dysfunctional uterine bleeding disorder
Introduction
Introduction to dysfunctional uterine bleeding Dysfunctional uterine bleeding is referred to as functional uterine bleeding or dysfunctional uterine bleeding. It is an abnormal endometrial hemorrhage caused by neuroendocrine disorders. It is a non-organic disease and is generally divided into two categories: anovulatory and ovulatory. Anovulatory type is more common, accounting for 80% to 90% of dysfunctional uterine bleeding, often occurring in adolescence and menopause. Ovarian dysfunctional uterine bleeding often occurs at the reproductive age, bleeding is periodic, ovulation but luteal function is insufficient, or the process of atrophy is prolonged, the menstrual cycle is shortened, the menstrual period is prolonged, the blood volume is more or the bleeding is bleeding before and after, often occurs in postpartum, abortion After that, it is related to the incomplete recovery of endocrine function. basic knowledge The proportion of illness: 0.006% Susceptible people: women who are born in the growing period Mode of infection: non-infectious Complications: anemia polycystic ovary syndrome
Cause
The cause of dysfunctional uterine bleeding
Lack of luteal function (25%):
There are follicular development and ovulation in the menstrual cycle, but the progesterone secretion in the luteal phase or the corpus luteum prematurely decline, resulting in poor endometrial secretion.
Endometrial shedding (25%):
That is, because the corpus luteum atrophy, estrogen and progesterone can not be rapidly decreased, the endometrial imbalance due to hormone levels can not be irregularly shedding, so that the bleeding period is prolonged, blood volume is increased, also known as corpus luteum atrophy.
Prolonged endometrial repair (25%):
Due to the endometrial exfoliation during the menstrual period, the new follicles are retarded or poor in the next cycle, and the secreted estrogen is insufficient, so that the endometrium cannot be regenerated and repaired as scheduled, and the menstruation is prolonged.
Ovulation bleeding (25%):
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.
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. The secretory phase changes. If the discharged egg fails to be fertilized, the ovarian corpus luteum degenerates about 14 days after ovulation, and no longer secretes estrogen and progesterone; at this time, the endometrium loses the support of estrogen and progesterone, and shrinks, the spiral artery contracts, and the vein Slow reflux and endometrial ischemic necrosis, causing the functional layer of the endometrium to fall off and go through. At the same time, a thrombus is formed in the end of the spiral artery of the endometrium, and the amount of bleeding is reduced. The new follicular cycle begins and secretes estrogen, which repairs the endometrium and stops bleeding. Therefore, the amount of bleeding in normal menstruation is relatively constant and naturally stops 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. Hyperthyroidism or hypotension during adolescence may be associated with functional uterine bleeding. The experiment found that when the thyroid function is low, the metabolic rate of ovarian cells is reduced, the follicles are poorly developed, and the secretion of estrogen is insufficient. In the human body, when the thyroid function is low, the blood TSH is elevated, which affects the production of gonadotropin, causing anovulation or luteal function. When hyperthyroidism occurs, ovarian hormone secretion increases, the menstrual cycle becomes shorter, or ovulation stops, endometrial hyperplasia is too long, and functional uterine bleeding occurs.
Polycystic ovary syndrome may occur in adolescence, characterized by anovulation, manifested as amenorrhea or functional uterine bleeding. Some cases have a combination of hairy, obese, 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 poor development of the hypothalamic-pituitary-ovarian axis. Mental stimulation or disease tends to cause functional uterine bleeding due to dysfunction of the newly developed hypothalamic-pituitary-ovarian axis.
Prevention
Dysfunctional uterine bleeding prevention
Maintaining good health is the main part of avoiding dysfunctional uterine bleeding.
1. Adolescent health knowledge should be popularized
Let adolescent girls understand about the normal growth and development of 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. Eat more fish, meat, eggs and milk, vegetables, eat spicy spicy food; use iron pot to cook, take iron-containing drugs such as ferrous sulfate oral solution, 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, wash the perineum 1 or 2 times a day to remove blood, and change the menstrual pad and underwear. 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 inflammation and acute infectious diseases. Usually pay attention not to rain and wading, the clothes should be replaced in time to avoid cold intrusion, 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
Dysfunctional uterine bleeding complications Complications anemia polycystic ovary syndrome
More bleeding, longer time, often combined with anemia. Some have thyroid dysfunction, adrenal hyperplasia and polycystic ovary syndrome.
Symptom
Symptoms of dysfunctional uterine bleeding symptoms Common symptoms Lower abdominal bulge, fatigue, weight loss, amenorrhea, irregular vaginal bleeding, loss of appetite, skin, purple pattern, palpitation, breast pain, female periodic nasal congestion and nasal discharge
Patients with anovulatory dysfunctional uterine bleeding can have a variety of clinical manifestations. The most common clinical symptom is irregular uterine bleeding, characterized by a disorder of the menstrual cycle. The menstrual period varies, the amount of bleeding is often less, and even a large amount of bleeding. Sometimes there are weeks or months before menopause, then irregular vaginal bleeding, blood volume is often more, lasting 2 to 4 weeks or more, not easy to stop; sometimes it is irregular vaginal bleeding at the beginning, can also behave It is a periodic bleeding similar to normal menstruation. There is no lower abdominal pain or other discomfort during the bleeding period. Those with more bleeding or longer time are often accompanied by anemia. The gynecological examination of the uterus is in the normal range, and the uterus is soft when bleeding.
Abnormal uterine bleeding classification
According to dysfunctional uterine bleeding abnormal uterine bleeding is divided into:
1. Menorrhagia: Menstrual rules, menstrual extension is greater than 7 days or excessive menstruation is greater than 80ml.
2. Excessive uterine bleeding: irregular period of menstrual period, excessive menstrual flow.
3. Irregular uterine bleeding: irregular cycle, prolonged menstruation and normal menstrual flow.
4. Month frequency: frequent menstruation, shortened cycle, less than 21 days.
Clinical typing
First, anovulatory dysfunctional uterine bleeding is divided into two groups according to age.
(1) Adolescent dysfunctional uterine bleeding: Seen after the menarche, due to the immature HPOU axis, it is impossible to establish regular ovulation. Clinical manifestations of menarche after menarche, short-term menstruation after irregular irregular menstruation, menstrual extension, dripping more than, resulting in severe anemia.
(2) Menopause (perimenopause) dysfunctional uterine bleeding: that is, 40-year-old women to menopausal women before and after menopause, the incidence of anovulatory dysfunctional uterine bleeding increased year by year. The clinical manifestations are: frequent menstruation, irregular cycle, excessive menstrual flow, and prolonged menstruation. 10 to 15% of patients have severe irregular menorrhagia, uterine bleeding and severe anemia. Endometrial biopsy often presents different degrees of intimal hyperplasia, so the diagnosis of scraping is necessary, especially to exclude gynecological tumors (uterine fibroids, endometrial cancer, ovarian cancer, cervical cancer) caused by non-dysfunctional uterine bleeding .
Second, ovulation-type dysfunctional uterine bleeding is most common in women of childbearing age, and some are seen in adolescent girls and menopausal women. The clinical classification is divided into the following types:
(a) ovulation-type menstrual disorders
1. Ovulation type menstrual thinning: seen in adolescent girls. After the menarche, the follicular phase is prolonged, the luteal phase is normal, the period is 40 days, the menstrual thinning and less menstruation, often a precursor to the polycystic ovary, rarely seen in menopausal menopausal women, often progress to natural menopause.
2. Ovulation-type menstrual frequency: Adolescent girls ovarian sensitivity to gonadotropin enhances follicular development, shortening follicular phase, frequent menstruation, but ovulation and luteal phase are still normal. If the patient is a climacteric woman, both the follicular phase and the luteal phase are shortened and early menopause.
(two) corpus luteum dysfunction
1. The corpus luteum is not healthy: the corpus luteum is prematurely degraded, and the luteal phase is shortened by 10 days Clinical manifestations include frequent menstruation, shortened cycles, premenstrual bleeding and menorrhagia, combined with infertility and early abortion. Endometrial pathology is irregular ripening or impaired secretion.
2. The corpus luteum atrophy: also known as prolonged luteal function, that is, the corpus luteum can not completely degenerate within 3 to 5 days, or prolonged degeneration, or continue to secrete a certain amount of progesterone during the menstrual period and cause endometrial irregular detachment ( Irregular shedding). The menstrual period is prolonged and the dripping is not limited. When the corpus luteum is degraded prematurely, it has frequent menstruation and menorrhagia. More common in induced abortion, induced labor, combined with uterine fibroids, endometrial polyps and adenomyosis.
Third, menstrual bleeding: also known as ovulation bleeding. Often accompanied by ovulation pain (intermenstrual pain or mittelschmerz) ovulation stimulation and estrogen fluctuations caused a small amount of bleeding (1 to 3 days) and abdominal pain. Individual bleeding is more frequent and lasts into the menstrual period and forms pseudo-menstrual frequent (pseadopolymenorrhea).
Examine
Examination of dysfunctional uterine bleeding
Physical examination
Including systemic examination, gynecological examination, etc., in order to exclude systemic diseases and genital organic diseases.
Auxiliary diagnosis
1. Diagnostic curettage: In order to exclude endometrial lesions and achieve hemostasis, a full curettage must be performed, and the entire cavity must be scraped. At the time of diagnosis, attention should be paid to the size and shape of the uterine cavity, whether the wall of the uterus is smooth, and the nature and amount of the scraped material. In order to determine the function of ovulation or corpus luteum, the palace should be cured within 6 hours of premenstrual or menstrual cramps; irregular bloody can be cured at any time. Endometrial pathological examination showed that the proliferative phase changes or hyperplasia is too long, and there is no secretory phase.
2. Hysteroscopy: endometrial thickening can be seen under hysteroscopy, but it can also be thickened, the surface is smooth and there is no tissue protrusion, but there is congestion. In the direct observation of the hysteroscopy, the lesion is selected for biopsy. The diagnostic value of the blind endometrium is higher, especially the diagnosis rate of early uterine lesions such as endometrial polyps, uterine submucosal fibroids and endometrial cancer.
3. Basal body temperature measurement: It is a simple and feasible method for measuring ovulation. The basal body temperature is single-phase, suggesting that there is no ovulation.
4. Cervical mucus crystallization examination: The leafy crystal of the fern plant appeared before the ovulation.
5. Vaginal exfoliated cell smear examination: smear generally shows middle and high estrogen effects.
6. Hormone determination: To determine the presence or absence of ovulation, serum progesterone or urinary gestational diol can be determined. In the medical history, the menstrual cycle is often shortened, and abortion occurs during infertility or early pregnancy. Gynecological examination of the reproductive organs is within the normal range. The basal body temperature is biphasic, but the body temperature rises slowly after ovulation, and the increase rate is low, and the rise time only decreases after 9 to 10 days. The endometrium showed poor secretion response.
Diagnosis
Diagnosis and differentiation of dysfunctional uterine bleeding
diagnosis
Mainly based on medical history, physical examination, ovulation measurement and other auxiliary examinations.
Medical history
1. Ask in detail about the age of the child, the history of menstruation, the history of marriage and childbirth, and the contraceptive measures. Whether there is a chronic history such as liver disease, blood disease, thyroid, adrenal gland or pituitary disease, etc., whether there is mental stress, emotional attack, etc. The factors of normal menstruation. Understand the course of the disease, such as the onset time, current bleeding, history of menstruation before bleeding, and past treatment.
Types of
Learn about several types of abnormal uterine bleeding:
1. Menorrhagia: cycle rules, but excessive volume (>80m1) or menstrual extension (>7 days);
2. Frequent menstruation: periodic rules, but shorter than 21 days;
3. Irregular uterine bleeding: irregular cycle, long period of menstrual period is not too much;
(4) excessive uterine irregular bleeding: irregular cycle, excessive blood volume.
Physical examination
Including systemic examination, gynecological examination, etc., in order to exclude systemic diseases and genital organic diseases.
Auxiliary
1. Diagnostic curettage: In order to exclude endometrial lesions and achieve hemostasis, a full curettage must be performed, and the entire cavity must be scraped. At the time of diagnosis, attention should be paid to the size and shape of the uterine cavity, whether the wall of the uterus is smooth, and the nature and amount of the scraped material. In order to determine the function of ovulation or corpus luteum, the palace should be cured within 6 hours of premenstrual or menstrual cramps; irregular bloody can be cured at any time. Endometrial pathological examination showed that the proliferative phase changes or hyperplasia is too long, and there is no secretory phase.
2. Hysteroscopy: endometrial thickening can be seen under hysteroscopy, but it can also be thickened, the surface is smooth and there is no tissue protrusion, but there is congestion. In the direct observation of the hysteroscopy, the lesion is selected for biopsy. The diagnostic value of the blind endometrium is higher, especially the diagnosis rate of early uterine lesions such as endometrial polyps, uterine submucosal fibroids and endometrial cancer.
3. Basal body temperature measurement: It is a simple and feasible method for measuring ovulation. The basal body temperature is single-phase, suggesting that there is no ovulation.
4. Cervical mucus crystallization examination: The leafy crystal of the fern plant appeared before the ovulation.
5. Vaginal exfoliated cell smear examination: smear generally shows middle and high estrogen effects.
6. Hormone determination: To determine the presence or absence of ovulation, serum progesterone or urinary gestational diol can be determined. In the medical history, the menstrual cycle is often shortened, and abortion occurs during infertility or early pregnancy. Gynecological examination of the reproductive organs is within the normal range. The basal body temperature is biphasic, but the body temperature rises slowly after ovulation, and the increase rate is low, and the rise time only decreases after 9 to 10 days. The endometrium showed poor secretion response.
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 can help identify this disease .
2. Abnormal pregnancy and pregnancy complications: such as abortion, ectopic pregnancy, trophoblastic tumor, placental residue, uterine involution, etc., according to the clinical history of pregnancy, blood urinary 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, 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.
