Irregular shedding of endometrial lining
Introduction
Introduction to irregular endometrial shedding Irregular endometrial shedding is caused by hypothalamic-pituitary-ovarian axis regulation dysfunction caused by luteal atrophy, and the endometrium continues to be affected by progesterone, so that it can not fall off intact. On the 3-4th day of the normal menstrual period, the membrane has completely shed during the secretory period and replaced with a membrane of the proliferative period of regeneration. However, when the endometrium is irregularly detached, the endometrium showing a secretory reaction can still be seen on the 5th to 6th of the menstrual period. Because the patient has a long menstrual period, the endometrium loses water, the interstitial becomes dense, the gland shrinks, and the glandular cavity is plum-like or star-shaped. The disease may be caused by abnormal secretion in the body, mainly due to the fact that the body is in a state of excessive estrogen secretion, causing a simple clinical manifestation of menorrhagia. The treatment method is from the 10th to 14th day before the next menstruation, daily oral administration of medroxyprogesterone 10mg, intramuscular injection of progesterone or oral natural micronized progesterone. Its function is to adjust the feedback function of the hypothalamic-pituitary-ovarian axis, so that the corpus luteum shrinks in time, and the endometrium falls off in time. basic knowledge The proportion of illness: 0.001% Susceptible people: women Mode of infection: non-infectious Complications: endometritis anemia
Cause
Endometrial irregular shedding cause
Uterine lesions (75%)
Common uterine fibroids, especially uterine submucosal fibroids, even smaller fibroids, can cause menorrhagia, followed by adenomyosis and pelvic endometriosis. Due to factors such as the growth of the endometrium to the uterine muscle wall and the enlargement of the uterus, menstrual flow is often more.
Endocrine factors (15%)
The disease may be caused by abnormal secretion in the body, mainly due to the fact that the body is in a state of excessive estrogen secretion, causing a simple clinical manifestation of menorrhagia.
Pathophysiology
The corpus luteum generally atrophy after 14 days of survival, and the endometrium falls off due to lack of support of estrogen and progesterone.
Irregular endometrial shedding is caused by hypothalamic-pituitary-ovarian axis regulation dysfunction caused by luteal atrophy, and the endometrium continues to be affected by progesterone, so that it can not fall off intact. On the 3-4th day of the normal menstrual period, the membrane has completely shed during the secretory period and replaced with a membrane of the proliferative period of regeneration. However, when the endometrium is irregularly detached, the endometrium showing a secretory reaction can still be seen on the 5th to 6th of the menstrual period. Because the patient has a long menstrual period, the endometrium loses water, the interstitial becomes dense, the gland shrinks, and the glandular cavity is plum-like or star-shaped.
The endometrium appears as a mixed type, that is, the membrane in the residual secretory phase coexists with hemorrhagic necrotic tissue and newly added endometrium.
Prevention
Endometrial irregular fall prevention
Pay attention to eating and drinking, pay attention to physical health, but also emotional reconciliation, pay attention to mental health.
1. Relieve mental stress. You can engage in some body exercises, such as swimming and running, once or twice a week for 30 minutes each time.
2, eat more decompression dishes, such as bananas, cabbage, potatoes, shrimp, chocolate, ham, corn, tomatoes and so on.
3, menstrual period to prevent cold and avoid moisture, to avoid rain, wading, swimming, drinking cold drinks, etc., especially to prevent the lower body from getting cold, pay attention to keep warm.
4, may wish to add green onions, beans, pumpkin, garlic, ginger, chestnuts, oranges and other foods in the recipe; in addition, vinegar, sauce, vegetable oil, pepper, pepper and other spices and beef stew, chicken broth, are caused by this situation The irregular menstruation has a certain effect.
Complication
Endometrial irregular shedding complications Complications endometritis anemia
Endometritis, anemia.
Symptom
Endometrial irregular shedding symptoms Common symptoms Menstrual blood clots excessive menstrual flow more abdominal pain
The performance of the menstrual interval is normal, but the menstrual period is extended, up to 9-10 days, and the amount of bleeding is large.
Examine
Endometrial irregular fall-off examination
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.
According to the clinical manifestations and the above related examinations, the determination of blood progesterone concentration 5 to 9 days before the help of ovulation-type dysfunctional uterine bleeding.
Diagnosis
Diagnosis and identification of irregular detachment of endometrium
In addition to the typical clinical manifestations, the basal body temperature is biphasic, but the decline is slow. Diagnostic curettage is performed on the 5th to 6th day of the menstrual period. Endometrial biopsy can still see the endometrium that is secreted, and coexists with the membrane during the bleeding period and proliferative phase.
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.
Identification with anovulatory dysfunctional uterine bleeding. If there is irregular bleeding, menstrual bleeding, bleeding after sexual intercourse, or sudden increase in menstrual blood, or pelvic pain, premenstrual abdominal pain, it may indicate organic disease. Whole blood and coagulation function tests are also very important. The adhesion function and aggregation function of platelets are checked to find out whether it is thrombocytopenia. Rarely, uterine arteriovenous fistula is diagnosed by uterine artery angiography. Wilansky (1989) performed TRH stimulation in 67 patients with normal menstrual flow with normal thyroid function. The TSH value of 31 patients with TSH (2.4±0.24) MU/L was (11.5±1.0) MU/L after TRH stimulation, and 16 cases of menstruation continued to exist. In another 15 patients (22%) with TSH (5.9±0.76) MU/L, the TSH peak was as high as (47.5±5.9) MU/L after TRH stimulation, and 8 of them received thyroid tablets, TSH decreased, T4 value Ascending, menstruation is normal for 1 to 3 years. The conclusion is that subclinical primary hypothyroidism may be one of the causes of menstrual flow. If you have obesity, apply non-antagonistic estrogen or tamoxifen, or polycystic ovary syndrome, you should pay attention to the exclusion of endometrial cancer. Fraser (1990) reported hysteroscopy and laparoscopy in 316 patients with more menstrual flow, and 49% of patients had organic disease. Uterine fibroids, endometriosis, endometrial polyps, and uterine adenomy are most common.
