There are many women who have been troubled by menstrual problems. So let’s talk about it with you. Menstrual disorders broadly include amenorrhea and irregular vaginal bleeding. I have previously written about “Amenorrhea” and “What if my period doesn’t come on time? and “What if I don’t get my period on time? Today, we will only talk about irregular vaginal bleeding. Irregular vaginal bleeding includes bleeding from the vaginal wall, bleeding from the cervix, and abnormal uterine bleeding. When you go to the gynecologist, you will first need a gynecological examination. Bleeding from the vaginal wall can be seen, usually after trauma or violent sex, and a timely vaginal wall repair can be performed. Cervical bleeding, which is usually caused by cervical lesions, will be seen by carefully following the medical history, basically every bleeding is after intercourse. This is when a cervical TCT or scraping is needed, and HPV testing for women over 30 years old. If there is a problem, further colposcopy and possibly a cervical biopsy will be done. The pathology results are then used to make a diagnosis and decide on the next course of treatment. The most complicated one is abnormal uterine bleeding. The 8th edition of the textbook “Obstetrics and Gynecology” says that the normal menstrual cycle is 24-35 days, the period lasts 2-7 days and the average blood loss is 20-60 ml. Anything that does not fall within these criteria is considered abnormal uterine bleeding. Remember, whenever your period is abnormal, you can first rule out the possibility of pregnancy by yourself if you have had sex in the last two months. If you get a positive pregnancy test on your own, it is recommended to go to the hospital as soon as possible. The cases of non-pregnancy discussed here include the following: i. Small amount of bleeding in between two periods. In this case, first consider an ultrasound to rule out endometrial polyps, and if not, then consider the diagnosis of ovulatory bleeding. The treatment is simple, except for polyps found to be larger than 25px, which are indicated for hysteroscopic treatment, others (those with uterine polyps smaller than 25px or those without uterine polyps) can be treated with the second half cycle of progesterone for 3 cycles. That is, 15 days of oral progesterone starting on the 15th day of menstruation. Second, before and after menstruation are dark in color and low in volume for more than 2 days, feel unpleasant to come and go unclean. This situation has a high possibility of luteal insufficiency. Test method: The diagnosis is established if the progesterone is less than 10ng/ml one week after ovulation. To get this result, two steps are needed. The first step is to determine the day of ovulation, either by going to the hospital to monitor ovulation (estimated to require at least 2 visits), or by taking urine LH test strips yourself. The second step is to go to the hospital for a blood test for progesterone one week after the day of ovulation. If you don’t have time to go to the hospital, you can start taking basal body temperature by yourself after your period clears and you can see after drawing a graph that if the high temperature period is less than 10 days, you are considered to have insufficient luteal function. The treatment is the same progesterone after half cycle treatment method, progesterone oral 15 days after ovulation, 3 consecutive cycles. The next menstruation will be cool! Third, the menstruation has been unclean, low volume, dragging on for more than a week. This situation is more complicated. Many kinds of possibilities: it is recommended to first perform ultrasound examination. If ultrasound examination suggests uneven endometrial echogenicity or small endometrial polyps, it is recommended to treat 3 cycles after half cycle of progesterone; if there is a history of cesarean section, no other findings, only suggesting uterine diverticulum, it is recommended to treat 3 cycles of oral short-acting contraceptive pill. Fourth, the menstrual flow is heavy and never clears. In this case, the patient may be anemic in severe cases. Ultrasound examination is recommended to exclude submucosal fibroids, intermyometrial fibroids compressing the endometrium, and endometrial echogenic disturbance (which may suggest benign or malignant endometrial lesions). Then women over 45 years of age or with endometrial lesions under consideration are advised to have hysteroscopy plus diagnostic curettage, or if bleeding persists too much for hysteroscopy to be performed, direct diagnostic curettage, which can stop the bleeding and the endometrium can also be examined pathologically. for women under 45 years of age, oral short-acting contraceptive pills or gynecological tablets can be taken first to stop the bleeding. Surgery is performed at a later date after the fibroids have stopped bleeding. If the fibroids are too large, surgery is recommended after short-term treatment with medication.