Adolescent dysfunctional uterine bleeding disorder
Introduction
Introduction to adolescent dysfunctional uterine bleeding Dysfunctional uterine bleeding is referred to as functional uterine bleeding or dysfunctional uterine bleeding, caused by neuroendocrine disorders, rather than pregnancy, endometrial tumors, infections or blood diseases, often occur in adolescence, are anovulatory functional Uterine bleeding, also known as adolescent functional uterine bleeding. basic knowledge The proportion of illness: 0.002% Susceptible people: women Mode of infection: non-infectious Complications: anemia polycystic ovary syndrome
Cause
The cause of dysfunctional uterine bleeding in adolescence
(1) Causes of the disease
The cause of anovulatory dysfunctional uterine bleeding is different in adolescence and menopause. The dysfunctional uterine bleeding is due to hypoplasia or delay of hypothalamic-pituitary-ovarian axis. A perfect positive feedback regulation mechanism has not been established between the hypothalamus and ovary. Under the action of pituitary follicle stimulating hormone (FSH) and luteinizing hormone (LH), follicles develop and secrete estrogen, but the positive feedback of estrogen to the hypothalamus should not form the peak of FSH and LH in the normal menstrual cycle, so there are Follicle development but not ovulation, menopausal dysfunctional uterine bleeding is mainly due to the natural decline of ovarian function, the number of follicles is reduced but not mature, and the response to pituitary gonadotropin is reduced, so ovulation stops when ovarian function declines, leading to menopause anovulatory dysfunctional uterine bleeding.
There are four reasons for ovulation-type dysfunctional uterine bleeding:
1. Insufficient function of the corpus luteum: follicular development and ovulation in the menstrual cycle, but insufficient progesterone secretion or premature corpus luteum in the luteal phase leads to poor endometrial secretion.
2. Endometrial insufficiency: that due to insufficiency of the corpus luteum, estrogen and progesterone can not be rapidly decreased, the endometrial imbalance due to hormone levels can not be irregularly shed, so that the bleeding period is prolonged, blood volume is increased, also known as corpus luteum atrophy Not complete.
3. Prolongation of endometrial repair: Due to the endometrial exfoliation during menstrual period, the new follicles in the next cycle are slow or poorly developed, and the secreted estrogen is insufficient, so that the endometrium can not be regenerated and repaired as scheduled, and the menstruation is prolonged.
4. Ovulation bleeding: due to the short-term decline of hormones during ovulation, the endometrium loses the support of hormones and some endometrial shedding causes withdrawal bleeding. When the estrogen is secreted enough, the endometrium is repaired and hemostasis.
(two) pathogenesis
The normal month is controlled by the hypothalamic-pituitary-ovarian axis. When the follicle develops and synthesizes estrogen, the endometrium proliferates; after ovulation, the ovary forms a corpus luteum, which synthesizes estrogen and progesterone; progesterone causes proliferating endometrium to occur. Changes in the secretory phase, such as the failure of the discharged eggs to fertilize, the ovarian corpus luteum degenerates about 14 days after ovulation, no longer secrete female, progesterone; at this time the endometrium loses the female, progesterone support and shrinks, spiral artery Strong contraction, slowing of venous return and ischemic necrosis of the endometrium, causing the functional layer of the endometrium to fall off while passing through. At the same time, thrombus is formed in the end of the spiral artery of the endometrium, the amount of bleeding is reduced, and the new follicular cycle begins. And secrete estrogen, so that the endometrium repair and stop bleeding, therefore, the normal menstrual bleeding is relatively constant, and naturally stop bleeding.
If no ovulation, ovarian does not synthesize progesterone, endometrium proliferate under the action of a single estrogen, when the estrogen level can no longer maintain thickened endometrium, part of the endometrial shedding and bleeding (breakthrough bleeding), a After the repair, the other part fell off again, causing the bleeding to continue. Due to the lack of progesterone, the end of the spiral end of the spiral artery does not shrink, resulting in more bleeding, such as multiple open blood vessels in the endometrial shedding area, then The amount of bleeding has increased dramatically.
Most of the girls' primary menstruation is not ovulation, so dysfunctional uterine bleeding can occur at the time of menarche, or within 2 to 3 years after menarche, or after regular menstruation.
Adolescent hyperthyroidism or hypothyroidism, may be associated with functional uterine bleeding, experimental findings, thyroid dysfunction, ovarian cell metabolic rate decreased, follicular dysplasia, secretion of estrogen deficiency, human observation, hypothyroidism, blood TSH rise High, affecting the production of gonadotropin, causing anovulation or luteal function. When thyroid function is hyperthyroidism, ovarian hormone secretion is increased, the menstrual cycle is shortened, or ovulation is stopped, endometrial hyperplasia is too long, and functional uterine bleeding occurs.
Polycystic ovary syndrome may occur in adolescence, characterized by non-ovulation, manifested as amenorrhea or functional uterine bleeding, some cases with hairy, obesity and/or bilateral ovarian enlargement.
In adolescent adrenal hyperplasia, functional uterine bleeding also occurs due to increased androgen in the body.
Most pubertal dysfunctional uterine bleeding is caused by the hypoplasia of the hypothalamic-pituitary-ovarian axis. Mental stimulation or disease may cause functional uterine hemorrhage due to dysfunction of the newly developed hypothalamic-pituitary-ovarian axis.
Prevention
Prevention of dysfunctional uterine bleeding in adolescence
Maintaining good health is the main part of avoiding dysfunctional uterine bleeding.
1. Adolescent health knowledge should be popularized
Make adolescent girls understand the normal growth and development process during adolescence, what is the cause of menstruation, what factors can cause menstrual abnormalities, what should be done, girls generally come to menstruation from 13 to 16 years old, most of them established normal after the first menstruation Menstrual cycle, according to the monthly menstruation; and a few due to its endocrine function is not fully mature, there may be menstrual disorders, excessive mental stress, fatigue, malnutrition, etc. can induce this phenomenon, therefore, adolescent girls must arrange learning and life Pay attention to work and rest, exercise, enhance physical fitness, ensure adequate nutrition (protein, vitamins, iron) intake, avoid cold diet, eat more fish, meat, eggs and milk, vegetables, bogey Eat spicy spicy food; use iron pot to cook vegetables, take iron-containing drugs such as ferrous sulfate oral liquid, etc., increase iron, improve anemia.
2. Prevent infection
When bleeding occurs, the uterine cavity communicates internally and externally. Because of the good growth environment, bacteria will rapidly multiply and cause disease. Therefore, it is necessary not only to prevent the occurrence of systemic diseases, but also to pay attention to menstrual hygiene. When bleeding, pay attention to the vulva clean and clean every day. The genitals are 1 or 2 times to remove blood stains, and the menstrual pads and underwear are changed frequently. Some vulvar cleansers can be used, but they can also be washed with warm water, but baths should be avoided. Married women should avoid sex during the bleeding period.
3. Other
If the amount of bleeding is large, it can cause anemia and the body's resistance is reduced. It is necessary to strengthen the hemostasis measures and anti-infection as appropriate to prevent the occurrence of inflammation and acute infectious diseases. Usually, do not take the rain and wading, and the clothes should be replaced in time to avoid cold. Invasion of evil, to prevent cold stagnation, obstruction and excessive bleeding or dripping.
Correctly understand the development process of adolescence, arrange learning and life reasonably, timely treat and prevent complications, and adolescent girls will successfully pass this physiological development period.
Complication
Adolescent dysfunctional uterine bleeding complications Complications anemia polycystic ovary syndrome
The amount of bleeding is large, the time is long, often combined with anemia, and some have thyroid dysfunction, adrenal hyperplasia and polycystic ovary syndrome.
Symptom
Symptoms of dysfunctional uterine bleeding in adolescence Common symptoms Shortness of edema, dizziness, vaginal continuous moderate bleeding, purple uterine bleeding, weight loss, amenorrhea, lack of appetite, loss of appetite
1. Uneven uterine bleeding: blood volume for a long time, or sudden increase, long menopause time, the amount of bleeding, and can last for more than a few months, the cycle is shorter than 21 days, when the flow stops.
2. Physical examination: normal genital examination, or bilateral ovarian symmetry slightly increased.
3. Basal body temperature: 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 symptoms of excretion of hormones: breast pain, lower abdomen bulge, emotional excitement, etc.
Examine
Examination of dysfunctional uterine bleeding in adolescence
1. Blood LH and FSH: There is no peak around 14 days before bleeding.
2. Blood E2: Maintain a level of no fluctuations.
3. Blood progesterone value: very low or can not be measured.
4. When thyroid dysfunction is combined: blood T3, T4, and TSH are abnormal.
5. In combination with congenital adrenal hyperplasia: increased blood androgen, or increased ketone steroids in 24h urine.
6. When combined with anemia: red blood cells and hemoglobin are low, and liver function is normal.
Other auxiliary inspections:
1. Diagnostic curettage: married patients with more bleeding or persistent non-stop, should first use diagnostic curettage to stop bleeding, and can explore the uterine cavity to determine whether there is organic disease, endometrial disease, no ovulation The endometrium of uterine bleeding is a proliferative phase change, or is a cystic, adenomatous hyperplasia, can be developed into atypical hyperplasia or endometrial cancer without treatment; ovarian bleeding is a "secretory change" "secretory secretion "On the fifth day of bleeding, the endometrium of the secretory phase can still be scraped, which is atrophy of the corpus luteum.
2. Cervical mucus crystallization: See the dentate crystallization in the mucus of the cervix before bleeding, suggesting that there is no ovulation bleeding.
3. Hysteroscopy: It is helpful to find small uterine lesions, such as small uterine polyps, submucosal uterine fibroids, etc., and can select biopsy under direct vision, which increases the detection of such organic diseases. rate.
4. B-ultrasound examination: small uterine fibroids (between muscle walls) and small ovarian tumors can be found, or no ovarian cystic enlargement, and uterine lesions can be found and the thickness of the endometrium can be measured, texture, etc.; Monitoring the downstream saline solution to increase the contrast of the sound image can improve the diagnosis rate of small intrauterine lesions such as polyps and submucosal fibroids.
Diagnosis
Diagnosis and diagnosis of dysfunctional uterine bleeding in adolescence
diagnosis
1. History: Detailed inquiries about the age of menarche, the cause of changes in the menstrual cycle, the characteristics of bleeding, accompanying symptoms and treatment methods, effects, etc., pay special attention to the history of contraceptives and estrogen application.
2. Physical examination:
(1) Systemic examination: whether there is weight loss, obesity, hairy, purple skin and purpura.
(2) gynecological examination: the history of asexual life anal finger diagnosis, determine the size of the uterus, attachment lumps, such as suspected organic lesions or pregnancy, should do a vaginal examination (first obtain parental consent).
Differential diagnosis
Identification of uterine bleeding caused by incomplete abortion, endometrial polyps, genital tumors and endocrine diseases.
1. Systemic diseases: such as blood diseases, liver diseases, hypertension, thyroid dysfunction, etc., may cause abnormal uterine bleeding, clinical and laboratory tests such as bone marrow, liver function, thyroid function tests, etc. can help identify this disease .
2. Abnormal pregnancy and pregnancy complications: such as abortion, ectopic pregnancy, trophoblastic tumor, placental residue, poor uterine involution, etc., according to the clinical history of pregnancy, blood urinary villus gonadotropin determination and B-ultrasound is not difficult to identify.
3. Genital tumors: such as endometrial polyps, submucosal uterine fibroids, endometrial adenocarcinoma, ovarian functional tumors, etc. should do a detailed gynecological examination, pay attention to whether there is a tumor near the uterus, if necessary, B-ultrasound examination, Diagnostic curettage and other tests to confirm the diagnosis.
4. Genital infections: such as acute and chronic endometritis, early endometrial tuberculosis can be blocked by the regeneration of the endometrial functional layer, but the amount of bleeding is generally small, may have the history and performance of infection, and can be It is cured by anti-infective treatment and is identified accordingly.
