Dysfunctional uterine bleeding (DUB), abbreviated as gonorrhea, refers to abnormal uterine bleeding due to dysfunction of the HPOU axis (Hypothalamus-pituitary-ovarian-uterus
axis, i.e. hypothalamus-pituitary-ovarian-uterus axis (HPOU) dysfunction, not due to organic lesions of the reproductive tract, and characterized by abnormal uterine bleeding due to menstrual disorders.
It is characterized by menstrual cycle disorders and changes in the quantity and nature of uterine bleeding, and can be divided into the following types.
1. Irregular uterine bleeding with sporadic menstrual cycles ≥ 40 days, often accompanied by menorrhagia.
2. Irregular uterine bleeding with frequent menstrual cycles ≤ 21 days, often accompanied by excessive menstruation.
3.Menorrhea refers to regular cyclic uterine bleeding with excessive menstrual flow and/or prolonged menstrual period.
4.Irregular menstruation refers to irregular menstrual cycle without excessive menstrual flow.
5.Irregular excessive menstruation refers to irregular menstrual cycle with excessive menstrual flow and prolonged menstruation.
6.Low menstruation refers to those who have regular menstrual cycle and only reduced menstrual flow.
7.Midmenstrual bleeding refers to a small amount of uterine bleeding between two regular menstrual periods, often accompanied by ovulation and ovulation pain.
The clinical typology can be divided into anovulatory uterine bleeding, ovulatory uterine bleeding and mid-menstrual bleeding (ovulatory bleeding).
I. Anovulatory meritorious hemorrhage is divided into two groups according to age.
1. Adolescent gonorrhea: seen in young girls after menarche, due to immaturity of HPOU axis and inability to establish regular ovulation. Clinical manifestations include sporadic menstruation after menarche, irregular menstruation after a short period of menopause, prolonged menstruation and dripping, resulting in severe anemia.
2, menopause (perimenopause) meritorious hemorrhage: that is, ≥ 40 years old women to women before and after menopause meritorious hemorrhage, during which the incidence of anovulatory meritorious hemorrhage increases year by year. The clinical manifestations are: frequent menstruation, irregular cycles, excessive menstrual flow and prolonged menstrual periods. 10-15% of patients present with severe irregular menstrual flow, avalanche and severe anemia. Endometrial biopsies mostly show varying degrees of hyperplasia, so scraping is necessary. Particular attention should be paid to exclude gynecologic tumors (uterine fibroids, endometrial cancer, ovarian cancer, cervical cancer) causing non-meritorious uterine bleeding.
Ovulatory uterine bleeding is most commonly seen in women of childbearing age, and partly in adolescent girls and menopausal women. 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.
2. Ovulatory type of 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.
(B) 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 cycles, premenstrual bleeding and excessive menstruation, combined with infertility and early miscarriage. Endometrial pathology is irregular maturation or incomplete secretion.
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, resulting in irregular dislodgement. If the menstrual period is prolonged and dripping, or if the corpus luteum degenerates prematurely, the menstrual period will be frequent and excessive. It is common after abortion and induction of labor, combined with uterine fibroids, endometrial polyps and adenomyosis.
Mid-menstrual bleeding
Also called ovulatory bleeding. It is often accompanied by ovulation pain, which is caused by small amount of bleeding (1 to 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.
Related tests Functional uterine bleeding, often manifested as heavy menstruation. Adolescent women are prone to this disorder, and those who suffer from it are at risk of developing anemia. Therefore, functional uterine bleeding should not 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 and not be so afraid.
The auxiliary tests often needed for patients with meritorious blood are
1. Basal body temperature measurement
(1) Anovulatory type of gonorrhea, the basal body temperature is monophasic
(2) Luteinizing insufficiency The basic 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 can be used to find out whether there is ovulation and luteal phase.
3.Hormone measurement can be used to understand the presence or absence of ovulation and the condition of the corpus luteum.
4.Diagnostic scraping. Diagnostic scraping can help to understand the endometrial reaction, to exclude intrauterine lesions and to stop bleeding. Adolescents with 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 count, platelet count and bleeding and 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, the patient should cooperate with the doctor in the treatment of all tests.
Since there is a difference between adolescence and menopause, the best treatment for meritorious hemorrhage is also different.
The principles of treatment for adolescent meritorious bleeding are rapid hemostasis and post-hemostatic adjustments to establish normal menstrual cycles, prevent recurrence and improve the general condition, correct anemia, and not perform diagnostic scraping. Hormones can be given to stop the bleeding, and sex hormones, i.e. progesterone, can be used to treat the bleeding. 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 Chinese herbal medicine, which has few side effects. Improving dietary habits and living standards, exercising appropriately and increasing blood circulation are very helpful for treatment.
Treatment of menopausal meritorious bleeding The treatment of menopausal meritorious bleeding should combine endocrine intervention, systemic supportive therapy and emotional regulation organically. To stop bleeding, adjust the cycle, reduce menstrual flow and prevent endometrial lesions as the treatment principles.
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 below 60 g/l) should be bed rest, in addition to iron supplements, a small number of blood transfusions, strengthen nutrition and vitamin supplementation. If the bleeding time is too long, antibiotics should be added to prevent infection.
3.Inhibit the growth of endometrium and prevent cancer: It is suitable for menopausal gonorrhea with excessive endometrial hyperplasia, or combined with uterine fibroids or endometriosis, such as danazol, endometrium, triamcinolone and gonadotropin-releasing hormone agonist, etc.
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 cancer.
In Chinese medicine, “gongbao” belongs to the category of “leakage of blood” in Chinese medicine. The main mechanism of this disease is due to the damage to the ramifications and the inability to consolidate. Most of the causes of the damage to the ramifications are blood heat, qi deficiency, qi depression, blood stasis, etc. Among them, blood heat and qi deficiency are the most common causes. 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 plugging 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, only to 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 gongbao. For specific treatment, please consult a local Chinese medicine hospital for the right remedy.
Diet
1, it is advisable to have a light diet, it is advisable to eat more fresh fruits and vegetables rich in vitamin c. Such as spinach, rape, kale, tomatoes, carrots, apples, pears, bananas, oranges, hawthorn, fresh dates, etc.. These foods are not only rich in iron and copper, but also contain folic acid, vitamin c and carotene, which are good for treating anemia and aiding in stopping bleeding.
2. Avoid overeating to avoid damaging the spleen and stomach; avoid cold and stimulating foods and condiments, such as chili, pepper, onion, garlic, ginger and wine. Because of the strong stimulating food, will increase the amount of menstruation.
3, menstrual contraindicated foods are Sydney, bananas, horseshoe, stone ear, stone flower, ground ear and other cold food; cinnamon, pepper, cloves, pepper, chili and other spicy stimulating food.
4, excessive menstruation, prolonged periods, will cause anemia, so attention should be paid to supplement protein and iron-rich foods, such as animal protein, such as milk, eggs, lean meat, pig liver, kidneys, heart, stomach and intestines and kelp, nori, soy, spinach, celery, rape, tomatoes, apricots, dates, oranges, etc. are rich in iron. These foods not only contain the essential amino acids needed by the body, but also rich in vitamins A, B1, B2 and B12, which are important foods for the treatment of meritorious blood.
Prevention
1, maintain a regular rhythm of life, so that there is tension and relaxation, avoid overwork. Young girls in adolescence should learn to 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 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 or subtract clothes, bedding, to avoid excessive cold and heat caused by the body endocrine disorder, resulting in prolonged periods, increased bleeding.