Dysfunctional uterine bleeding is abnormal uterine bleeding due to dysfunction of the hypothalamic-pituitary-ovarian axis, not caused by organic lesions. According to the pathogenesis, it can be divided into two categories: anovulatory uterine bleeding, mostly seen in adolescent and menopausal women, accounting for 70%-80%; ovulatory uterine bleeding, mostly seen in women of childbearing age, accounting for 20%-30%.
Anovulatory dysfunctional uterine bleeding.
Etiology
1. Factors inside and outside the body affect the mutual regulation of the subthalamic-pituitary-ovarian axis through the cerebral cortex and central nervous system, which can lead to menstrual disorders.
Common factors.
(1) excessive mental stress
(2) Environmental changes
(3) Sudden climatic changes
(4) Overexertion
(5) Other systemic diseases
2.Organismal factors affect the synthesis, transport and effect of sex hormones on target organs, which may also lead to menstrual disorders.
Common factors.
(1) Malnutrition
(2) Anemia
(3) Metabolic disorders
(4) Abnormalities of thyroid and adrenal glands
Clinical manifestations
1. Abnormal uterine bleeding.
(1) Excessive menstrual flow;
(2) Frequent menstruation;
(3) Irregular bleeding;
(4) Short-term amenorrhea followed by irregular bleeding.
2.Anaemia of different degrees.
3.Gynecological examination: no organic lesions.
Diagnosis
1.Medical history.
(1) Age, menstrual history, history of marriage and childbirth, contraceptive measures, and the presence of chronic systemic diseases;
(2) Know the onset of the disease: time, bleeding, history of menopause, previous treatment; c. Type of abnormal uterine bleeding.
2. Physical examination: gynecological examination and general examination to discharge organic lesions.
3. Auxiliary examinations: basal body temperature measurement (BBT), vaginal exfoliative cell examination, cervical mucus crystallization, diagnostic scraping, hysteroscopy, hormone measurement (E, P, PRL, FSH, LH, T, etc.). Others: pelvic ultrasound, coagulation, blood loss, urine pregnancy test, etc.
Objectives of diagnostic curettage.
Timing of hemostasis to exclude endometrial lesions.
(1) with or without ovulation – premenstrual period, within 6 hours of menstrual flow
(2) incomplete endometrial shedding —- on the 5th day of menstruation
(3) Irregular bleeding or suspected cancer – scrape the uterus at any time.
Notes on scraping.
(1) comprehensive
(2) the nature of the scraped material
(3) send to pathology.
Treatment
1, general treatment: nutrition, rest; correction of anemia; prevention of infection; elimination of predisposing factors.
2, drug treatment.
Principle: Adolescence: stop bleeding, adjust cycle, promote ovulation; Menopause transition: stop bleeding, adjust cycle, reduce menstrual flow, prevent endometrial lesions.
(1) Hemostasis.
Hormonal hemostasis ( preferred in adolescence): endometrial shedding method (drug scraping); endometrial repair method; endometrial atrophy method.
Scraping to stop bleeding ( preferred during menopause): to exclude organic lesions.
(2) Adjustment of cycle: artificial cycle, oral contraceptives, post-progestational half therapy; 3) Ovulation promotion: clomiphene, HCG, HMG;
3) Surgical treatment.
(1) Diagnostic scraping: stop bleeding and exclude endometrial lesions
(2) Endometrial resection: recalcitrant gonorrhea, contraindicated to perform hysterectomy
(3) Hysterectomy: >40 years old, pathology suggesting atypical endometrial hyperplasia, or serious symptoms, and conservative treatment is ineffective.