Treatment of anovulatory abnormal uterine bleeding is divided into two steps: the first step is to stop the bleeding, and the second step is to adjust the menstrual cycle. (a) There are 3 methods to stop bleeding: sex hormone therapy, curettage, and adjuvant therapy 1. Sex hormone therapy There are 4 methods: ① endometrial shedding method, ② endometrial repair method, ③ endometrial atrophy method, and ④ compound short-acting oral contraceptive pill. It is a treatment plan based on hemoglobin. For patients with hemoglobin greater than 80g/L: use the endometrial shedding method: use progestin, which converts the endometrium that continues to grow under the effect of estrogen into a secretory phase and has an anti-estrogen effect. It has been reported that a very experienced doctor will still leave part of the endometrial tissue after scraping the uterus. After using the endometrial shedding method, the endometrium is shed very completely, and precisely because it is very complete, it may lead to a drop in hemoglobin of 20g to 30g/L. Therefore, when using this method, the hemoglobin should not be too low, otherwise it will cause serious anemia, so it is necessary to check the blood routine before using the medicine. With progesterone, it is better to use progesterone injection, because progesterone injected into the blood is more stable, while progesterone taken orally has liver first-pass effect, and the blood concentration is not as stable as progesterone injected by muscle. During this period, we need to observe: whether the bleeding decreases or stops when progesterone is injected intramuscularly, and whether the withdrawal bleeding clears up within 7 days after stopping the medication. If the blood volume is still high after using progesterone or the withdrawal bleeding is more than 10 days after using the medication, endometrial lesions need to be considered and hysteroscopic scraping is recommended. If the patient has less blood or stops after progesterone injection, and the retreat bleeding is clean within 7 days after stopping the medication, after the blood is clean, ultrasound will be done to observe the endometrial thickness and whether it is uniform and regular in shape. If the endometrium is thin at this time, proceed to the second step to adjust the menstrual cycle. For hemoglobin less than 80 g/L and in poor general condition: Patients with anovulatory abnormal uterine bleeding in adolescence: endometrial repair with estrogen can be used. High doses of estrogen can rapidly promote endometrial growth and stop bleeding by repairing the trauma in a short period of time. I don’t know if you have noticed, but estrogen in adolescent children is often not low, sometimes up to about 100~200pg/ml, so to stop bleeding with estrogen, the dose used must be greater than the level of estrogen secreted in her body to stop the bleeding, so at this time, the dose of 12 or 18 tablets per day should be used to supplement Jiale, and the side effects of using such a large dose of estrogen are also relatively large. When the hemoglobin rises to normal, it is necessary to use progestin to retreat the bleeding. Patients with anovulatory abnormal uterine bleeding in adolescence can also use the compound short-acting oral contraceptive pill, which is used to stop bleeding at a maximum dose of 3 tablets. If the use of 3 tablets still does not stop the bleeding, the presence of organic lesions should be highly considered; in addition, the use of contraceptives is divided into four levels, with no restrictions at the first level: among them, the age requirement is from the first menstruation to 40 years old, and the body mass index is less than 30 kg/m2. Patients with anovulatory abnormal uterine bleeding during menopause: the endometrial atrophy method can be used, in which highly efficient synthetic progesterone can cause the endometrium to atrophy, thus stopping the bleeding. thereby achieving hemostasis; compounded short-acting oral contraceptives can also be used. The guidelines clearly state that for hemostasis and menstrual cycle adjustment, short-acting oral contraceptives can also be used in menopausal patients with anovulatory anomalous uterine bleeding, provided that cardiovascular disease and high risk factors for thrombosis are excluded and that the patient is a non-smoker. Summary of hemostasis in the first step of anovulatory abnormal uterine bleeding: when hemoglobin is greater than 80g/L: use the endometrial shedding method; when hemoglobin is less than 80g/L, use the endometrial repair method or the compound short-acting oral contraceptive pill in adolescent patients; use the endometrial atrophy method or the compound short-acting oral contraceptive pill in menopausal patients. 2.Scraping The indications for scraping in the 2009 meritorious blood guideline are: age >40 years, endometrial thickness >12mm, abnormal uterine bleeding for more than half a year can be considered as diagnostic scraping or scraping after hysteroscopy; 2014 China’s meritorious blood guideline diagnostic scraping criteria: age >45 years, long-term irregular uterine bleeding, accompanied by high risk factors of endometrial cancer such as hypertension, obesity, diabetes, etc., ultrasound If the endometrial thickening is excessive, the echogenicity is uneven and the effect of drug treatment is not significant, it is recommended to perform diagnostic scraping. Comparing the two indications, the new guideline suggests that if there is no obvious organic lesion, sex hormone therapy should be used first; if there is a high suspicion of endometrial lesion, scraping is recommended. 3. Adjuvant treatment Use tranexamic acid, testosterone propionate, correct anemia, etc. (ii) Adjustment of menstrual cycle: In normal people, when estrogen is greater than 200 pg/ml in the middle of menstruation and lasts for more than 50 hours, it will have a positive feedback effect on LH, which will reach a peak and thus induce ovulation, and after ovulation, progesterone will be produced. In patients with ovulation disorder, the estrogen in the middle of menstruation is less than or even greater than 200 pg/ml, but cannot last for more than 50 hours, so it cannot produce positive feedback on LH, and LH will not reach the peak, and without the peak, there will be no ovulation, and without ovulation, there will be no progesterone production, and the endometrium will show irregular bleeding or endometrial lesions under the effect of single estrogen for a long time. Therefore, what is lacking can be supplemented by regular progesterone supplementation. To facilitate your understanding, here are my summary of the types of progestins. There are three major types of progestins: the first type is the oral progestins: progesterone, dydrogesterone, and methylhydroxyprogesterone. Dose of progestin: daily endometrial dose: progesterone 200-300mg/day, medroxyprogesterone 5-10mg/day, dydrogesterone 10-20mg/day; time of progestin use: if progestin is used monthly for 7 days the chance of endometrial cancer is 3-5%, for 10 days the chance is 2%, and for more than 12 days the chance is 0. It can be seen that not only should the dose of progestin be given, but also the time of use must be sufficient. The second type is the compound short-acting oral contraceptive pill, which is a combination of estrogen and progestin, but the progestin activity is the strongest, and its progestin activity is more than ten times that of estrogen, so from another perspective, it can also be regarded as an efficient progestin, so it can also be used to adjust menstrual cycle; the third type is The third category is the Mannedrine ring, which contains levonorgestrel, also a highly effective progestin, so it can also be used to treat anovulatory abnormal uterine bleeding and protect the endometrium. How can I adjust my menstrual cycle? You can use progestin in the second half of the menstrual cycle, or compound short-acting oral contraceptives for 3-6 months, and observe after stopping the drug. If the bleeding is still irregular, we can use it again for 3-6 months because its root cause we sometimes can’t remove. When adjusting menstrual cycle treatment: patients with anovulatory abnormal uterine bleeding in adolescence use oral progestin or compounded short-acting oral contraceptives; menopausal patients use progestin or intrauterine placement of Mannitol, preferably without oral contraceptives because of the risk of blood clots with long-term use. In conclusion: treatment of anovulatory abnormal uterine bleeding is divided into 2 steps: the first step is to stop the bleeding and the second step is to adjust the menstrual cycle. There are three methods to stop the bleeding: sex hormone therapy, curettage, and adjuvant therapy. There are 4 methods in sex hormone therapy: endometrial shedding method, endometrial atrophy method, endometrial repair method and compounded short-acting oral contraceptives.