Functional uterine bleeding, referred to as gynecological bleeding, is a common gynecological disorder that refers to abnormal uterine bleeding, which is not found to have systemic and genital organ organic lesions after diagnosis, but is due to dysfunction of the neuroendocrine system. It manifests as irregular menstrual cycle, excessive menstrual flow, prolonged menstrual period or irregular bleeding.
Types
Characterized by disruption of the menstrual cycle and changes in the quantity and nature of uterine bleeding, it can be divided into the following types.
I. Irregular uterine bleeding with sporadic menstrual cycles ≥ 40 days, often accompanied by menorrhagia.
II. Irregular uterine bleeding with frequent menstrual cycles ≤ 21 days, often accompanied by excessive menstruation.
Excessive menstruation refers to regular cyclic uterine bleeding with excessive menstrual flow and/or prolonged menstrual period.
Irregular menstruation refers to irregular menstrual cycle without excessive menstrual flow.
V. Irregular menstrual flow refers to irregular menstrual cycle with excessive menstrual flow and prolonged menstrual period.
Low menstrual flow refers to regular menstrual cycle with only reduced menstrual flow.
Mid-menstrual bleeding refers to a small amount of uterine bleeding between two regular menstrual periods, often accompanied by ovulation and ovulation pain.
Symptoms
Uterine bleeding
Functional uterine bleeding manifests clinically as irregular uterine bleeding, disturbance of the menstrual cycle, prolonged bleeding time, heavy menstrual bleeding, or even heavy bleeding or dripping. The former is the most common, accounting for about 80-90% of cases, and mainly occurs in adolescence and menopause, while the latter is mostly seen in women in their reproductive years.
Anovulatory gonorrhea
Clinical manifestations: Bleeding occurs after a period of amenorrhea, and can be irregular, with variable amount, duration and interval. Some of them only show increased menstrual flow and prolonged menstruation. In case of heavy bleeding, severe anemia can be caused.
(1) Functional uterine bleeding in adolescence When menstruation starts, the hypothalamus-pituitary-ovarian axis is in the process of maturation, so within two years after menstruation starts, irregular menstrual cycles are normal and can generally be adjusted and restored by themselves. If the bleeding time is long and the bleeding is heavy and causes anemia, dizziness, palpitations and other symptoms, it means that the gonadal axis is not fully mature and is easily affected by nutrition, mental factors and other conditions.
(2) Functional uterine bleeding during menopause Among patients with anovulatory functional uterine bleeding, functional uterine bleeding during menopause is more common, but there are also more organic lesions at this age, and pathological examination must be done.
Clinical features: Because of anovulation, there is no corpus luteum formation and no progesterone secretion in the body. Estrogen levels increase and decrease with follicular development and atrophy. When the estrogen level keeps increasing, the endometrium continues to proliferate and no bleeding occurs at this time, while withdrawal bleeding may occur when the estrogen level in the body suddenly decreases. The clinical manifestations may occur after a period of amenorrhea, and the bleeding may be irregular, with the amount, duration and interval varying, while some may only show increased menstrual flow and prolonged periods. In cases of heavy bleeding, severe anemia may result. Due to estrogen stimulation, the uterus may be slightly larger and softer, the cervical opening is loose, and the cervical mucus is clear and abundant, with varying degrees of lambdoid crystals or atypical crystals. Basal body temperature is monophasic. Endometrial biopsies are mostly simple or cystic hyperplasia, and occasionally adenomatous or atypical hyperplasia is seen. Sometimes it may also show atrophic changes. Progesterone measurement stays at the basal level of the proliferative phase.
Ovulatory type of gonorrhea
Clinical manifestations: regular menstrual cycle, but shortened cycle, or a small amount of bleeding a few days before menstruation, the amount of menstrual blood may not change.
Clinical features: It occurs mostly in women of reproductive age, mostly in the recovery period after childbirth or miscarriage. Generally speaking, the gonadal axis of women of childbearing age should be in a stable state. Most of the abnormal uterine bleeding occurs due to organic lesions, such as inflammation, flab, uterine fibroids, endometriosis, etc., and should be promptly checked and diagnosed in a hospital. It also sometimes appears during menopause. It can be divided into two kinds of luteal insufficiency and luteal atrophy insufficiency.
1. Luteal insufficiency
Luteal insufficiency can be caused by insufficient secretion of estrogen before ovulation, resulting in premature atrophy of the corpus luteum. If the corpus luteum is underdeveloped, the secretion function is poor and the amount of progesterone secretion is insufficient. Clinical manifestations have a regular menstrual cycle, but the cycle is shortened, or there is a small amount of bleeding a few days before menstruation, and the amount of menstrual blood may be unchanged. Premenstrual endometrial biopsy reveals poor or uneven glandular secretion. Interstitial edema is not evident. Basal body temperature is biphasic but rises slowly, and the luteal phase is shorter than normal, usually around 10 days. Due to insufficient gestation period, infertility or early miscarriage is often formed.
2.Luteinizing body atrophy incomplete
Luteal development is mostly good, and the function can last too long because the corpus luteum fails to fully atrophy in time. The amount of progesterone secretion is insufficient, but the secretion time is prolonged, the endometrium is irregularly shed, the bleeding time is prolonged, the amount of menstrual blood increases, but the intermenstrual interval is still more normal, the amount is more on the 2nd and 3rd day of menstruation, and later the dripping can be more than 10 days long. If the endometrium is taken on the 5th or 6th day of menstruation, a secretory reaction is still seen, which can be a basis for diagnosis. Basal body temperature is biphasic, often rising slowly after ovulation, with a low rise, and the rise is not maintained for a long time, and then declines slowly.
Other common symptoms
1.Irregular uterine bleeding occurs mostly in adolescent and menopausal women. Its bleeding is characterized by disrupted menstrual cycle, prolonged menstruation, increased blood volume, irregular bleeding time, bleeding volume and interval time, often after a short period of amenorrhea.
2. Frequent menstruation The bleeding time and bleeding volume may be normal but the menstrual cycle is shortened, usually less than 21 days, and can occur in women of all ages.3 Excessive menstruation One is a large amount of menstrual blood, especially more on the second and third days, accompanied by blood clots, and a total blood loss of 500-600 ml in 1 menstruation with a normal cycle. The second is prolonged menstruation, which takes 10-20 days for the menstrual blood to clear, and the amount of menstruation is not – necessarily more.4 Intermenstrual bleeding Uterine bleeding occurs in the middle of two menstrual periods, the amount of bleeding is small and often goes unnoticed, mostly occurs in the 12-16 days of the menstrual cycle and lasts 1-2 It occurs between 12-16 days of the menstrual cycle, lasts 1-2 hours to 1-2 days, and rarely reaches menstrual volume. It is often considered to be frequent menstruation.5 Postmenopausal uterine bleeding occurs again after 1 year of amenorrhea with a small amount of bleeding in drips and drabs, but due to the high incidence of malignant tumors in the uterus after menopause, the possibility of malignant tumors should be excluded at the hospital.
Examination
Ovulatory anovulatory type of gonorrhea due to estrogen stimulation, the uterus may be slightly larger, softer in quality, loose cervical opening, transparent cervical mucus, high volume, and may show different degrees of lambdoid crystals, or atypical crystals.
Basal temperature monophasic type: Endometrial biopsy is mostly simple or cystic hyperplasia, occasionally adenoma-like or atypical hyperplasia is seen. Sometimes it may also show atrophic changes. Progesterone measurement stays at the basal level of the proliferative phase. Endometrial biopsy in the premenstrual phase of ovulatory type of uterine bleeding shows poor or uneven glandular secretion. Interstitial edema is not evident.
Basal body temperature is biphasic but rises slowly and the luteal phase is shorter than normal, usually around 10 days. Infertility or early miscarriage often develops due to inadequate gestation.
Diagnostic points
Medical history
Diagnostic points of functional uterine bleeding
(A) Medical history
1.Inquire in detail about the age of onset, menstrual cycle, changes in menstrual period, duration of bleeding, amount of blood loss, nature of bleeding, duration of illness and accompanying symptoms, and compare with the menstrual cycle before onset.
2. Ask whether there is menopause before bleeding and whether there is early pregnancy reaction.
3.Find out whether there are chronic diseases such as liver disease, hypertension, hemophilia, etc.
4.To understand the history of pregnancy and childbirth, contraception, and the presence of adverse mental stimulation.
5.Whether you have received endocrine treatment before consultation.
6.For prolonged bleeding or excessive bleeding, ask if there are any symptoms of anemia.
Physical examination
Diagnostic points of functional uterine bleeding
(II) Physical examination
For long duration of the disease or anemic appearance, a comprehensive physical examination should be performed, except for circumstantial organic diseases. Sometimes the uterus is slightly enlarged, or the distended ovaries can be palpated.
Auxiliary examination
Diagnostic points of functional uterine bleeding
(III) Auxiliary examinations
1. Diagnostic scraping is used for married women to understand the size and shape of the uterine cavity, whether the uterine wall is smooth, whether the softness and hardness are consistent, and the nature and amount of the scraped material. The scraped tissue can be sent for pathological examination to clarify the diagnosis.
2.Basal body temperature measurement The anovulatory type shows a monophasic curve; the ovulatory type shows a biphasic curve.
3.Cervical mucus crystalline examination The presence of lambdoid crystals before menstruation indicates anovulation.
4.Vaginal exfoliative cell smear In anovulatory type, it reflects the effect of estrogen. Luteinizing insufficiency reflects insufficient progesterone action and lack of typical cell accumulation and folds.
5.Hormone measurement If ovulatory function and luteal function need to be determined, progesterone glycol can be measured.
6.Hysterosalpingography can be used to understand the uterine cavity lesions, except for organic lesions.
7.Check the routine blood, clotting time and platelet count to understand the degree of anemia and exclude blood disorders.
Treatment
Treatment for functional uterine bleeding includes: hemostatic treatment; diagnostic curettage; hormone therapy.
Instrumental curettage
Many people have heard of “curettage” to stop bleeding, which is a minor procedure that can be performed on an outpatient basis, usually with local anesthesia. Under sterile conditions, the doctor uses a small scraper to reach into the uterine cavity and scrape, mechanically allowing the proliferating endometrium to fall off quickly, thus stopping the bleeding. This method is painful, but it is fast, safe, and generally reliable in stopping bleeding. More importantly, the scraped endometrium can be collected and sent to the pathology department for laboratory tests to find out whether there are polyps, tumors and other diseases, which has a clear diagnostic value. Therefore, for married patients with a long course of irregular bleeding, especially those over 40 years old, scraping should be used to stop the bleeding. However, if the uterus has been scraped recently and no organic disease is seen in pathological tests, it is not necessary to scrape the uterus repeatedly. The bleeding generally decreases immediately after curettage and stops completely within about a week. It is usually necessary to rest for about 7 days before going back to work.
Drug scraping method
For unmarried patients, scraping is not considered as much as possible or the method of drug scraping is used instead. Drug scraping is for the pathophysiological changes affected by the lack of progesterone in the body of patients with anovulatory uterine bleeding, and the patient is given intramuscular progesterone injections of 20 mg daily for 3 days, with the endometrium transformed into the secretory phase. The drug is then discontinued, causing an artificial decrease in blood progesterone levels. This is called “withdrawal bleeding”, which is similar to a menstrual bleeding and lasts for about 7 days, sometimes in large amounts, which is expected and inevitable. Therefore, before using progesterone, we must explain to the patient that the hemostatic effect will occur only after the withdrawal bleeding has stopped, so that the patient will not mistakenly think that the treatment has failed and find another doctor or switch to other hormones, resulting in disorderly use of medication.
In order to reduce the amount of withdrawal bleeding, testosterone propionate (an androgen preparation) can be injected at the same time as intramuscular progesterone, 25-50 mg daily for 3 days. If the amount of blood is still high, the patient should be put to bed rest and given general hemostatic drugs such as vitamin K, hemostatic minerals, vitamin C, hemostatic aromatic acid by oral or intramuscular injection, or even glucose solution and blood transfusion. Estrogen and progesterone preparations should not be used in case of withdrawal bleeding.
Estrogen hemostasis method
If a young, unmarried patient with meritorious bleeding has lost too much blood or has severe anemia (hematocrit <7.0 g/L) due to other problems, and is unable to undergo curettage at that time, and cannot accept the withdrawal bleeding caused by the above-mentioned "drug curettage", such a patient should be hospitalized.
Superconducting ablation knife treatment
Superconducting ablation knife treatment for functional uterine bleeding is non-surgical, non-invasive, on-the-go, and can be cured at one time. Superconducting ablation knife is not a real surgical knife, but the most cutting-edge technology in the world. The superconducting ablation knife treatment for uterine bleeding is to destroy the basal layer of the uterus under superconducting monitoring, after the destruction of the basal layer there is no longer a growth function, endocrine disorders do not act on the functional layer, so the purpose of treating uterine bleeding is achieved. This treatment does not affect the ovarian function in any way, i.e. it avoids the premature failure of ovarian function due to hysterectomy, and preserves the woman’s uterus.
Diet
For adolescent functional uterine bleeding with real heat, diet should be light and easy to digest, avoiding nourishing and warming things that move fire, and eating more leafy greens and foods that have a hemostatic effect, such as water chestnuts, yellow cauliflower (fresh cauliflower should be steamed or boiled before consumption to prevent colchicine poisoning), lotus root, celery, fungus, etc., as well as carrots, tomatoes, lilies, melons and other vitamin-rich and calming foods. Those who are deficient can eat more food with the role of nourishing Yin and blood, such as goat meat, black chicken, cinnamon, red dates, wolfberries, etc.; deficient heat should be clear tonic, it is appropriate to eat snapper, cuttlefish, turtle meat, scallops, light vegetables, duck meat, eggs, fish, lean meat, silver fungus, etc. Diet to avoid eating cold fruits and spicy stimulating food. Adolescent girls with the needs of body development, energy consumption, need to increase nutrition to meet the needs of body development, should be supplemented with protein, trace elements iron, copper, zinc and vitamin A, vitamin B, vitamin C, vitamin E, etc.. These nutrients are not only needed for body development, but also for ovarian and gonadal development. Supply of adequate nutrients is important to promote ovarian development and prevent the occurrence of functional uterine bleeding during puberty.
Food therapy recipes
(1) Brown sugar fungus. 120 grams of wood fungus (water hair), 60 grams of brown sugar. Boil the fungus first, add brown sugar and mix well. 1 time to finish. Take for 7 days for a course of treatment. It is suitable for functional uterine bleeding.
(2) Pork soup with corn beard. Corn beard 15g-30g, pork 250g. Boil the above two flavors together, then eat the meat and drink the soup after the meat is cooked. 1 dose daily. It is suitable for functional uterine bleeding.
(3) Ume plum paste. 1500 grams of pure black plum. Add 3,000ml of water to the plum, decoct it with charcoal fire, wait for the water to evaporate to half, then add water to the original amount, decoct it thickly, filter the residue with clean gauze, and bottle it for use. Adults take 5ml-10ml each time with boiled water, 3 times a day. It is suitable for functional uterine bleeding.
(4) Pig skin jelly. Pork skin 1000g, yellow wine 250g, brown sugar 250g, cut the pig skin into small pieces, enlarge the pot, add water, simmer over low heat until the meat skin is rotten and the juice is thick and sticky, add yellow wine, brown sugar, mix well to cease fire, pour into a porcelain pot, cool and set aside, eat with the amount of meals. It has the function of nourishing Yin, nourishing blood and stopping bleeding. It is suitable for excessive menstruation, functional uterine bleeding and all bleeding disorders.
(5) Ume plum and brown sugar soup. Ume plum 15 grams, brown sugar 30 grams – 50 grams. Boil the black plum and brown sugar together, add 1½ bowls of water, decoct the remaining to half a bowl, remove the residue and take warm. It has the effect of tonifying blood and stopping bleeding, beautifying the skin and pleasing the face. Suitable for women with excessive menstruation or functional uterine bleeding. (6) Red dates stewed pig skin. Red dates 15 ~ 20 (remove the core), 100 grams of pig skin. Scrape the pig skin and cut into small pieces, red dates cleaned and de-nucleated, together in a stewing cup, add a small amount of water, stewed in water until the pig skin is cooked and rotten. It has the effect of nourishing the spleen and blood, increasing the luster and elasticity of the skin. It is suitable for the treatment of spleen deficiency type of leakage and physical weakness.
(6) Mussel soup with ginger juice and rice wine. Ginger juice 3ml-5ml, rice wine 20ml-30ml, mussels 150g-200g, cooking oil, salt each appropriate amount. Mussel meat cut clean, sautéed with peanut oil, add rice wine, ginger juice and appropriate amount of water to cook with, and then add salt to taste after the meat is cooked. With nourishing Yin and nourishing blood, clearing heat and detoxification, moisturizing and rejuvenating effect. It is suitable for excessive menstrual flow and physical weakness.
Dietary treatment for women with menorrhagia
Women’s menstrual blood comes down from time to time, and the amount is as much as a landslide, called blood collapse or collapse in; the bleeding amount is small, but continuous and dripping, like a house leak after rain, called after leakage. The collapse and leakage can be transformed into each other and are not easily separated, so they are often called collapse and leakage together. According to Chinese medicine, the main cause of collapse and leakage is the lack of consolidation of the rhythm.
Differentiation
(a) Systemic diseases: blood disorders, hypertension, liver disease and hypothyroidism, etc.
(ii) Pregnancy-related bleeding disorders In married women of childbearing age, if uterine bleeding occurs, abnormal pregnancy, such as miscarriage, ectopic pregnancy and gravidity, should be considered first. If secondary to postpartum or post-abortion, placental residue, placental polyp, uterine insufficiency, endometritis, choriocarcinoma, etc. need to be considered.
(C) Genital tumors common organic diseases of the uterus such as endometrial polyps, myometrial cancer; if uterine bleeding occurs after menopause, it may be endometrial adenocarcinoma. In addition, functional tumors of the ovary, such as granulosa cell tumors and follicular membrane cell tumors, can also cause uterine bleeding.
(iv) Inflammatory diseases of the genital cavity, uterine cavity infection, and obstruction of regeneration of the functional layer of the endometrium, resulting in heavy and prolonged bleeding; endometritis after abortion, chronic endometritis, cervical polyps, etc. also often have bleeding and need to be distinguished from gonorrhea.
(E) Improper application of sex hormone drugs.
Prevention
Pay attention to physiological hygiene: During the adolescent period, the reproductive system of girls is developing, and they are young, so they tend to be negligent at the time of menarche, which may lead to menstrual disorders due to negligence. For this reason, when choosing a menstrual belt, you need a fabric that is soft and easy to wash. The used menstrual belt should be washed with soapy water in time, scalded with boiling water; placed in the sun to dry, and then wrapped in a clean cloth for backup. Within the physiological period, daily wash the vulva with clean warm water, wash from the front to the back, not from the back to the front, so as not to bring the bacteria near the anus to the vulva area, the physiological period can not be a tub bath or sitz bath, can take a shower or scrub bath. The towel for scrubbing the vulva should not be shared with others, nor should it be used for bathing or foot rubbing to avoid bringing bacteria into the vulva.
Enhance physical health care and pay attention to diet: functional uterine bleeding is mainly caused by endocrine system disorders, so we should pay attention to increasing nutrition in our daily life and eat more protein-rich foods, vegetables and fruits. During the physiological period, the body’s ability to resist is weak, so do not eat cold, spicy and stimulating food, but always eat food containing protein and vitamins. In life, combine work and rest, do not participate in heavy physical work and strenuous activities, get enough sleep, have a happy spirit, do not have unnecessary stress in the mind, so as not to affect the endocrine system in the long run.
Diet
1. It is advisable to have a light diet and to eat more fresh fruits and vegetables rich in vitamin C. For example, spinach, rapeseed, sweet potatoes and other vegetables. 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 eating stimulating foods and condiments, such as chili, pepper, onion, garlic, ginger, wine, etc.. Because of the strong stimulating food, will increase the amount of menstruation.
3, menstruation taboo foods are Sydney, bananas, horseshoes, stone ears, stone flowers, ground ears 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 essential amino acids needed by the body, but also rich in vitamins A, B1, B2, B12, etc., which are important foods for the treatment of meritorious blood. Young girls in adolescence should learn self-restraint, do not stay up all night on the Internet and entertainment, to prevent endocrine disorders caused by irregular life and overwork, which will contribute to the occurrence and development of adolescent gonorrhea.
Hazards
1.Anemia: Long-term anemia is caused to varying degrees, and some patients suffer from severe anemia.
2.Secondary infection: Long-term uterine bleeding gives an opportunity for bacteria and viruses to attack. Therefore, patients with gonorrhea are prone to secondary pelvic infections, causing abdominal pain, abnormal discharge and other manifestations.
3.Infertility: Patients with gonorrhea are infertile due to non-ovulation or insufficient luteal function; in addition, anemia and pelvic infection are also causes of infertility.
4.Proliferative endometrial adenoma or endometrial adenocarcinoma: Patients with irregular uterine bleeding without ovulation for a long time or those treated with estrogen for a long time should pay attention to whether the changes in the endometrium develop into adenomatous proliferative endometrium or endometrial adenocarcinoma.
Differentiation
I. Ovulatory bleeding. About 10 days after menstruation, there will be a small amount of bleeding from the vagina, which will clear in a day or two, and this is ovulatory bleeding. In contrast, gonorrhea is a disease with more frequent bleeding, the amount of bleeding will be more than menstruation, and it will last longer, so most patients will feel anemic and weak, and their spirits will be very bad, and if it is serious, shock or even death will occur.
Frequent menstruation. Frequent menstruation is characterized by a shortened menstrual cycle, usually less than 21 days, but the amount of bleeding and the number of days of bleeding are relatively normal.
Third, heavy menstruation. Generally, the menstrual cycle is normal, but the amount of bleeding can be excessive, sometimes even reaching several hundred milliliters each time.
IV. Dripping menstruation. Although some women have normal menstrual cycles, there is already a small amount of bleeding with dark color for several days before the onset of menstruation, and then it is dripping for several days after the onset of menstruation, and the bleeding may continue for ten days before and after the menstruation. (Is this a symptom of irregular menstruation or a symptom of gongbao)
V. Irregular bleeding from the uterus. Menstruation is early or staggered and completely irregular.
Prevention
Adolescent gonorrhea is a functional disease suffered by adolescent girls, so how can adolescent girls prevent the occurrence of adolescent gonorrhea? Adolescent girls should correctly understand the development process of puberty, reasonably arrange their study and life, timely medical treatment and prevention of complications, adolescent girls will successfully pass this period of physical development.
1.Popularize the knowledge of puberty hygiene
The knowledge of puberty hygiene should be popularized, so that adolescent girls can understand the normal growth and development process of puberty, what is going on with menstruation, what factors can cause abnormal menstruation and what should be done. Adolescent girls generally get their periods at the age of 13 to 16. Most of them establish a normal menstrual cycle soon after their first menstruation and menstruate according to the month; while a few may have menstrual disorders because their endocrine function is not fully mature.
This phenomenon can be triggered by excessive stress, exertion and malnutrition. Therefore, adolescent girls must arrange their study and life, pay attention to the combination of work and rest, exercise, enhance physical fitness, to ensure adequate nutrition (protein, vitamins, iron) intake, avoid cold diet.
2.Keep clean
When the uterus bleeds, the inside and outside of the cavity are connected, and bacteria will rapidly multiply and cause disease because there is a good growth environment. Therefore, when bleeding, we should pay attention to vulva cleanliness, change underwear and menstrual pads and other menstrual products; never do not wash the vulva because of bleeding, on the contrary, the menstrual period must be cleaned daily to remove blood stains. Some vulva cleansers are available, as well as warm boiled water, but should avoid basin Yu.
3.Prevent the occurrence of infection
If the amount of bleeding is large, it can lead to anemia and reduced body resistance, should strengthen the hemostatic measures and anti-infection as appropriate to prevent inflammation and the occurrence of acute infectious diseases.