I. Examination items
Functional uterine bleeding, often manifested as excessive menstruation. Adolescent women are prone to this disorder and those who suffer from it are likely to have anemia. Therefore, functional uterine bleeding is not to be taken lightly. Because many women do not know much about this, they often seem confused as to what will happen next before going to the hospital. Therefore, by knowing what needs to be checked for functional hemorrhage, patients can also relax a little and not be so afraid.
Second, patients with meritorious blood, often need to do auxiliary tests are
1.Basal body temperature measurement
(1) Anovulatory type of gonorrhea, the basal body temperature is monophasic
(2) Luteinizing insufficiency The basal body temperature is biphasic, but it rises slowly and the luteal phase is short.
(3) Luteal atrophy with biphasic basal body temperature, but delayed or gradual decrease in temperature.
2.Vaginal exfoliative cell smear examination: to understand the presence or absence of ovulation and luteal condition.
3.Hormone measurement: to understand the presence or absence of ovulation and the condition of the corpus luteum.
4.Diagnostic scraping: Diagnostic scraping can understand the endometrial reaction, exclude intrauterine lesions and achieve the purpose of hemostasis. Adolescents suffering from organic lesions or malignant disease is rare, generally do not need to use diagnostic scraping to assist in the diagnosis; unless serious bleeding or by drug treatment is ineffective before the need to use diagnostic scraping. Scraping is the most rapid and effective method to stop bleeding.
5.Laboratory tests: routine blood, platelet count and bleeding, clotting time to determine the degree of anemia and the presence of blood disorders.
6. Other tests: thyroid, adrenal and liver functions to exclude abnormal uterine bleeding caused by these disorders.
The purpose of these tests is to diagnose the patient’s condition and to provide targeted treatment. Therefore, patients should cooperate with the doctor to do all the tests during the treatment.
III. Diagnosis
The purpose is to determine the etiology, pathology and clinical typing of abnormal uterine bleeding and to exclude bleeding due to organic lesions of the genital tract.
1. Medical history: Carefully inquire about personal developmental and menstrual history (age at menarche, cycle, menstrual period, menstrual flow, accompanying symptoms and signs), etiology and causative factors, onset, treatment process, especially the name, dosage and efficacy of hormones and drugs used, hormone measurement and pathological results of endometrial scraping.
2, physical examination: pay attention to the general nutritional status, the presence of anemia, blood diseases, signs and symptoms of bleeding diseases (bleeding spots, bruises, purpura and jaundice), lymph nodes and thyroid and breast examination. The pelvic and abdominal cavities should be examined for masses and enlarged liver and spleen.
3. Gynecological examination: only ano-abdominal examination should be performed for unmarried women. Married women should be routinely examined by triple diagnosis. Pay attention to the amount, source and nature of bleeding, and the presence of tumors, inflammation, endometriosis and other organic lesions in the cervix, uterus and ovaries. Anal examination should be performed to understand the posterior pelvic and rectal conditions.
Auxiliary examination
The purpose is to understand ovarian function (ovulation and luteal function) and endometrial histopathological changes.
1. Diagnostic scraping: to monitor ovulation, scraping should be performed 1 to 2 days before menstruation or within the first 6 hours of menstruation. To determine the type of gonorrhea, it should be scraped after the fifth day of menstruation. Diagnostic scraping has a double meaning of diagnosis and treatment, so it must be thorough and comprehensive, especially attention should be paid to both sides of the horn of the uterus, scraping out all the materials sent for examination. Except for unmarried girls, diagnostic scraping is a necessary step in the diagnosis and treatment of gonorrhea.
2.Ovulation and luteal function monitoring
(1) Basal temperature: biphasic curve indicates ovulation, shortened high temperature phase (<8 days) or unstable is seen in luteal dysfunction. Monophasic curves suggest anovulation.
(2) Vaginal cytology and cervical mucus function tests: to assess ovulation and luteal function.
(3) Hormone measurement: including: FSH, LH, PRL, E2, P, TO, 17KS, 17OHCS, T3, T4, etc.
(4) Ultrasonography: to observe follicular development, ovulation and luteal conditions, and to exclude ovarian tumors.
(5) Blood and coagulation, fibrinolytic function examination: including hemoglobin, red blood cells, white blood cells, hematocrit, clotting time, prothrombin time, serum iron measurement and bone marrow aspiration if necessary.
(6) Liver and kidney function tests: including: total protein, A/G, transaminases (GOT, GPT, γ-GT) bilirubin, BUN, blood glucose and lipid determination.
V. Treatment
Since there is a difference between adolescence and menopause, the best treatment for meritorious hemorrhage is also different.
1.Treatment of pubertal meritorious blood
The principles of treatment for pubertal meritorious hemorrhage are rapid hemostasis and adjustment to establish normal menstrual cycle after hemostasis, prevention of recurrence and improvement of general condition, correction of anemia, and inability to perform diagnostic scraping. Hormones can be given to stop the bleeding, and sex hormones, i.e. progesterone, are usually used for treatment. However, hormone treatment should be under the guidance of a doctor, and cannot be purchased privately, and hormone treatment should focus on adjusting menstruation after stopping bleeding, and cannot rely on hormone, otherwise it will aggravate endocrine disorder, which is a phenomenon of treating the symptoms but not the root cause. Adjustment of menstruation can be done with traditional Chinese medicine, which has few side effects. Improving dietary habits and living standards, and exercising properly to increase blood circulation are very helpful for treatment.
2.Treatment of menopausal meritorious bleeding
The treatment of menopausal menstrual bleeding should combine endocrine intervention, systemic support therapy and emotional regulation. The treatment principle is to stop bleeding, adjust the cycle, reduce menstrual flow and prevent endometrial lesions.
(1) Hemostasis: The methods of hemostasis for menopausal hematemesis include scraping, progestin endometrial shedding method, synthetic hormone endometrial atrophy method and hemostatic agents. Prolonged hemostasis with progestin therapy can be added with androgens as adjuvant therapy, which can reduce pelvic congestion and enhance uterine tone and reduce bleeding. Testosterone propionate is commonly used for intramuscular injection.
(2) Improve general condition and correct anemia: those with mild anemia can take oral iron, such as ferrous sulfate, blood treasure, etc. Severe anemia (hematocrit less than 60 g/l) should be bed rest, in addition to iron supplements, should also be a small number of blood transfusions, strengthen nutrition, vitamin supplementation. For too long bleeding, additional antibiotics are needed to prevent infection.
(3) Inhibit the growth of endometrium and prevent cancer: Applicable to menopausal gonorrhea with excessive endometrial hyperplasia, or combined with uterine fibroids or endometriosis, such as danazol, endometrium, triamcinolone and gonadotropin-releasing hormone agonists.
(4) Surgical treatment: Applicable to near-menopausal women with endometrial adenomatous hyperplasia, atypical hyperplasia or those whose repeated treatment has failed. Hysteroscopic surgery can be performed to destroy the endometrium in order to avoid hysterectomy, and hysterectomy should be done for those with suspected cancerous changes.
Sixth, Chinese medicine
”Gongblood” belongs to the category of “leakage” in Chinese medicine. The main mechanism of this disease is that it is caused by the damage to the punching point and the inability to fix it. Most of the causes of the damage to the ramifications are blood heat, qi deficiency, qi depression and blood stasis. However, blood heat and qi deficiency are more common. The Ming dynasty doctor Fang Yozhi in the “Danxi Xinfa Attachment” cloud: “the initial use of stopping the blood to plug its flow, the middle of the heat to cool the blood to clarify its source, the final use of blood to restore its old, if only plug its flow without clarifying its source, the monstrous momentum can not be curbed; if only clarifying its source without restoring its old, the orphaned son of the Yang can not be established, so the end is not lost, before and after the disorder, before we can say that the treatment.” Later generations of physicians have adopted the three major rules of treatment advocated by him, namely “blocking the flow”, “clarifying the source”, and “restoring the old” as the three major rules for treating gongblood. The formula can be used: prunus ginseng, rehmannia, mugwort, angelica, cyperus, dry lotus grass, aconite, cyperus, motherwort, decoction with water, and increase or decrease the amount of medicine according to the age and physical weakness.
1.Quickly stop bleeding to treat the symptoms, followed by Chinese medicine to treat the root cause
For patients with heavy bleeding, married patients should undergo curettage, while unmarried patients can be treated with 2ml of progesterone caproate and 2mm of estradiol benzoate intramuscularly, which can stop bleeding within 6 to 24 hours. Later, the drug should be discontinued at the rate of 2ml of progesterone caproate once a week as maintenance dose for 4 weeks. After the hemorrhage is stopped or the blood volume is reduced, the treatment can be based on clinical manifestations and identification. Those with blood heat should clear heat and fix the flush; those with qi deficiency should strengthen the spleen and benefit qi to fix the flush; those with kidney deficiency can supplement the kidney to fix the flush; those with blood stasis use the method of removing stasis and regulating menstruation to clarify the source and fix the root. This approach adopts the respective advantages of Western medicine to stop bleeding quickly and Chinese medicine to have a solid and long-lasting effect, creating favorable timing and conditions for Chinese medicine to treat the root cause while the symptomatic evidence of bleeding is relieved. This combination of Chinese and Western medicine treatment method brings into play the strengths of both Chinese and Western medicine, and the recent and long-term results are more satisfactory.
2. Combined application of qi-enhancing, flushing and hemostatic drugs and antifibrinolytic drugs for adolescent meritorious bleeding
Most of the patients with pubertal gonorrhea are clinically manifested as irregular vaginal bleeding, dripping or accompanied by anemia, but other symptoms are not obvious. The efficacy of Western medicine or Chinese medicine alone is not satisfactory. The bleeding in adolescent gonorrhea is characterized by heavy bleeding and constant dripping. In addition, the increased fibrin lysis products in the serum and menstrual blood of patients with gonorrhea inhibit the apical closure of the endothelial spiral arteries and the coagulation process, resulting in a large amount of bleeding, and the use of antifibrinolytic drugs is often effective. Therefore, the disease can be treated with a combination of beneficial Qi and antifibrinolytic drugs to stop bleeding. The method of Beneficial Qi and Qi Qi Qi fixation to stop bleeding is based on the basic formula of Fixation and Qi Qi Qi Tang. The formula; Atractylodes Macrocephala 20g, Astragalus membranaceus 35g, Bonesetter 20g, Oyster 20g, Paeonia lactiflora 25g, Cyperus rotundus 15g, Haidao 15g, Brown charcoal 25g, Diyu charcoal 25g, Phellodendron charcoal 15g, Artichoke 15g, Red Gynostemma 4Og, Radix et al. 20g. decoction with water. Yunnan Baiyao 1g, 3 times a day with the above medicine to wash; anti-fibrinolytic drugs: hemostatic cyclic acid 0.4g added to 10% glucose solution 40-50ml, intravenous injection. Also can be used Anluo blood 10mg, 2 times a day intramuscular injection, or Anluo blood tablets 10mg, 3 times a day orally. Both therapies are applied simultaneously. This combination of Chinese and Western medicine is more effective in treating adolescent gongblood.
3. Combination of supporting and benefiting Qi and supportive therapy to enhance the body’s ability to resist disease
Patients with prolonged or massive bleeding accompanied by anemia are weak, lacking in positive qi, lacking the right to take in blood, and not being able to consolidate the flush, thus manifesting as bleeding that does not stop and does not heal for a long time. Therefore, it is necessary to protect the positive energy and strengthen the body’s resistance, which is the basis of the treatment of the disease and also a very important means, that is, “if the positive energy exists inside, evil cannot dry up”. Support for positive qi: generally use ten whole tonic soup (pill), eight precious soup, ginseng nourishing glory soup (pill), ginseng spleen soup, ginseng spleen pill; support therapy: use small dose, intermittent transfusion of fresh whole blood, 100-200ml each time, once a week for 3 weeks, both methods at the same time. Through the above treatment, the organism status can be improved, and the next step of treatment on this basis is mostly effective.
VII. Prevention
1, maintain a regular rhythm of life, so that there is tension and relaxation, avoid overexertion. Young girls in adolescence should learn self-restraint, do not stay up all night on the Internet and entertainment, to prevent endocrine disruption due to irregular life and overwork, which will contribute to the occurrence and development of adolescent gonorrhea.
2, pay attention to emotional regulation, avoid excessive tension and mental stimulation. Research shows that the emotional changes of adolescent girls are often greater than other periods in their lives, and emotional fluctuations or mental stimulation is one of the important triggering factors of adolescent gonorrhea. Therefore, during this period, parents should not only pay attention to the girl’s learning and dietary conditions, but also pay attention to the girl’s emotional changes, communicate with her more, understand the changes in her inner world, help her to release bad emotions, so that she can maintain a relatively stable mental state and avoid emotional ups and downs.
3, strengthen the dietary regulation, increase the food rich in protein, iron and vitamins, such as meat, eggs, milk and fresh vegetables, fruits, etc.. A proper diet is good for improving the body’s metabolism and strengthening the body; it is also good for enhancing the hemoglobin content and reducing the degree of anemia.
4, pay attention to the weather changes to add and subtract clothes, bedding, to avoid too cold and too hot cause endocrine disruption of the body and lead to prolonged periods, increased bleeding.