Dysfunctional uterine bleeding is a modern medical term for abnormal uterine bleeding caused by ovarian dysfunction, not caused by reproductive tract pathology, and characterized by menstrual disorders. It is referred to as “gongbao”. It is often manifested as loss of normal menstrual cycle, excessive menstrual flow, prolonged menstrual period, or even irregular vaginal bleeding, which can lead to anemia in serious cases. Any factor inside or outside the body that affects the regulation of any part of the subthalamic-pituitary-ovarian axis can lead to menstrual disorders.
The former is a disorder of ovulatory function, which is common in adolescence and menopause; the latter is a disorder of luteal function, which is common in women of reproductive age. The main symptoms are menstrual cycle disorder, increased menstrual flow, prolonged bleeding time and dripping.
Modern medicine believes that the body is affected by internal and external factors, such as excessive mental stress, environmental and climatic changes, poor nutrition or metabolic disorders, which can interfere with the mutual regulation and control of the hypothalamic-pituitary-ovarian axis through the cerebral cortex. When this relationship is malfunctioning, it suddenly manifests itself in ovarian dysfunction, which affects the endometrium and leads to dysfunctional uterine bleeding. According to Chinese medicine, “the kidney is the master of reproduction”, “the kidney is the source of life”, and “the meridian is based on the kidney”, so dysfunctional uterine bleeding is mostly closely related to the kidney, and also has some connection with the liver, spleen and blood stasis. It is also related to the liver, spleen and blood stasis.
For example, in adolescent patients, the bleeding should be stopped first, and after that, cycle therapy should be performed to induce ovulation and restore ovarian function, but only under the guidance of a doctor.
In married women, if it is difficult to be controlled by medication, scraping can be considered. In about half of the patients, the symptoms can often be relieved after scraping. The treatment can destroy ovarian function and cause permanent amenorrhea, but it has a great impact on systemic metabolism and should not be used as a last resort.
Clinical typology.
The anovulatory type is divided into two groups according to age.
(a) Adolescent gonorrhea: seen in post-menarcheal girls, due to immaturity of the HPOU axis and inability to establish regular ovulation. Clinical manifestations include sporadic menstruation after menarche, sudden onset of irregular menstruation after a short period of menopause, prolonged periods and dripping, resulting in severe anemia.
(B) Menopause (perimenopause): women ≥ 40 years old to women before and after menopause, during which the incidence of anovulatory hemorrhage increases year by year. The clinical manifestations are: frequent menstruation, irregular cycles, excessive menstrual flow and prolonged periods.
Ovulatory type of functional hemorrhage is mostly seen in women of childbearing age. It is clinically classified into the following types.
(a) Ovulatory menstrual disorders
1. Ovulatory menstrual disorders: seen in adolescent girls. The follicular phase is prolonged after menarche, the luteal phase is normal, the cycle is ≥40 days, and menstruation is sporadic and scanty, often as a precursor of polycystic ovaries. This condition is rarely seen in menopausal women near menopause and often progresses to natural menopause.
2. Ovulation type frequent menstruation: Ovarian sensitivity to gonadotropins is increased in adolescent girls, resulting in accelerated follicular development, shortened follicular phase and frequent menstruation, but ovulation and luteal phase are still normal. In menopausal women, the follicular and luteal phases are shortened and menopause is early.
(II) Luteal dysfunction
1. Luteal failure: premature degeneration of the corpus luteum and shortening of the luteal phase by ≤10 days. Clinical manifestations are frequent menstruation, shortened cycle, premenstrual bleeding and excessive menstruation, combined with infertility and early miscarriage.
2. Luteal atrophy: also known as prolonged luteal function, i.e. the corpus luteum does not degenerate completely within 3-5 days, or the degeneration time is prolonged, or the endometrium continues to secrete a certain amount of progesterone during menstruation and the endometrium is irregularly dislodged. If the menstrual period is prolonged and dripping, or if the corpus luteum degenerates prematurely, the menstrual period will be frequent and excessive. Most often seen after abortion, induction of labor, combined with uterine fibroids, endometrial polyps and adenomyosis.
(iii) Mid-menstrual bleeding, also known as ovulatory bleeding. It is often accompanied by ovulation pain, caused by small amount of bleeding (1-3 days) and abdominal pain due to ovulation stimulation and estrogen fluctuation. In some cases, the bleeding is more frequent and continues into the menstrual period, resulting in pseudo-frequent menstruation.
Diagnosis.
The gynecological examination of meritorious hemorrhage is usually not special, the uterus is normal in size, and ultrasound examination is not abnormal. The basal body temperature (BBT) of anovulatory type is monophasic; BBT of ovulatory type is biphasic.
Treatment points.
Adolescence is based on adjusting menstruation to promote ovulation; fertility is based on adjusting menstruation to complement luteal function; menopause is based on reducing bleeding to induce menopause.
Treatment: Acupuncture, diet, medication, physical therapy and surgery are the main therapies.
(I) General treatment
Relieve the patient’s ideological concerns, pay attention to nutrition and correct anemia. During the bleeding period, attention should be paid to proper rest to avoid mental tension, overexertion or strenuous exercise and to prevent infection. If there is a lot of bleeding, the patient should rest in bed to reduce pelvic bleeding, and take uterine contraction drugs and hemostatic drugs. If there is anemia, take blood supplements. In case of serious anemia, blood transfusion should be considered if available.
(B) Stop bleeding
1, scraping for married women the best way to stop bleeding, after scraping the uterus can be reduced or stop bleeding, scraping the uterus to strive for complete clean. After scraping the first owe menstruation may increase, should be noted.
2.Sex hormone hemostasis
(1) functional uterine bleeding in adolescence: mostly anovulatory type, estrogen hemostasis is the main treatment, such as the application of oestradiol.
(2) Functional uterine bleeding in women of childbearing age: it is common in childbearing age to have a small amount of continuous bleeding due to luteal insufficiency.
(3) Functional uterine bleeding during menopause: after scraping the uterus to exclude malignant changes of the uterine ostium, choose to use gynecomastia tablets combined with haloestradiol, or one triple hormone intramuscular injection, and if the blood volume is still not controlled at 24 hours, organic lesions should be considered.
3.Antifibrinolytic treatment
(C) Adjustment of menstrual cycle
(iv) Ovulation promotion therapy
(V) Surgical treatment
Hysterectomy should be performed for those who are older, have severe anemia, have ineffective medication or curettage, or have atypical hyperplasia of the endometrium as proven by pathology.
Chinese medicine treatment of meritorious blood
The main manifestations of this condition are shortened menstrual cycle, heavy menstrual flow and long menstrual period. It belongs to the category of menstrual disorders in Chinese medicine, such as pre-menstruation, heavy menstruation and prolonged menstruation. For adolescent and fertile menstrual bleeding, the principle of treatment is to tonify the kidneys, promote ovulation and regulate the cycle, while for menopausal menstrual bleeding, the main treatment is to regulate menstruation, stop bleeding and promote menopause, combined with Chinese medicine.