uterine bleeding
Introduction
Introduction Uterine bleeding is physiological and pathological. Physiological uterine bleeding is a normal category. It is a cyclical physiological reaction of the body. There are many reasons for pathological uterine bleeding. In addition to common functional uterine bleeding, there are many cervical diseases. It can cause uterine bleeding, which must be taken seriously.
Cause
Cause
There are many causes of uterine bleeding, such as uterine lesions, uterine fibroids, cervical lesions, uterine malignancies, etc.; if the uterus is normal, irregular intimal detachment can also cause bleeding, caused by endocrine disorders, such as excessive tension, Excessive fatigue, environmental changes, metabolic diseases, malnutrition, etc.; long-term use of anticoagulant drugs, hormone replacement after menopause can also cause abnormal uterine bleeding.
1. Cervical tumor: When suffering from cervical cancer, when the tumor invades the interstitial blood vessels, it can cause vaginal bleeding, and begins to be contact bleeding. Later, it develops into a small amount of irregular vaginal bleeding, and the amount of late bleeding increases, even massive bleeding.
2, cervical inflammation: cerebral polyps, cervical erosion sometimes vaginal bleeding, mostly vaginal bloodshot, and mostly contact bleeding. When suffering from cervical tuberculosis, the diseased tissue can be ulcerated, the ulcer surface is ruptured, leading to bleeding; sometimes the diseased tissue is nodular, papillary, and is prone to bleeding due to its crisp texture.
3, vaginal bleeding caused by organic diseases: by vulvar, vaginal injury, can cause vaginal bleeding. In addition, cancer and benign tumors, such as uterine fibroids, uterine adenomas, ovarian tumors with hormone secretion, etc. can also cause vaginal bleeding. Sometimes urethral prolapse can also cause bleeding.
4, women of childbearing age, vaginal bleeding may be caused by improper birth control measures, such as oral contraceptives, progesterone, etc., or caused by pregnancy complications, such as placenta previa. In addition, ectopic pregnancy, hydatidiform mole, endometriosis, cancer, etc. can cause vaginal bleeding.
Examine
an examination
Related inspection
Gynecological Ultrasound Examination Endocrine Function Test Latex Agglutination Inhibition Test (LAI)
1. Physical examination: development and nutritional status with or without anemia, systemic skin and mucous membranes with or without yellow staining and bleeding points, hemorrhagic purpura, blood pressure, pulse.
2. Gynecological examination: If there is vaginal bleeding, it should be sterilized and examined when it is checked. If it is unmarried, it should be examined by anal. Care should be taken to exclude bleeding associated with pregnancy, as well as bleeding from inflammation, tumors, etc.
3. Laboratory tests: blood routine, platelet count, out, clotting time, reticulocyte count, liver function, urine pregnancy test if necessary, blood hCG.
4. Auxiliary inspection:
(1) Determination of basal body temperature to understand the presence or absence of ovulation and corpus luteum function.
(2) cervical mucus crystallization and vaginal exfoliation cell examination, to understand estrogen levels, with or without progesterone.
(3) Determination of estrogen and progesterone levels and gonadotropin levels in blood.
(4) Thyroid function T 3 , T 4 , TSH and other tests.
5. Diagnostic curettage: Diagnostic curettage is recommended for patients with more bleeding, conservative treatment, or inability to exclude endometrial lesions. Surgical segmentation should be performed during the operation, pay attention to the size, shape, smoothness of the uterine cavity, and the nature of the scraping. Should be fully cured, the bilateral uterine horns should not be missed, if necessary, can be operated under the guidance of hysteroscopy. In order to understand the presence or absence of ovulation, corpus luteum function and endometrial tuberculosis, it can be cured within 12 to 24 hours of menstrual cramps; suspected endometrial irregular desquamation corpus luteum atrophy, can be cured on the fifth day of menstrual cramps; Irregular bleeding or long bleeding time can be used to fight the infection without any time.
6. Hysteroscopy: can be found in the uterine cavity with or without polyps, submucosal small fibroids, etc., and can be treated at the same time.
Diagnosis
Differential diagnosis
Gynecological diseases that cause uterine bleeding:
First, cervical lesions
1. Cervical tumor: When suffering from cervical cancer, when the tumor invades the interstitial blood vessels, it can cause vaginal bleeding, and begins to be contact bleeding. Later, it develops into a small amount of irregular vaginal bleeding, and the amount of late bleeding increases, even massive bleeding.
2, cervical inflammation: suffering from cervical polyps, cervical erosion sometimes cause vaginal bleeding, mostly vaginal bloodshot, and mostly contact bleeding. When suffering from cervical tuberculosis, the diseased tissue can be ulcerated, the ulcer surface is ruptured, leading to bleeding; sometimes the diseased tissue is nodular, papillary, and is prone to bleeding due to its crisp texture.
Second, vaginal diseases
1. Vaginal tumor: When a tumor such as vaginal cancer occurs in the vaginal wall, the surface of the tumor may be necrotic or ulcerated due to infection, causing irregular bleeding of the vagina, and the amount of bleeding is generally small.
2, vaginal injury: vaginal foreign body can damage the vaginal wall caused by bleeding; postmenopausal women due to vaginal wall faint, sexual life may also cause damage, leading to vaginal bleeding. These conditions generally have a relatively clear medical history.
3, vaginal inflammation: For example, when severe fungal vaginitis occurs, the vaginal mucosa can be covered with a white membrane, wipe it off and see the vaginal wall has a superficial ulcer surface or erosion surface, the ulcer surface can have bleeding. Patients were often accompanied by genital itching and bean dregs-like vaginal discharge. In the case of senile vaginitis, the patient's vaginal wall may have a small bleeding point, or ulceration and bleeding, the general amount is very small, mostly with blood in the vaginal discharge, accompanied by genital itching.
Third, cervical diseases
1. Cervical valgus: The cervix tears during childbirth, induction of labor, and abortion. If it is not repaired in time, the scar tissue will contract in the future and the cervix will be everted. If the infection is combined and chronic cervicitis is formed, there may be contact bleeding.
2, cervical polyps: generally from the cervical mucosa, for the accumulation of cervical mucosa, more than inflammation is the formation of polyps. Polyps are usually soft, bright red, and fragile. Polyps often have no obvious symptoms at very low hours and may be found when gynaecological examinations are performed for other gynecological diseases. Larger polyps can cause increased vaginal discharge, bloody vaginal discharge or contact bleeding, especially after sexual activity or stool exertion. These symptoms are similar to early cervical cancer.
3, cervical erosion: This is the most common cause of cervical contact bleeding. Cervical erosion is a common local feature in the process of chronic cervicitis and is a manifestation of infection of the cervix. During the cervix inflammatory period, there will be more purulent discharge, soaking the epithelium around the outer mouth of the cervix, causing it to lose vitality and fall off, eventually forming an ulcer surface, which will cause bleeding.
4. Cervical leukoplakia: A white opaque patchy lesion that appears in the uterine neck. The cause is not well understood and may be related to endocrine disorders, stimulation of chronic cervicitis, and effects of vaginal trichomoniasis. In recent years, it has also been found that the occurrence of cervical leukoplakia may be related to cervical cancer. Simple leukoplakia often has no obvious symptoms. If there is cervical erosion or endometrial valgus, the vaginal discharge increases, or occasionally vaginal blood secretions and contact bleeding.
5, cervical cancer: is one of the common cancers in women. Contact bleeding may be its earliest clinical manifestation and is often found after sexual intercourse or during vaginal examination. This kind of bleeding is generally very irregular, and the amount is also less and less, so you should be vigilant.
Fourth, uterine lesions
1. Intrauterine device: Irregular vaginal bleeding is one of the complications of intrauterine devices. This is due to the mechanical compression of the intrauterine ring, which causes local damage, necrosis and superficial ulceration of the endometrium.
2, endometriosis, uterine muscle adenopathy may also appear irregular vaginal bleeding.
3, uterine tumor: uterine fibroids can not only hinder the contraction of the uterus to stop bleeding, but also enlarge the uterine cavity area due to the protrusion of the fibroids to the uterine cavity, the uterine cavity deformation, affecting the normal fall of the endometrium; submucosal uterine muscle Tumors are also prone to necrosis and infection. These reasons may lead to more menstrual flow, or prolonged menstruation, or irregular vaginal bleeding. Endometrial polyps can also cause these symptoms by increasing the area of the endometrium or secondary infection. Furthermore, when suffering from endometrial cancer or uterine sarcoma, a small amount of irregular vaginal bleeding or postmenopausal uterine bleeding may occur.
4, endometrial inflammation: suffering from acute endometritis, endometrial congestion, edema, severe endometrial surface can form ulcers, resulting in excessive menstrual flow, or vaginal bleeding dripping; chronic endometritis patients The regeneration and repair of the endometrium is also affected, resulting in increased menstrual flow or prolonged menstruation, or irregular vaginal bleeding. In addition, when suffering from endometrial tuberculosis, the endometrium can be destroyed, the surface ulcers, causing irregular bleeding in the vagina.
5, dysfunctional uterine bleeding: more common in adolescent and menopausal women. The performance is abnormal during the menstrual cycle and menstrual period. The bleeding can be frequent for a long time, sometimes there is no, and even dripping is not enough. 90% of the patients were anovulatory dysfunctional uterine bleeding. The causes of dysfunctional uterine bleeding are fatigue, emotional stress, environmental changes and other factors that interfere with the coordination mechanism between the hypothalamic-pituitary-ovarian axis of the human body, causing dysfunction of the ovary and disorder of sex hormone secretion, resulting in the cycle of the endometrium. Sexual changes are abnormal.
Menstruation loses its normal and regular cycle, replaced by excessive frequency of different frequencies, prolonged menstruation, or manifested as irregular uterine bleeding, when the flow stops, the blood volume is also less and less. Anovulatory blood supply is generally painless, often accompanied by anemia when excessive blood loss.
