Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding
[Summary]



Dysfunctional uterine bleeding (dysfunctional uterine bleeding, DUB), or reactive blood means because HPOU axis dysfunction, and not for reproductive tract caused by organic disease, menstrual disorder characterized by abnormal uterine bleeding.



[Diagnosis]




Purpose is to determine the cause of abnormal uterine bleeding, pathology and clinical type, and the exclusion of reproductive tract bleeding caused by organic disease.

A personal history of the development and asked in detail about the history and the history of menstruation (menarche age, cycle, menstrual, the amount of accompanying symptoms and signs), etiology and incentives, incidence, diagnosis and treatment, with particular attention to the hormone and the names of the medicines, dosage, effects of hormones and endometrial up scraping the pathological findings.

Second, check the attention of the general nutritional status, whether anemia, blood disease, and disease symptoms and signs hemorrhage (bleeding, siltation grouper, Purpura and jaundice), lymph nodes and thyroid and breast examinations. Pots abdominal tumor and there, such as the liver and spleen is enlarged.

Third, gynaecological examinations for unmarried women only anal belly up. Married women should routinely check up triple. Take note of the amount of bleeding, the source, nature, cervix, uterus, ovary whether tumors, inflammation, endometriosis症等of disease. Anal investigation after pelvic and rectal understanding of the situation.

Fourth, understand the purpose of supporting check ovarian function (ovulation and luteal function) and endometrial tissue pathological changes.

(1) diagnostic curettage: For monitoring period before ovulation should be 1 to 2 days or pass through the first six hours of consultation scratch. Reactive to determine blood type, should be in consultation via the fifth day after the scraping. Attending both clinics scraping double meaning, it must be thoroughly comprehensive, in particular should pay attention to both sides of the cornea, all the scraps of censorship. In addition to unmarried girls, blowing up clinics blood is reactive steps must be carried out.

(B) ovulation and luteal function monitoring

1. Basis of the temperature (BBT): biphasic curve have suggested that ovulation, high-temperature phase shortening (<8 days) or unstable seen luteal dysfunction. Single-phase curve suggested that without ovulation.

2. Vaginal cytology and cervical mucus functions (volume, viscosity, and the drawing of crystalline) Examination: assessment of ovulation and luteal function.

3. Hormone determination:: FSH, LH, PRL, E2, P, TO, 17KS, 17OHCS, T3, T4, etc..

4. Ultrasonography: Observation of follicular development, ovulation and luteal, and the exclusion of ovarian tumors.

(C), and blood coagulation and fibrinolytic function tests include: hemoglobin, RBC, WBC, hematocrit, blood coagulation time, prothrombin time, serum iron determination and, if necessary, examination of bone marrow puncture.

(4) liver and kidney function tests: include: total protein A / G, transaminase (GOT, GPT, γ-GT) bilirubin, BUN, blood glucose and lipid determination.


[Treatment]




According to the patient's age, and the credit blood type, endometrial pathology, fertility treatment requirement of the principles, methods, drugs and monitoring. Reactive blood treatment system include: wipe out the causes and rapid bleeding, menstrual adjustment, recovery and avoid relapse, and so on.

1, no ovulation treatment of DUB DUB adolescence without ovulation to ovulation, the establishment of menstruation, to avoid the recurrence of governance. Reactive blood menopause without ovulation, while containing endometrial hyperplasia induced menopause, prevent cancer as the focus.

(1) bleeding: methods include curettage, and hormone therapy drug

1. Curettage: In addition to unmarried women, regardless of ovulation or ovulation-reactive blood without bleeding, curettage can be quickly and effectively both diagnosis and treatment of bleeding double significance. Curettage should be thorough, sending all the scraps of pathological examination. And in accordance with endometrial pathology in the beginning Tiaojing fifth day after treatment.

2. Hormone: include: estrogen, progesterone and androgen bleeding.

(1) dose estrogen hemostasis: adolescent power only for the less serious blood anemia (Hb ≥ 80 g / L) were. Principle is that large doses of estrogen promote rapid intimal hyperplasia, repair wounds and bleeding. Disadvantage is that large doses, gastrointestinal reactions heavy bleeding after treatment withdrawal, and suppress the hypothalamus - pituitary axis danger, it is less used.

Methods: Yixicifen 2 mg estradiol benzoate or intramuscular injection every 6 to 8 hours 1. The injection of 3 to 4 times (24 to 36 hours) after the cessation of bloodshed reductions. Every three days is decreasing 1 / 3 of the dose rate to 1 mg / d (intramuscular injection or oral), to stop bleeding after 20 days. From the beginning of the fifth day of withdrawal bleeding Tiaojing treatment.

(2) dose progesterone hemostasis: apply to the various age groups reactive blood. Principle is the promotion of secretory endometrium synchronization and bleeding, after stopping a concentration of the withdrawal bleeding.

Methods: ① oral: norethisterone 5.0 to 7.5 mg, or megestrol acetate, and medroxyprogesterone 8 ~ 10 mg. Every four to six hours once. After 3 to 4 times after oral administration (24 to 36 hours) to stop the bloodshed, to one every eight hours, oral. Every three days and then decrease 1 / 3 doses of magnitude to maintain the volume. Norethindrone 2.5 to 5.0 mg / d, or megestrol acetate, and medroxyprogesterone 4 to 6 mg / d in 20 days after stopping bleeding. To prevent breakthrough bleeding, but also compatibility small dose of estrogen such as phenol B Di 0.25 to 0.5 mg / d evening clothes. Withdrawal bleeding from the beginning of the fifth day of Tiaojing treatment; ② intramuscular injection: acid compound has progesterone (progesterone acid 250 mg estradiol valerate + 5 mg / Amp) an intramuscular injection, 1 or 2 days to stop bleeding. 7 ~ 10 days in a further injection of progesterone, acid compound that has completed one cycle of treatment. In order to expedite the bleeding may also add 2 mg estradiol benzoate, or a compound progesterone (progesterone + 20 mg estradiol benzoate 2 mg / Amp). Bleeding after a weekly injection of progesterone compound, three to four times to complete one cycle of treatment. Withdrawal bleeding from the beginning of the fifth day of Tiaojing treatment; ③ drug-curettage: apply to a small hill with the recent massive bleeding and bleeding. Principle is the use of progesterone to endometriosis in the short term and focused on the withdrawal of endocrine. Methods: Progesterone 20 mg / d × 3 to 5 days, after stopping three to five days concentration of natural retreat bleeding stopped. To reduce the amount of bleeding also compatible testosterone propionate-25 ~ 50 mg / d. Or use a triple hormone / d × three day visit of drug curettage. Retreat from the beginning of the fifth day of bleeding Tiaojing treatment.

(3) androgen: only as estrogen and progesterone hemostasis adjuvant therapy to anti-estrogen to reduce congestion and enhance pelvic muscle tone and reduce uterine bleeding, but it can not shorten the bleeding time and complete hemostasis. Adolescent girls cautiously uses. Testosterone propionate-25 ~ 50 mg / d × 3 ~ 5 days per week to 1 or 2 times, cycle a total dose of not more than 300 mg.

3. Drug therapy include: hemostatic and fibrinolytic anti-drug, prostaglandin synthetase inhibitor, coagulation factors, such as blood transfusion and contractions of comprehensive measures.

(1) hemostatic: aimed at improving platelet function, blood coagulation shorten the time and reduce vascular permeability and brittleness, improve microcirculation and stimulate blood. Methods: ethamsylate (dicynone) 250 ~ 500mg intramuscular injection or intravenous infusion; Tongxinluo the blood (adrenosin) 5 ~ 10mg intramuscular vitamin K, C oral.

(2) anti-fibrinolytic drugs: the aim of anti-fibrinolytic and inhibit plasminogen activating factor. Methods: ① 6 - has been Amino acid (EACA) 4 ~ 6g 10% glucose infusion of 100 ml fast (15 to 30 minutes), later renamed the 1 g / h rate maintained, the total daily 6 ~ 12 g; ② aminomethylbenzoic acid (PAMBA) 300 ~ 500mg 10% glucose infusion of 100 to 200 ml per day total of 600 to 1000 mg; ③ bleeding acid (Trans-AMCA) 200 ~ 300mg 10% glucose solution infusion, the total daily of 400 to 600 mg.

(3) prostaglandin synthetase inhibitor: ① indomethacin (indomethacine) 25mg × 3 / d; ② A niflumic acid (acid mefenamice) 250mg × 3 / d; ③ eliminate chlorine acid (acid chlofenamice) 200mg × 3 / d.

(4) coagulation factor and blood transfusion: such as fibrinogen, blood platelet and fresh input. Traditional Chinese Medicine on March 7, Yunnan Baiyao also a good hemostatic effect. Contractions of no significant bleeding.

(B) The adjustment period: the treatment of the bleeding on the basis of simulation reproductive hormone rhythm to estrogen - progesterone cycle of therapy, promote development and endometrial shedding cycle, improve HPO axis feedback function after treatment, there may be anti-jump reconstruction of ovulation and menstrual regularity.

1. Full cycle therapy

(1) female - progesterone sequential therapy: DUB applicable to adolescence. In the beginning of the fifth day menstrual cycle oral Yixicifen 0.5 to 1.0 mg / d × 20 ~ 22 days. Served 10 days plus medroxyprogesterone 8 ~ 10 mg / d, or add the progesterone five days after the 20 mg / d. 1 treatment cycle 3.

(2) female - progesterone combined therapy: apply to reactive blood of childbearing age and menopause, endometrial hyperplasia, who menorrhagia. ① oral contraceptives or Ⅰ, Ⅱ, the tablets (or half-full dose of tablets) from the fifth day of the menstrual cycle oral a / d × 22 days, a total of three cycles. ② medroxyprogesterone Yixicifen 4 mg + 0.5 mg / d or 2.5 mg + Yixicifen norethindrone 0.5 mg / d × 20 ~ 22 days, a total of three cycles.

(3) progesterone therapy: norethisterone 2.5 to 5.0 mg / d; or megestrol acetate, and medroxyprogesterone 4 to 8 mg / d; chlorine and progesterone or 12 mg / d × 20 ~ 22 days. A total of three cycles.

(4) pregnancy - androgen therapy: that is, progesterone therapy on the basis of the daily Des Voeux and methyl testosterone-containing 5 to 10 mg, to strengthen HPOU axis inhibition.

2. Therapy after half cycle: limited to conditioning cycle, supporting luteal, control bleeding. Methods: From the menstrual cycle of 15 ~ 24 days (the latter half cycle) or intramuscularly daily oral estrogen - progesterone for 10 days. Substances, including: ① oral contraceptives or Ⅰ, Ⅱ, the tablets (or half-full dose of tablets) / d; ② norethindrone 2.5 ~ 5.0 mg, or megestrol acetate, and medroxyprogesterone 6 to 8 mg + 0.25 Yixicifen ~ 0.5mg / d; ③ a compound progesterone / d × 5 to 7 days (21 to 25 day cycle).

(C) ovulation induction treatment: apply to adolescence without ovulation-reactive blood, and women of childbearing age DUB hope fertile. Ovulation treatment can be a fundamental measure to prevent the recurrence of blood work.

Ovulation treatment of reproductive hormones as a guide, appropriate choice ovulation induction drugs and Compatibility: ① CC-hCG; ② hMG-hCG; ③ GnRHa pulse therapy; ④ such as bromocriptine therapy.

(D) contain endometrial hyperplasia, prevent cancer, induced menopause, menopause without ovulation for the blood work with endometrial hyperplasia (glandular cyst / adenoma type), or combined uterine myoma, endometriosis of persons. Common drugs and treatments include:

1. Danazol (Danazol) 200mg × 3 / d, oral.

2. Qualcomm in the United States (R2323, Gestrinone) 2.5mg × 2 / week, oral.

3. Tamoxifen (Tamoxifen) 20 ~ 40mg / d, oral.

4.GnRHa 300 ~ 500 μ g × / d, 1H.

More than three drugs are on a course of treatment. When necessary, repeat the treatment.

(5) surgical therapy: suitable for the treatment of hormone or drug ineffective or recurrence. Methods include: microwave hysteroscopy, infrared, and cryosurgery, laser or surgical endarterectomy for microsurgery. Near postmenopausal women, endometrial adenomatous hyperplasia, dysplasia, the merger uterine fibroids, adenomyosis, and severe anemia can be implemented hysterectomy.

Second, ovulation-reactive blood is the treatment of excessive menstrual suppression, supporting luteal function adjustment cycle, relapse prevention.

(1) inhibition menorrhagia: ① full cycle of estrogen - progesterone combined therapy; ② progesterone cycle therapy; ③ pregnant - androgen therapy; ④ androgen therapy: From the beginning of the menstrual cycle fifth day of the oral-methyl-testosterone 10mg / d × 20 ~ 22 days. Or testosterone propionate-25 mg × 2 / week, a total of four weeks; ⑤ the latter half of the estrogen and progesterone combined therapy; ⑥ prostaglandin synthetase inhibitor; ⑦ anti-estrogen - progesterone therapy (danazol, in the United States-three phenoxy amines, etc.).

(B) assist luteal function

1. Ovulation induction therapy for follicular maturation in poor luteal not health, and infertility, habitual abortion. Methods: ① CC-hCG; ② hMG-hCG; ③ pFSH-hCG; ④ GnRHa therapy, etc..

2. Accessory luteal function: apply to non-luteal function and the failure to shrink. Methods: ① hCG therapy: in the period of ovulation hCG5000 ~ 10000IU intramuscular injection, five days after intramuscular injection of 5000 IU accessory Huang. 4,6,8 days after ovulation or daily intramuscular injection hCG2000IU; ② CC therapy; ③ progesterone therapy: the Palace after ovulation progesterone 4 to 8 mg / d × 10 days of oral or BBT began seven days after rising progesterone intramuscular injection 10-20mg / d × 5 to 7 days; ④ after half cycle of estrogen - progesterone combined therapy; ⑤ bromocriptine therapy. Applicable to the merger hyperprolactinemia, from the beginning of the fifth day menstrual cycle oral bromocriptine 2.5 mg / d; ⑥ dexamethasone therapy. Apply to the merger of Kaohsiung hormone hyperlipidemia, 0.5 mg / d.

Third, treatment of uterine bleeding complications often with anemia, hypoproteinemia, malnutrition and, therefore, should strengthen support therapy. In addition, blood work can be the first symptom of certain systemic diseases (such as aplastic anemia, leukemia, idiopathic thrombocytopenic purpura, hypersplenism, cirrhosis of the liver), or deposit with endocrine and metabolic diseases (thyroid, adrenal gland disease, diabetes) and gynaecological diseases (uterine fibroids, endometrial polyps, pelvic congestion disease, polycystic ovary, ovarian tumors, endometrial cancer), the active treatment of the primary disease and complications is very important.


[Etiology:




First, systemic factors, including adverse psychological trauma, stress, malnutrition, endocrine and metabolic disorders, such as iron deficiency, anemia, aplastic anemia and anemia, blood disease and Hemorrhage, diabetes, thyroid and adrenal diseases.

Second, HPO axis dysfunction including reproductive hormone release dysrhythmia, feedback dysfunction, ovulation and luteal function.

Third, uterine and endometrial factors include spiral arteries, microcirculation vascular bed structure and function of abnormal endometrium steroid receptor and lysosomal dysfunction, abnormal partial coagulation mechanism, and prostaglandin TXA2, PGI2 secretion disorders.

4, iatrogenic factors include steroid category contraceptives, intrauterine devices interfering with normal HPOU axis function. Certain systemic diseases, drugs (especially in the spirit of nervous system) to the neuroendocrine effects of normal menstrual function.


[Pathogenesis]




Normal menstrual cycle is a phenomenon clock (biological clock) by the internal and external environmental factors and the impact of the regulation of neuroendocrine to female reproductive physiology, reproductive endocrine function follow strict biological rhythm (biological rhythm), which is a clear circadian rhythms (circadian Rhythm ), on rhythm (lunar rhythm) and the season, such as law. Any interference with menstrual regulation of neuroendocrine factors, which may menstrual disorders and abnormal uterine bleeding.

First, hormone secretion without ovulation reactive blood disorders, a single, long-term estrogen to stimulate progressive endometrial hyperplasia, to a high degree of proliferation of capsule-type adenovirus, adenomatous hyperplasia, or even progress as endometrial cancer. Due to the lack of confrontation and glandular secretion of progesterone, endometrial hypertrophy, increased glands, glandular enlargement, glandular epithelial dysplasia. Endometrial blood flow increased small artery kinking spiral wound. And estrogen caused by acid mucopolysaccharide (AMPS) and gel polymerization, the stromal vascular permeability in the lower material impact on the exchange, causing local tissue ischemia, necrosis and loss caused bleeding, and the concentration of AMPS role, but also prevented from unloading endometrium, endometrial a non-synchronization of exfoliation, causing long-term endometrial irregular bleeding.

Ovulatory DUB, the corpus luteum or premature degradation of a short luteal phase, the frequency of menstruation; incomplete or atrophy, progesterone secretion by continuing luteal phase (as before) bleeding, menstrual extension of the hill more, or both combination. Is the mechanism of estrogen - inadequate secretion of progesterone, especially progesterone secretion insufficient to enable the endometrium entirely secretion of glands, and vascular mesenchymal immature, and because estrogen - progesterone non-synchronization of the withdrawal, resulting in the uterus stripping and abnormal membrane irregular bleeding.

Second, the role of prostaglandin is known prostaglandin (PG), in particular PGE1, E2, F2 α, thromboxane (thromboxane, TXA2) and PGI2 (prostacyclin, PGI2) is a group of strong regulation of vascular function and blood coagulation factors, They regulate the uterine blood, spiral small arteries and circulation, muscle activity and endometrial function and blood clotting lysosome fibrinolytic activity affects five functional endometrial bleeding.

TXA2 in platelet formation, its cause microvascular contraction, platelet aggregation, thrombosis and bleeding. PGI2 in the vascular wall and the formation of a strong and TXA2 expansion microvascular the contrary, anti-platelet aggregation, preventing thrombosis, its activity PGE120 ~ 30 times PGD210 ~ 15 times. PGI2 also inhibit arachidonic acid, ADP, collagen-induced platelet aggregation by, and reverse inner / outer Procoagulant source material caused by the clotting reaction. TXA2 and PGI2 functional coordination and balance of power, is to maintain normal endometrial bleeding and bleeding of the important mechanisms, and the role of the sex hormones, epinephrine to the regulation of neural activity, but also by the uterine muscle contraction activities.

Human muscles of the uterus and endometriosis there are two types of PG receptor (R1 and R2), respectively, and PGE2, a strong affinity PGF2 α, PGA, E diastolic, and PGE2, F2 α microvascular contraction, microcirculation; on the myometrium PGI2, E1, D2 was lax, PGD2, H2 contraction in the role.

Third, endometrial spiral arteries and the structure and function of lysosomes.

Spiral small vascular abnormalities, interference endometrial function of the microcirculation, endometrial function of the impact of shedding and stripping of vascular epithelial repair and affect vascular systolic and diastolic function and partial coagulation fibrinolytic function caused abnormal uterine bleeding.

Endometrial cells function of the lysosomal sex hormone regulation, and a direct impact on prostaglandin synthesis, thereby shedding and bleeding and endometrial related. Endometrial cells are known within the golgi apparatus - lysosome complex (Golgi-lysomal complex) Sulfhydryl hydrolase (acy-hydrolase enzymes), the phospholipase A2 (phospholipase A2), in control of arachidonic acid from Phosphatidyl Coombe Oil release. Once arachidonic acid release, and metabolism of the waterfall activity generated PGE2, F2 α, TXA2, PGI2 affect endometrial structure and function.

Ultrastructural observations confirmed endometriosis: follicular phase to the luteal phase, the number of lysosomes and increased sexual activity. Estrogen and progesterone stability undermine the stability of lysosomal membrane. Therefore, when pre-menstrual lower progesterone, or reactive blood when estrogen / progesterone ratio imbalance, both will undermine the stability of lysosomal membrane, resulting in phospholipase A2 from the lysosome in precipitation released into the cytoplasm of cells (Cytoplasmic cell), arachidonic acid caused activation of a waterfall and PGs. On the other hand the lysosomal membrane rupture destructive enzymes (destructive hydrolases) and the release of precipitation will cause endometrial cells rupture, endometrial layer collapse and necrosis and hemorrhage.

4, coagulation and fibrinolytic system activation observed: DUB often accompanied by coagulation factors Ⅴ Ⅶ Ⅹ, Ⅻ lack of thrombocytopenia, anemia, iron and Minot-Von Willebrand syndrome. At the same time, endometrial plasminogen activation increased and activity of plasminogen activation of plasminogen formation. Cracking plasminogen to fibrin fibrin degradation products (FDP) increased plasma fibrin reduced to the formation of the womb fibrinogen (afibrinogenaemia) state, thereby affecting the normal endometrial spiral arteries and vascular top of the lake (vascular lakes) coagulation and bleeding process, causing long-term massive bleeding.


[Pathological changes:




1, no ovulation-reactive blood endometrial pathological changes

(1) of endometrial hyperplasia:多见. Organizations like the same normal proliferative phase change, but there has been continued in the early (photo 1).



Photos 1 endometrial hyperplasia

(B) gland cystic endometrial hyperplasia: Swiss cheese-also called endometrial hyperplasia. Endometrial hypertrophy was polypoid hyperplasia, increase in the number of glands, glandular enlargement, but different patterns, with a Swiss cheese (Swiss cheese) structure. Columnar epithelium was high and hyperplasia was false or rehabilitation of the complex layers. Interstitial edema, spiral small artery dysplasia, endometrial surface microvascular kinking, congestion, focal necrosis, or bleeding.

(C) adenomas of endometrial hyperplasia: glands substantial increase in the number, sizes, a back-to-back phenomena are closely. Notable glandular epithelial hyperplasia was false or rehabilitation of papillary cavity into the gland, the cell center, deep into the nuclear Pulp clear boundaries, there are dual mitosis (photo 2).



Photos 2 adenomatous hyperplasia of endometrium

(D) atypical endometrial hyperplasia: in the adenoma-proliferation on the basis of epithelial hyperplasia and highly active in mitosis, the nuclear heterogeneity, the nuclear size, dark stained nucleus and cytoplasm unclear boundaries, the ratio Dystrophy (photo 3).



Photos 3 atypical endometrial hyperplasia

Different types of endometrial hyperplasia without ovulation-reactive blood more than 90% of all blood Gong 30.8 ~ 39.4%. (31 documents, 4,850 cases of reactive blood analysis). And that: adenoma-and atypical endometrial hyperplasia and endometrial for precancerous lesions, and this should arouse sufficient attention to clinicians and to impose aggressive treatment.

Second, ovulation-reactive blood endometrial pathological changes

(1) irregular mature endometrium: detection rate of 21%. Luteal function not of health, lack of progesterone secretion. Clinical luteal phase has shortened menstrual frequent. Inspection showed endometrial before menstruation and secretion of secretory endometrium incomplete coexist phenomenon. Characterized by perivascular of normal secretory endometrium, and away from secretion of vascular endothelium incomplete, gland dysplasia, mild bending, glandular epithelial secretory less elongated oval nucleus. Decidual stromal no response.

(2) irregular from dumping endometrium: detection rate of 11%. Luteal insufficiency of atrophy, progesterone secretion contingent of continued lack of menstruation is extended not only the hill. If five days after the bloodshed in endometrial inspection, we can see that degradation secretion of a new phase endometrium and endometrial Health Organization as mixed or both. Secretory response of a plum blossom-shaped gland or stellate. Epithelium cytoplasm rich, transparent, pyknosis, mesenchymal compact, spiral arteries degradation, in some regions there are still bleeding. The images can also be seen and uterine fibroids, endometrial polyps.

3, atrophic endometrium

The detection rate of 1.9 ~ 21.9%, was particularly prevalent in perimenopausal women reactive blood.

Reactive blood when ovarian tissue pathology changes with age and blood type of relevant work. Reactive blood increased adolescent ovarian follicle and retention cysts (d ≥ 3 cm) without a corpus luteum formation, and some of polycystic ovary was not broken luteinized follicular (LUFS) change.

Growth Period normal ovarian blood work, that corpus luteum cyst. Perimenopausal ovarian blood work also showed polycystic ovary change cortex full size follicles or follicular cysts. Examination that mesenchymal cells in a cell hyperplasia.


[Clinical]




To the menstrual cycle disorders and bleeding quantity and nature of change features can be divided into the following types:

First, the lean period (oligomenorrhea) cycle ≥ 40 days of irregular bleeding, accompanied on the less.

Second, the frequency of menstruation (polymenorrhea) cycle ≤ 21 days of irregular bleeding, accompanied menorrhagia.

Third, menorrhagia (hypermenorrhea or menorrhagia) by means of excessive and / or with a regular menstrual extension of cyclical bleeding.

4, irregular menstruation (metrorrhagia) refers to irregular menstrual cycle, and the amount to little.

5. Irregular menorrhagia (menomefrorrhagia) refers to irregular menstrual cycle and with the volume of excessive menstrual prolonged.

Six month after less (hypomenorrhea) means menstrual cycle regularity, only to reduce the amount.

7, the medium-term menstrual bleeding (intermenstrual bleeding) means twice the normal laws of a small amount of bleeding between menstruation and ovulation and ovulation accompanied pain.

Clinical classification

1, no ovulation-reactive blood divided into two groups according to age.

(1) Reactive blood adolescence: girls found after menarche, HPOU axis immature, and can not be established by the laws of ovulation. After the onset of menstruation clinical manifestations dilute hair, short-term post-menopausal menstrual irregularity of the harm excessive menstrual extension of the hill more, a result of severe anemia.

(B) menopause (perimenopause) DUB: ≥ 40-year-old woman to work for women before and after menopause blood, blood work during non-ovulation rate increase every year. Clinical manifestations are as follows: frequent menstrual cycle irregular, the volume of excessive menstrual extension. 10 ~ 15% of the patients had serious abuses menorrhagia, Metrorrhagia and severe anemia. Endometrial biopsy showed varying degrees of more than endometrial hyperplasia, it is necessary to blow up, giving special attention to exclude gynecological tumors (uterine fibroids, endometrial cancer, ovarian cancer, cervical cancer) hemorrhagic bleeding caused by non-reactive .

Second, ovulation-reactive blood found in most women of childbearing age, and some found in adolescent girls and menopausal women. Clinical divided into the following types:

(1) ovulatory menstrual disorders

1. Ovulatory menstrual dilute: found in adolescent girls. After the follicular phase extension of menarche, luteal phase normal cycle ≥ 40 days, and the menstrual Lean on the small, often the sign of polycystic ovary rare in the past menopause postmenopausal women, and often progress to natural menopause.

2. Ovulatory menstrual frequency: adolescent girls gonadotropin sensitivity of the ovarian follicle development而使enhance acceleration, follicular phase shortened menstrual frequent, but ovulation and luteal phase remains normal. If patients menopausal women showed follicular and luteal phase period were shortened and early menopause.

(B) luteal dysfunction

1. Non-luteal: luteal premature degradation, luteal phase shortened ≤ 10 days. Clinical manifestations frequent menstrual cycle shortened by the former menstrual bleeding and excessive, with infertility and early abortion. Endometrial pathology irregular mature (irregular ripening) or secretion of incomplete (imcomplete secretion).

2. Luteal insufficiency atrophy: also known as the luteal function of the extension, that is, not in the luteal 3 ~ 5 days, complete degradation, degradation or time extension, or menstrual period continued in a number of progesterone secretion result of the endometrium from irregular disposal ( irregular shedding). Menstrual extension of the hill more, the merger luteal premature degradation, the frequency of menstrual performance, menorrhagia. Predilection for abortion, induction of labor, combined uterine fibroids, endometrial polyps, and adenomyosis.

Third, the medium-term menstrual bleeding, also known as ovulation hemorrhage. Accompanied ovulation pain (intermenstrual pain or mittelschmerz) of the ovulation-stimulating estrogen and a small amount of bleeding caused by fluctuation of (1 to 3 days), and abdominal pain. Individual and continued to hemorrhage more menstrual period and the formation of pseudo-menstrual frequency (pseadopolymenorrhea).


[Diagnosis]




Designed to remove organic diseases caused by abnormal uterine bleeding. Different age women of abnormal uterine bleeding due to:

1, newborn and young girls view

The impact of estrogen mother

Grape-sarcoma

Ovarian Cancer

Injury

Infection

Foreign Bodies

Second, puberty

Mental trauma, stress

Hypothalamus - pituitary - premature ovarian axis

Luteal dysfunction

Malnutrition

Third, growth period

(1) Pregnancy complications

Ectopic Pregnancy

Missed placenta, the placenta polyps

Abortion

Trophoblastic disease (hydatidiform mole, invasive hydatidiform mole, choriocarcinoma)

(B) No ovulatory

CENTRAL: nervous system tumors, trauma

Endocrine: thyroid disease, adrenal disease metabolic diseases

Gonad: Polycystic Ovary

Target organs: endometrial hyperplasia

Organic disease: functional ovarian tumor

(C) ovulatory

Frequency of menstruation (follicular or luteal phase of shortening)

Endometrium from irregular disposal

Blood coagulation and fibrinolytic system abnormalities

Luteal sustained syndrome (Halban's syndrome)

Iatrogenic factors (anticoagulant drugs. IUD)

Organic lesions (tumors, inflammation, submucosal fibroids)

4. Menopause

Endometrial cancer

Cervical cancer

Cervical polyp

5. Postmenopause

Exogenous estrogen

Cervical cancer

Endometrial cancer

Ovarian Cancer

Atrophic Vaginitis