Dysfunctional uterine bleeding is the abbreviation for dysfunctional uterine bleeding, which is caused by dysfunctional hypothalamic-pituitary-ovarian axis rather than organic pathology. It can be divided into two main categories: anovulatory and ovulatory hemorrhage. The former is mostly seen in adolescent and menopausal women, while the latter is mostly seen in women of reproductive age.
Anovulatory hematemesis
The hypothalamic-pituitary-ovarian axis is not yet mature in adolescent women with anovulatory dysfunction, so they cannot establish a stable menstrual cycle. In addition, adolescent girls are in a period of physiological and psychological changes, and the hypothalamic-pituitary-ovarian axis is susceptible to the influence of multiple factors in the internal and external environment, resulting in irregular uterine bleeding of varying duration and amount, which may even lead to anemia and shock. In women with menopausal transition, ovarian function is gradually declining and follicles are about to be exhausted, so ovulation does not occur, resulting in clinical disorders of the menstrual cycle.
Ovulatory hematemesis
Most often seen in women of reproductive age, the patient has ovulation but abnormal luteal function. There are two common types: luteal insufficiency and irregular shedding of endometrium; clinical manifestations are shortened menstrual cycle, frequent menstruation, sometimes normal menstrual cycle but prolonged follicular phase and shortened luteal phase, women of reproductive age manifest infertility or miscarriage.
General treatment.
The first line of treatment is pharmacological treatment. In adolescent gonorrhea, hemostasis and adjustment of the menstrual cycle and ovulation promotion are the main treatments. For example: sex hormones to stop bleeding, estrogen and progesterone sequential establishment of artificial cycle, oral contraceptives and ovulation-promoting drugs, if drug therapy is ineffective, endoscopy is performed if there is a lot of bleeding; menopausal transition patients to stop bleeding, adjust the menstrual cycle, reduce the volume of menstruation and prevent endometrial lesions. Commonly used menstrual regulating drugs include Clomid, Tocopherol, Daying-35, Mafulon, Gynecomastia tablets, etc.
Surgical treatment.
For patients with poor results of medication, those older than 35 years old, those without fertility requirements, and especially those with moderate to severe anemia should undergo surgical treatment to stop bleeding completely and once and for all. First, diagnostic segmental scraping of the endometrium should be performed to exclude malignant lesions of the endometrium. Both hysteroscopic endometrial electrosurgery and hot bulb treatment can achieve ideal results.
1.Scraping: It is suitable for those with long duration of disease, poor drug treatment, acute hemorrhage or considering the existence of high risk factors for endometrial cancer, which can stop bleeding and obtain specimens for pathological diagnosis.
2.Hysteroscopic endometrial resection: Using hysteroscopic methods such as metal ring, laser, rolling ball electrocoagulation or heat therapy, the endometrium is completely removed or the endometrial tissue is coagulated or necrosed under the microscope. It is suitable for patients with heavy menstrual flow, menopausal transitional uterine bleeding and those who have failed hormonal treatment and have no fertility requirements.
(1) Hysteroscopic endometrial resection: hysteroscopic excision with circular electrodes or heat with sufficient power to necrosis the whole endometrial cells under direct view is still the most commonly used and most effective method of endometrial removal. After surgery, 90% of patients do not have menstrual periods, and those who do have menstrual periods have very few and gradually decreasing amounts. It does not cause the ovarian function to diminish and premature aging.
(2) Microwave and thermal ball endometrial resection: It has been applied since the late 1990s, including: freezing, radiofrequency, circulating hot water, laser, microwave, thermal ball system and photodynamic therapy. It has the advantages of shorter operation time than hysteroscopy, blind operation and outpatient treatment, etc. The disadvantages are more obvious postoperative pain and high incidence of blood accumulation in the uterine cavity. Contraindications are that the uterine cavity is too large, too small or has occupying lesions.
3.Hysterectomy: Patients with poor efficacy by drug treatment, especially those aged 40 years or older and with endometrial pathology diagnosed as endometrial complex hyperplasia or even with atypical hyperplasia, may choose hysterectomy after informed choice by the patient and family.
(1) Laparoscopic hysterectomy: it has the advantages of minimally invasive, fast postoperative recovery and few complications, and the technique is now mastered by experienced laparoscopic specialists.
(2) Transvaginal hysterectomy
(3) Open hysterectomy: traditional surgical approach without minimally invasive features, long postoperative recovery time and more postoperative discomfort than minimally invasive procedures such as laparoscopy.
Ovulatory uterine bleeding.
Diagnostic curettage can be performed on the 5th-6th day of menstruation, and progesterone and chorionic gonadotropin treatment can be used after excluding organic lesions. Preferred progestin therapy is to regulate menstruation.
If you are a patient with meritorious hemorrhage, have severe anemia and no more fertility requirements, you can come to our hospital for hysteroscopic endometrial electrosurgery. This procedure is economical, minimally invasive, with exact results, preserves the uterus, does not affect ovarian function, and has high postoperative satisfaction.