Adolescent dysfunctional uterine bleeding
Introduction
Introduction to adolescent dysfunctional uterine bleeding Adolescent dysfunctional uterine bleeding (dysfunctionaluterinebleedingintheadolescentatpuberty) refers to the painlessness from the uterine cavity, long-term, large, irregular bleeding, and no local organic lesions or systemic causes. basic knowledge The proportion of sickness: 0.01%-0.03% (high incidence of adolescent girls) Susceptible people: women Mode of infection: non-infectious Complications: anemia
Cause
Adolescent dysfunctional uterine bleeding cause
(1) Causes of the disease
Adolescent priming begins with a number of factors that are currently not well understood, affecting the increase in the amount of gonadotropin-releasing hormone (GnRH) secreted by the hypothalamus. These factors include:
1 weight and basal metabolic rate increase;
2 reduction of autologous hormone and pineal hormone inhibition;
3 The effects of neuronal hormones and neurological factors in the myelinal nerve, the pineal gland can regulate the endocrine function of puberty, and the melatonin secreted by it is transported through the blood or cerebrospinal fluid, directly acting on the pituitary or specifically acting on the lower body. The thalamus regulates the secretion of hormones in the hypothalamus. Others such as the thyroid gland and the adrenal cortex also affect the pituitary gland. Putting the pituitary tissue of immature animals into the sella of the mature animal can secrete gonadotropins, indicating that the adolescent is in the center of the puberty. When the nervous system matures, the hypothalamus is liberated from the influence of depression, secreting gonadotropin (GnRH) to stimulate the pituitary secretion-releasing hormone (GnTH) to initiate normal endocrine activity of the ovary, in the early adolescence due to the hypothalamus-pituitary-ovary The axis is not well developed and can not establish a regular ovarian cycle. Therefore, the first few menstrual periods (about 15 months) after menarche are often an anovulatory cycle. At this time, irregular menstruation is a normal phenomenon, such as long-term single estrogen. (E) Intimal hyperplasia under stimulation, the level of E is low, the endometrial shedding is bleeding, clinical manifestation Oligomenorrhea, the quantity and constantly dripping, menstruation.
(two) pathogenesis
After 20 menstruation after menarche, about a mid-late period of puberty, a new E positive feedback mechanism matures, and under the influence of the rapidly increasing E level in the mid-menstrual period, the secretion of luteinizing hormone (LH) is rapidly increased. Growth, the formation of a prominent LH secretion peak, this high concentration of LH in the synergistic effect of follicle stimulating hormone (FSH) ovulation, the formation of ovarian corpus luteum, progesterone secretion increased, leading to endometrial secretion changes, then female Proper stimulation of progesterone, the stability of the intimal structure is maintained, and finally the corpus luteum degeneration, the retreat of estrogen and progesterone, triggers a series of changes in the endometrium, the most important of which are endometrial shrinkage and spiral arteries. The prolongation of rhythmic contraction time and the increase of intensity, accompanied by intimal shrinkage, decreased blood flow of spiral artery, decreased venous return, and the time and intensity of contraction of spiral artery are prolonged and increased once, causing endometrial order and progression. Ischemic, intimal collapse, the formation of ovulation-type menstruation.
When the new E positive feedback effect is insufficiently developed, the body is still in an early puberty state, the negative feedback mechanism remains normal without LH peak appearing, and ovulation cannot occur. In the absence of progesterone to inhibit endometrial growth, the intimal hyperplasia, In particular, the irregular stimulation of estrogen does not promote the well-developed dense layer of dense structure. The lack of corresponding tissue structure supports the endometrial tissue to be extremely fragile, and it is prone to spontaneous superficial breakthrough hemorrhagic necrosis. When a hemorrhagic lesion has not yet Complete healing, new breakthrough bleeding in another place, due to part of the intima, irregular and unsynchronized collapse, shedding bleeding leads to continuous bleeding and prolonged bleeding time, such as breakthrough bleeding with multiple vascular access Open, combined with the loss of rhythmic contraction of the blood vessels, can cause severe bleeding.
Prevention
Adolescent dysfunctional uterine bleeding prevention
(1) Adolescent health knowledge should be popularized so that adolescent girls can understand the normal growth and development process during adolescence, what is the cause of menstruation, and what factors can cause menstrual abnormalities. What should be done. Girls usually come to menstruation between the ages of 13 and 16. Most of them established a normal menstrual cycle soon after the first menstruation, and the menstrual cycle was performed on a monthly basis; while a few of them were not fully mature due to their endocrine function, menstrual disorders may occur. Excessive mental stress, fatigue, malnutrition, etc. can induce this phenomenon. Therefore, adolescent girls must arrange for study and life, pay attention to work and rest, exercise, enhance physical fitness, to ensure adequate intake of nutrients (protein, vitamins, iron), to avoid cold diet.
(2) When the uterine cavity is connected inside and outside during bleeding, the bacteria will rapidly multiply and cause disease due to a good growth environment. Therefore, pay attention to the vulva when bleeding, change the underwear and menstrual pad and other menstrual supplies; do not clean the vulva because of bleeding, on the contrary, the menstrual period must be cleaned daily to remove blood. Some vulvar cleansers can be used, but they can also be washed with warm water, but should be avoided; married women should avoid sex during the bleeding period.
Complication
Adolescent dysfunctional uterine bleeding complications Complications anemia
Anemia, severe cases can be complicated by anemia.
Symptom
Symptoms of dysfunctional uterine bleeding in adolescence Common symptoms Vaginal continuous moderate bleeding, menopause, threatened abortion, uterine bleeding, thrombocytopenia, bleeding, nosebleeds, coagulopathy, incomplete abortion, hepatosplenomegaly
Adolescent dysfunctional uterine bleeding mostly belongs to anovulatory menstruation, can be divided into:
1.E too much type:
The endometrium rapidly hypertrophy and hypertrophy, necrosis, resulting in excessive menstrual flow, shortened menstrual cycle interval, manifested as frequent menstruation with menorrhagia.
2.E low type:
Although the E level is low, some follicles have not completely atrophied due to irregular follicles, and other follicles develop and accumulate E. It also makes the endometrial hypertrophy, and the amount of bleeding is long when it falls off. It lasts for a long time and has a period of menopause. There is bleeding after the time, so there are often irregular menstruation accompanied by excessive menstrual flow, prolonged menstruation, the latter two are more common.
Examine
Examination of dysfunctional uterine bleeding in adolescence
Blood routine examination, clotting time, prothrombin time and thromboplastin time, fibrinogen, blood biochemistry such as thyroid function, liver function examination, tumor marker examination. B-check.
Diagnosis
Diagnosis and differentiation of dysfunctional uterine bleeding in adolescence
diagnosis
Adolescent dysfunctional uterine bleeding should be diagnosed on the basis of exclusion of other lesions, so a detailed medical history, detailed and comprehensive physical examination, especially pay attention to the presence or absence of hepatosplenomegaly in order to find coagulopathy, pay attention to gynecological examination Hymen, anus examination attention to the size and hardness of the uterus, in order to rule out the most common pregnancy complications, such as threatened abortion, incomplete abortion, if the patient's mother has a history of taking synthetic E drugs such as diethylstilbestrol during pregnancy, we should consider the exclusion of vaginal cervical adenosis and The possibility of clear cell cancer, girls are vulnerable, such as mental stress (such as exams, scares), excessive physical exertion (such as exercise, work tired), mild hypothyroidism can cause menstrual disorders, so thyroid function should be listed For the routine.
Coagulopathy also plays an important role in many cases of adolescent menstruation, especially idiopathie throm bocytopenic purpura (ITP). Claesseus (1981) reported that 18.6% of 59 cases of adolescent menstruation were primary Sexual coagulopathy, 4 cases were idiopathic ITP, 3 cases were willebrand disease (autosomal dominant inheritance, congenital hemorrhagic quality, prolonged bleeding time, deficiency of factor VIII), and 2 cases of Glanzmanus disease (platelet insufficiency) , poor blood clot retraction, prolonged bleeding time), globin-producing anemia (thalassaemia), 1 case of congenital aplastic anemia syndrome, 49% of the above 59 cases of severe menorrhagia (29/59) On admission, hemoglobin <100g / L, the average hemoglobin 79g / L, of which 28% (17 / 59) for coagulopathy, 35% of cases requiring blood transfusion or plasma transfer due to coagulation defects, thus visible coagulopathy and adolescent menstruation Too many relationships, when asked about the history of the disease, to emphasize whether there is nose bleeding, bleeding gums and skin blue, and a family history of bleeding disorders.
Differential diagnosis
Should pay attention to tuberculous pelvic inflammatory disease, endometrial tuberculosis, endometritis, secondary to bleeding in the coagulation mechanism, identify the menstrual cycle caused by bleeding disorders.
