menorrhagia
Introduction
Introduction to menstruation Menorrhagia is defined as the number of menstrual bleeding in consecutive menstrual cycles, but the menstrual interval and bleeding time are regular, no menstrual bleeding, post-intercourse bleeding, or sudden increase in menstrual blood, ovulation A class of dysfunctional uterine bleeding. Clinically, bleeding time and basal body temperature (BBT) curve were compared, and ovulation-type dysfunctional uterine bleeding was divided into two types: menstrual flow and inter-menstrual bleeding. basic knowledge Sickness ratio: 10-20% Susceptible people: women Mode of infection: non-infectious Complications: anemia, endometrial hyperplasia, adenocarcinoma
Cause
Menorrhagia
First, the cause:
The cause of abnormal uterine bleeding in ovulatory women without organic disease may be caused by a slight abnormality of ovulation function, caused by irregular or loosening of the endometrium or improper proportion of estrogen and progesterone.
Second, the pathogenesis:
1. From the perspective of endocrine analysis, abnormal uterine bleeding can be caused by the following conditions:
(1) Estrogen withdrawal bleeding: uterine bleeding occurs when the appropriate amount and course of estrogen is given to women who have been removed from the ovaries, or the amount of estrogen is reduced by more than half, which is called "estrogen withdrawal bleeding." "But if the dose of estrogen given is too low, the course of treatment is too short, or the magnitude of estrogen reduction is too small, there is no uterine bleeding. The blood estrogen concentration of postmenopausal women also fluctuates at a low level, but there is no Menstrual cramps, this is because the endometrial proliferation must reach a certain thickness and then lose blood to support the bleeding, some scholars envisioned "estrogen endometrial bleeding threshold; beyond this threshold, if the estrogen stimulation is weakened Below the above threshold, uterine bleeding will occur; conversely, if the estrogen stimulation intensity is below the above threshold and fluctuates below this threshold level, no bleeding will occur.
(2) Estrogen breakthrough bleeding: a considerable concentration of estrogen long-term effects, no progesterone antagonistic effects, can cause endometrial hyperproliferation to a different degree of hyperplasia, no anti-estrogen stimulation through direct action on blood vessels, Reduce vascular tone; stimulate interstitial VEGF expression, reduce PGF2a, AngII production, promote nitric oxide (N0), PGE2, PGI2 production and other pathways leading to vasodilation, increased blood flow, or due to endometrial stroma, blood vessels, glands Unsynchronized development, lysosome overdevelopment and instability, release of hydrolase, causing increased or continuous bleeding, unpredictable, known as "estrogen breakthrough bleeding."
(3) progesterone breakthrough bleeding: the ratio of progesterone to estrogen concentration in the body is too high, can not maintain the integrity of the membrane during the secretion period and cause bleeding, the specific mechanism is still unclear, Fraser et al (1996) integrated the application of single pregnancy Hormone contraceptives, such as norplant, the results of breakthrough bleeding mechanism after long-acting ketoprogesterone, suggest that the clinical features of progesterone breakthrough bleeding are irregular and persistent small amount of bleeding; there must be a progesterone effect at the same time Continued low levels of estrogen; endometrial inhibited secretion or atrophy, focal flaky shedding; hysteroscopy can be seen in the uterine superficial vasodilation, thin vessel wall, microvascular density and fragility Increased, ecchymosis; blood flow disorder, increased white blood cell infiltration, etc. These changes have reference value for naturally occurring ovulatory dysfunctional uterine bleeding, and studies suggest increased local MMP expression, vascular endothelial cell dysfunction, VEGF, etc. Changes in angiogenic factors or transitional leukocyte function leading to intimal disintegration and repair abnormalities may be associated with such bleeding.
(4) Others: The cause of local endometrial hemorrhage can also be seen in abnormalities of local blood vessels, such as arteriovenous fistula; systemic hemostasis, abnormal blood coagulation.
2, the pathogenesis of more menstrual flow
Compared with women with normal menstrual flow and normal menstrual flow, the dynamic changes of serum LH, FSH, E2 and salivary P concentration in the menstrual cycle, endometrial tissue phase, no difference in results, endometrial estrogen and progesterone receptor There was no significant difference in the results of the content score (monoclonal immunohistochemistry). The variation of the above receptors was different among different individuals, but Gleeson (1993) reported that the menstrual volume of patients with late menstrual endometrial ER, PR Higher than normal (monoclonal solid phase immunoassay), there are reports of more menstrual blood plasma and menstrual blood coagulation factors, uterine blood vessel density are normal, recent studies have positive findings of the following factors:
(1) Proportional imbalance between different PGs in the endometrium: It is known that different PGs have opposite effects on vasomotor and platelet function. Prostacyclin (PGI2) can dilate blood vessels and inhibit platelet aggregation; thromboxane A (TXA2) The blood vessels contract and promote platelet aggregation. Both PGE2 and PGF2 can promote platelet activity, but the former causes the blood vessels to dilate, and the latter causes the blood vessels to contract. Studies have shown that the ratio of the amount of PGE2/PGF2a in the endometrium of patients with more menstrual flow is increased, PGl2 And the ratio of the respective metabolite -6-ketone PG-TXB2 of TXA2 is also increased, and the imbalance of the two pairs of PG production leads to vasodilation and a tendency of inhibition of platelet aggregation function, which causes an increase in menstrual flow.
(2) Intimal fibrinolytic system hyperfunction: the myometrium and intima contain a large amount of tissue-type plasminogen activator (tPA), Gleeson (1994) study shows that endometrial tPA activity in normal women from late lactation It began to rise and peaked on the second day of the next menstrual cycle. The endometrial tPA activity increased in the middle of the middle menstrual period, and the late menstrual cycle and the second day of the next menstrual cycle, the membrane and menstrual blood tPA And the activity of type I plasminogen activator inhibitor (PAI-I) was significantly higher than normal. There was a strong positive correlation between membrane tPA activity and menstrual blood loss during the second day of the cycle, possibly due to the high activity of intima tPA. The function of the fibrinolytic system is hyperthyroidized, causing the thrombus of hemostasis to be unstable or recanalized, the degradation of extracellular matrix collagen and adhesion proteins is intensified, and the endometrial exfoliation is extensive and long-lasting, resulting in a large amount of menstruation.
(3) Others: In the follicular phase, endometrial VEGF, increased NO expression increased blood flow, endometrial ET release, bFGF receptor decreased leukocyte infiltration, and endometrial hemorrhage related factor gene expression was too strong.
Prevention
Menorrhagia prevention
1. Birth control: In terms of birth control and abstinence, it is necessary to pay attention to it. Birth control and abstinence can prevent the occurrence of diseases. This can also avoid excessive frequency of births (people flow) and even during menstruation and postpartum. Otherwise, damage to the red, blood, kidney, and finally lead to menstrual disease. Therefore, we should pay more attention to it during the menstrual period and postpartum, which can reduce and prevent the occurrence of diseases.
2, keep warm: in some places where the temperature is warm. It is necessary to appropriately increase or decrease clothes and quilts according to changes in the climate environment, and not to be too cold or too cold, so as to avoid incuring external evils, damaging blood gas, and causing menstrual diseases.
3, eat: when eating, should not overeating, or eat some foods that are too fat, greasy, cold, spicy, spicy, so that you can avoid damage to the spleen and stomach to biochemical deficiency, or poly Wet sputum or cool blood, burning blood causes irregular menstruation.
4, the mood is comfortable: in the usual life, it is necessary to carry out a good adjustment of emotions, to maintain a comfortable mood at any time, it is also possible to avoid anxiety and anger, damage the liver and spleen, or the seven emotions, the five ambitions, the disturbance It is a menstrual disease.
Complication
Menorrhagia complications Complications, anemia, endometrial hyperplasia
Can be complicated by anemia, secondary infection, mental burden, endometrial hyperplasia or adenocarcinoma.
Symptom
Menstrual symptoms, common symptoms, menstrual swelling, menstrual flow, blood stasis, menstrual period, menstrual period, menstrual period, ovulation dysfunctional uterine bleeding
Patients with ovarian dysfunctional uterine bleeding with more menstrual flow have more than 80 ml of blood loss per menstrual cycle. The standard of subjective judgment of bleeding volume varies greatly from each patient. It is reported that among patients with more menstrual flow, only 40% of the blood loss measured by objective measurement is more than 80ml. There are many menstrual periods in patients with ovarian dysfunctional uterine bleeding. Although there are disorders in menstruation, there are often regular rules.
Generally, the amount of bleeding can be estimated according to the frequency of changing the sanitary napkin. If it is customary to use a relatively thick sanitary napkin and change the sanitary napkin to be more diligent, the amount of bleeding is large.
Examine
Menorrhagia
Blood routine examination, hormone level test, coagulation function, platelet adhesion function and aggregation function test, BT measurement, timing for endometrial or blood progesterone determination.
Hysteroscopy, laparoscopy, B-mode ultrasound, uterine artery angiography.
Diagnosis
Menstrual multiple diagnosis
Menstrual flow is a common symptom of women's menstrual period, may be accompanied by other symptoms.
According to the clinical manifestations and the above related examinations, the determination of blood progesterone concentration 5 to 9 days before the determination of ovulation-type dysfunctional uterine bleeding.
Although there are disorders in menstruation in patients with ovulatory dysfunctional uterine bleeding, there are often regular rules to follow, so a detailed inquiry about the start and end time of bleeding and the amount of bleeding will help to identify the nature of bleeding.
Different from anovulatory dysfunctional uterine bleeding, if there is irregular bleeding, inter-menstrual bleeding, bleeding after sexual intercourse, or sudden increase of menstrual blood, or pelvic pain, anterior abdominal pain, suggesting that there may be organic diseases, all Blood and coagulation function tests are also very important, platelet adhesion function, aggregation function check to find out whether it is thrombocytopenia, rare uterine arteriovenous fistula, diagnosis by uterine artery angiography, Wilansky (1989) on 67 cases of thyroid function Patients with normal menstrual flow underwent TRH stimulation test. The 31 patients with TSH had a base value of (2.4±0.24) MU/L. The peak TSH after TRH stimulation was (11.5±1.0) MU/L, and 16 of them were followed by more menstrual flow. Persistence, the other 15 cases (22%) TSH base value (5.9 ± 0.76) MU / L TSH peak after stimulation with TRH up to (47.5 ± 5.9) MU / L, of which 8 cases after thyroid tablets, TSH decreased The value of T4 rises and the menstruation is normal after 1 to 3 years of follow-up. It is concluded that subclinical primary hypothyroidism may be one of the causes of menstrual flow. If there is obesity, use non-antagonistic estrogen or tamoxifen, or polycystic Ovarian syndrome, should pay attention to the exclusion of the endometrium Fraser (1990) reported hysteroscopy and laparoscopy in 316 patients with more menstrual flow. Results showed that 49% of patients had organic diseases, uterine fibroids, endometriosis, endometrial polyps, Uterine adenomyosis is the most common.
