bleeding, referred to as dysfunctional uterine bleeding, refers to abnormal uterine bleeding characterized by menstrual disorders caused by dysfunction of the HPOU axis rather than by genital tract lesions. The normal menstrual cycle is a biological clock phenomenon affected by internal and external environmental factors and neuroendocrine regulation, so that female reproductive physiology, reproductive endocrine function follows a strict biological rhythm, that is, there are obvious circadian rhythms, monthly rhythms and seasonal laws. Any factors that interfere with menstrual neuroendocrine regulation can cause menstrual disorders and abnormal uterine bleeding. basic knowledge The proportion of illness: 0.005% Susceptible people: good for adult women Mode of infection: non-infectious Complications: uterine fibroids uterine hypertrophy
Cause
Cause of dysfunctional uterine bleeding
Systemic factors (12%):
These include poor trauma, stress, malnutrition, endocrine and metabolic disorders such as iron deficiency, anemia, aplastic anemia, blood and bleeding, diabetes, thyroid and adrenal diseases.
Uterine and endometrial factors (35%):
Including spiral arterioles, microcirculatory vascular bed structure and dysfunction, endometrial corpus callosum receptor and lysosomal dysfunction, abnormal local coagulation mechanism, and prostaglandin TXA2, PGI2 secretion disorders.
Endocrine disorders (30%):
Hypothalamic-pituitary-gonadal dysfunction includes reproductive rhythm disorder, feedback dysfunction, ovulation, and luteal dysfunction.
Iatrogenic factors (15%):
Including steroidal contraceptives, intrauterine devices interfere with normal hypothalamic-pituitary-gonadal axis function. Certain systemic diseases (especially in the mind, nerves) can be converted to normal menstrual function via neuroendocrine machines.
The normal menstrual cycle is a biological clock that is influenced by internal and external environmental factors and neuroendocrine regulation, which makes female reproductive physiology, reproductive endocrine function follow strict biological rhythm (biological rhythm), that is, obvious circadian rhythm (circadian) Rhythm), lunar rhythm and seasonal law, any factors that interfere with menstrual neuroendocrine regulation can cause menstrual disorders and abnormal uterine bleeding.
First, anovulatory dysfunctional uterine bleeding endometrial pathological changes
(1) Proliferative endometrium: more common, tissue changes like normal proliferative phase, but it persists in the premenstrual period.
(B) glandular capsule intimal hyperplasia is too long: also known as Swiss cheese type intimal hyperplasia is too long, endometrial hypertrophy is polypoid hyperplasia, glandular number increases, glandular enlargement, but the shape is different, is Swiss cheese ( Swiss cheese) structure, glandular epithelium is high columnar and proliferative stratified or pseudo-stratified, interstitial edema, spiral arterioles dysplasia, endometrial microvascular tortuosity, congestion, necrosis or focal bleeding.
(3) The adenoma type intimal hyperplasia is too long: the number of glands is obviously increased, the size is different, and the arrangement is closely back-to-back. The glandular epithelium is significantly proliferated as a pseudo-stratified layer or a papillary spurt into the glandular cavity, and the nucleus is mostly in the middle, deeply stained. The boundaries of the nucleoplasm are clear, and even mitosis can be seen.
Photo 2 endometrial adenomatous hyperplasia
(4) Atypical endometrial hyperplasia is too long: that is, on the basis of adenoma-type proliferation, glandular epithelium is highly proliferated and active mitosis occurs, nuclear heterogeneity, nuclear size is different, deep staining, nucleoplasm boundary is unclear, proportion Disorder.
Different types of proliferative endometrium account for more than 90% of anovulatory dysfunctional uterine bleeding, accounting for 30.8 to 39.4% of all dysfunctional uterine bleeding, and that adenoma and atypical intimal hyperplasia are too long, which is caused by endometrial precancerous lesions. Clinicians pay enough attention and give positive treatment.
Second, ovulation-type dysfunctional uterine bleeding endometrial pathological changes
(I) Irregular mature endometrium: the detection rate is 21%, the luteal function is not healthy, and the progesterone secretion is insufficient. The clinical manifestation of luteal phase shortening, frequent menstruation, premenstrual endometrial examination showing secretion and secretion Incomplete endometrial coexistence, characterized by normalization of perivascular secretion around the blood vessels, incomplete secretion from the intima of the blood vessels, glandular dysplasia, mild curvature, less secretion of glandular epithelium, long oval shape, interstitial No enamel reaction.
(2) Irregular detachment type endometrium: the detection rate is 11%, the corpus luteum atrophy is incomplete, and the progesterone is continuously secreted insufficiently, which leads to prolonged menstruation, and dripping is not enough. If the endometrium is examined after 5 days of bleeding, one kind can be seen. The endometrium of the degenerating secretory phase and the newly added endometrium are mixed or coexisting with the tissue. The gland of the secretory reaction is plum-like or stellate. The glandular epithelium is rich in cytoplasm, transparent, nuclear pyknosis, dense interstitial, and degeneration of the spiral arteriole. There is still bleeding in some areas, and this image is also seen in uterine fibroids and endometrial polyps.
Third, atrophic endometrium
The detection rate is 1.9 to 21.9%, which is more common in women with peri-menopausal dysfunctional uterine bleeding.
Pathological changes of ovarian tissue during dysfunctional uterine bleeding, related to age and dysfunctional uterine type, adolescent dysfunctional uterine ovarian enlargement and retention of follicular cyst (d 3cm) without luteal formation, part of polycystic ovary and luteinized non-ruptured follicles (LUFS )change.
During the growth period, the ovarian uterus is normal, and the corpus luteum cyst can be seen. The ovary of the menopausal dysfunctional uterus is also changed by polycystic ovary. The cortex is filled with follicles or follicular cysts of different sizes. Microscopic examination reveals a cell proliferation phenomenon of interstitial cells.
Prevention
TB prevention
1. Keep your body healthy: Keeping your body healthy is the main part of avoiding dysfunctional uterine bleeding.
2. Pay attention to menstrual hygiene: In addition to preventing the occurrence of systemic diseases, we must also pay attention to menstrual hygiene, clean the perineum 1 or 2 times a day, and change the menstrual pad and underwear frequently; work and rest moderately, try to avoid excessive mental stress.
3. Strengthen nutrition: eat more fish, meat, eggs and milk, vegetables, eat spicy spicy food; use iron pot to cook vegetables, take iron-containing drugs such as ferrous sulfate oral liquid, etc., add iron To improve anemia.
4. Note: Usually pay attention not to rain and wading, the clothes should be replaced in time to avoid cold intrusion, prevent cold stagnation, sputum stagnation and cause excessive bleeding or dripping.
Complication
Complication dysfunction Complications Uterine fibroids Uterine hypertrophy
1, menstrual disorders or excessive patients with ovarian dysfunction, may also be complicated by organic lesions.
2, long-term, irregular ovulation patients, or long-term use of estrogen therapy, should pay attention to changes in the endometrium, whether it develops into adenoma-type proliferative endometrium or endometrial adenocarcinoma.
3, another noteworthy complication is uterine fibroids with anovulatory dysfunctional uterine bleeding, especially in menopause, if diagnosed early, according to menopausal dysfunctional uterine bleeding, patients with uterine hypertrophy or small fibroids can be exempted Surgical treatment can also provide better conditions for the necessary surgery (such as fibroids).
Symptom
Symptoms of dysfunctional uterine bleeding Common symptoms Adolescent dysfunctional uterine bleeding, abortion, uterine bleeding, menstrual bleeding, menstrual bleeding, premenstrual bleeding, endometrial shedding, late menstruation
1. Irregular uterine bleeding blood volume for a long time, or suddenly increased. Elderly people with amenorrhea have a lot of bleeding and can continue for several months. The period is shorter than 21 days, and the time is long.
2. The physical examination of the genitals is normal, or the bilateral ovaries are slightly increased symmetrically.
3. The basal body temperature is single-phase type.
4. Anemia symptoms Excessive blood loss can cause anemia, severe cases can occur dizziness, palpitation, shortness of breath, fatigue, edema, loss of appetite and so on.
5. Excessive hormone excretion symptoms, breast pain, lower abdominal bulge, emotional arousal, etc.
Examine
Check of dysfunctional uterine bleeding
(1) Diagnostic curettage: To monitor ovulation, it should be diagnosed 1 to 2 days before menstruation or 6 hours after menstruation. To determine the type of dysfunctional uterine bleeding, it should be diagnosed after the fifth day of treatment, and the diagnosis and treatment have both meanings. Therefore, it must be thoroughly comprehensive, especially pay attention to the corners of both sides of the palace, scraping all sent for inspection, in addition to unmarried girls, diagnosis is a necessary step in the treatment of blood.
(two) ovulation and corpus luteum function monitoring
1. Basic temperature (BBT): Biphasic curve suggests ovulation, high temperature phase shortening (<8 days) or instability seen in corpus luteum dysfunction, and single-phase curve suggesting no ovulation.
2. Vaginal cytology and cervical mucus function (quantity, viscosity, drawing and crystallization) examination: evaluation of ovulation and corpus luteum function.
3. Hormone determination: including: FSH, LH, PRL, E2, P, TO, 17KS, 17OHCS, T3, T4 and so on.
4. Ultrasonography: observe follicular development, ovulation and corpus luteum, and exclude ovarian tumors.
(C) blood and blood coagulation, fibrinolysis function check: including hemoglobin, red blood cells, white blood cells, hematocrit, clotting time, prothrombin time, serum iron determination and bone marrow puncture if necessary.
(D) liver and kidney function tests: including: total protein, A / G, transaminase (GOT, GPT, -GT) bilirubin, BUN, blood sugar and blood lipid determination.
Diagnosis
Diagnosis of dysfunctional uterine bleeding
diagnosis
Ask your medical history in detail
1. Age, past menstruation, marriage, pregnancy, parity, childbirth.
2. The onset time, the amount of bleeding, the duration, the presence or absence of blood clots and tissue excretion.
3. Whether there is periodicity of bleeding, duration and amount of bleeding.
4. What are the incentives, such as: recent trauma, mood swings, fatigue, etc.
5. Contraceptive methods, whether or not oral contraceptives are applied, and the upper ring.
6. General health conditions, with or without chronic liver disease, blood disease, hypertension, heart failure and metabolic diseases.
Differential diagnosis
Gongxue should be differentiated from all organic diseases that cause abnormal uterine bleeding, including bleeding in the non-genital tract and other parts of the reproductive tract, systemic diseases, reproductive system diseases, and iatrogenic bleeding.
1. Abnormal pregnancy or pregnancy complications: ectopic pregnancy, hydatidiform mole, poor uterine involution, placental residue, placental retention, placental polyps, miscarriage, trophoblastic disease (hydatidiform mole, choriocarcinoma, etc.).
2. Intrauterine device or foreign body injury, infection.
3. Genital tract infections: acute or chronic endometritis, uterine myositis, atrophic vaginitis, etc.
4. Reproductive tract tumors: endometrial cancer, cervical cancer, choriocarcinoma, uterine fibroids, ovarian functional tumors
5. Systemic diseases: blood diseases, liver damage, hyperthyroidism or underground.
6. Iatrogenic factors (anticoagulant drugs. IUD), inappropriate use of sex hormones.
