Pai Terren Special Biopology | An article takes you to understand the 9 major causes of abnormal uterine bleeding

Abnormal Uterine Bleeding (AUB) is a common symptom and signs of gynecology. It refers to the abnormal bleeding of any item of the periodic frequency, regularity, menstrual length, menstrual bleeding during the period of normal menstruation.AUB is limited to non -pregnancy women during the age of childbearing age. Therefore, bleeding related to pregnancy and puzzle during pregnancy and puzzle must not include youthful bleeding before and after menopause.The specific situation of abnormal uterine bleeding can be seen below.

As long as those who meet the above symptoms are abnormal uterine bleeding (AUB).However, the cause of AUB is complicated. It cannot be generalized. In 2011, the International Obstetrics and Gynecology Alliance (FIGO) proposed the term and abnormal uterine hemorrhage related terms and formulated a new classification system (PALM-COEIN system). The specific AUB cause disease is as follows: below:

However, these diseases do not exist alone, and some patients may coexist at the same time at the same time, causing AUB together.Let’s learn more about it below.

Endometrial polyps (AUB-P)

It accounts for 21%-39%of the entire AUB reasons.Endometrial polyps are one of the common benign lesions of the uterine endometrium. It is the limited hyperplasia of the endometrium base layer. It forms a crash to cause the category of chronic endometritis and is easy to relapse.

[Symptoms] Symptoms (70%-90%) are mainly manifested by irregular vaginal bleeding (increased menstrual flow, extension of menstrual periods, meridian bleeding, vaginal bleeding after menopause) and infertility.A small number of leucorrhea and blood leucorrhea are the main performance.About 30%of patients still have obvious clinical symptoms.

[Good people] Women over 35 years old, as well as those who merge the following diseases: uterine adenomia, cervical polyps, diabetes, obesity, hypertension, endometritis, endometriosis, uterine fibroids, and use of use, and useHis Moqifen’s woman and so on.

[Diagnosis] Usually, it can be found that the best examination time is before the 10th day of the menstrual cycle, and the diagnosis must be removed under the hysteroscopy.

[Treatment] For the functional uterine endometrial polyps with diameter <1cm, if there is no symptom, the natural disappearance rate is about 27%within 1 year, and the malignant variable rate is low. You can observe and follow up.For the> 1cm, symptomatic uterine endometrial polyps are recommended for treatment. There are many treatment methods, but hysteroscopy is considered to be the best choice for diagnosis and treatment of endometrial polyps.Especially applicable to those who are not pregnant or still have pregnancy requirements, and those who have multiple internal medicines in the elderly; the risk of recurrence of endometrial polyps is about 3.7%-10.0%.The key is that Zuo Nuo Genone and Man Yuele can reduce the recurrence risk of polyps, especially for women who take him.

Uterine adenomia (Aub-A)

Uterine adenomyosis is the endometrium gonad or intermediary, which is located in the uterine muscle layer. At the same time, it is also accompanied by the hyperplasia and hypertrophy of the surrounding muscle layer cells, forming a diffuse or limited lesions.The incidence of domestic reports in uterine adenoscles is 13.4%, foreign reports ranging from 5%to 70%, and there is a continuous rise, which has now become a common disease of gynecology.Most of the maternal mothers at the age of 30-50, in recent years, the obvious incidence of adenomy disease has risen and the age of illness is young.About 15%are combined with endometriosis at the same time, and about 50%of the uterine fibroids.

[Symptoms] Typical clinical manifestations are dysmenorrhea (15%~ 77.8%) or HMB caused by chronic pelvic pain.Moon passage generally manifested as a large amount of bleeding for several consecutive menstrual cycles, generally exceeding 80ml.The incidence of compression symptoms, abortion and infertility is low.Nearly 30% of patients with adenomyotomia have no obvious symptoms, but they were accidentally discovered when they were checked in a healthy test or other diseases.

[Diagnosis] Preliminary diagnosis can be used to diagnose uterine disconneys. Clinically, preliminary diagnosis can be made according to typical symptoms and signs and blood CA125 levels.The layer cyst, or the endometrium and the grassroots are owed to clear, and the increased heterogeneity of the muscle layer indicates that the uterine adenomy disease is reminded.

[Treatment] Although uterine resection is the only cure method, hormone therapy is effective for most women.Treatment includes: oral contraceptives (estrogen and progesterone), single progesterone therapy, gonadotropin release hormone, and aromatase inhibitors.The most effective method of progesterone is Man Yuele.Hormone therapy can not only reduce menstrual flow, but also relieve the pain.

Except for uterine resection, other surgical methods include: endometrium erosion or resection, disconnection of adenomiasis, and electromagotomystop ominage of uterine muscle layer under the peritoneal.Drug treatment may be better than a single surgical treatment after surgery.Uterine embolism or ultrasonic focus surgery guided by MRI has certain advantages.Uterine resection is one of the treatment options for women without fertility.

Uchmop Smoomyoma (AUB-L)

About 20%of adult women will have different types of uterine fibroids in their lives. Depending on the growth site, uterine smooth fibroids can be divided into mucosa fibroids and other fibroids that affect the shape of the uterine cavity. The former is most likely to cause AUB.

[Symptoms] After the increase in volume and extension of menstruation, severe cases can follow anemia, and symptoms such as fatigue and palpitations.When the submucosal fibroids are accompanied by necrotic infection, there may be irregular vaginal bleeding or blood -like purulent drainage, while fibroid degeneration (glass -like change, cystic change, red -like changes, sarcoma -like changes, calcification, calcification) may occur may occur.Other symptoms such as pain, in addition, uterine fibroids may increase miscarriage risk, reduce pregnancy rate, and cause pregnancy complications, including limited fetal growth, premature placenta, abnormal fetal position, and premature birth.

[Diagnosis] Physical examination and double clinic are the most important evaluation methods of the uterus to evaluate the size and outline of the uterus.Imaging helps to evaluate the size, quantity and location of the fibroids.Imaging examination includes: vaginal or abdominal ultrasound, diagnostic hysteroscopy, MRI, and uterine fallopian tube angiography.After menopausal bleeding or abnormal bleeding, the possibility of hyperplasia or malignant tumors can be eliminated by endometrial sampling.

[Treatment] Conservative treatment is suitable for those who have no obvious symptoms, especially women in recent menstrual periods, which can be followed up every 3-6 months.Drug therapy is suitable for those who are mild, the age of near menopamental, or systemic conditions should not be surgery.The treatment of uterine fibroids includes GNRH agonist and progesterone receptor regulators, Rolloxen and aromatase inhibitors.Surgical treatment is applicable to those who have a long -occurred anemia, and drug treatment is invalid; severe abdominal pain; large volume may affect compression symptoms such as bladder and rectum; suspected evil changes;By.Hysteroscopic uterine fibroid electromotive (TCRM) is considered to be the first choice for treating submucosal fibroids in the uterine.Hysteroscopic endometrial endometrial removal is suitable for patients with a large menstrual flow, no fertility requirements, but hoping to retain the uterus or tolerance for uterine resection.If fibroids are found after pregnancy, it is conservatively treated, and surgical treatment is generally not advocated.

Endometriosis and typical hyperplasia (AUB-M)

The endometrium is not typical of hyperplasia and evil changes. It is rare and important for AUB.The typical hyperplasia of the uterine endometrium is an anterior cancer lesion, and the cancer variable rate of 13.4 years is 8%to 29%.Patients who are common in polycystic ovary syndrome (PCOS), obesity, and use his Monifen, occasionally see those with ovulation and lack of luteal function.

[Symptoms] Irregular uterine bleeding can occur alternately with menstruation.A few manifestations are inter -meridian bleeding, and patients often have infertility.

[Diagnosis] The pathological examination of endometrial biopsy is required.For those who are ≥45 years of age, long -term irregular uterine bleeding, high -risk factors such as endometrial cancer (such as hypertension, obesity, diabetes, etc.), B -ultrasound indicate that the endometrium is too thickened and echoed, and the effect of drug treatment is not significant.Disclosure scraping in parallel medical examination, the preferred hysteroscopy looked directly under the biopsy.

[Treatment] The treatment of non -typical hyperplasia of the uterine endometrium requires different treatment plans according to the severity of the endometrium, the age of the patient, and the whether there are fertility requirements.Age> 40 years old, patients with no fertility requirements are recommended for uterine cutting.For young and fertilized patients, after comprehensive evaluation and full consultation, they can adopt a full cycle of continuous and efficient synthetic hypotonic hormone endometrium atrophy, such as hydroxygenone, hydroxylone, nortyle a progesterone, etc.Consultation and suction palace (to achieve the purpose of comprehensive materials).If the endometrium does not reverse the dose, the dose should be increased, and review after 3 to 6 months.If the endometrium is not typical of the hyperplasia disappearance, the auxiliary reproductive technology is actively given after the progesterone is discontinued.While using progesterone, high -risk factors in response to endometrial hyperplasia, such as obesity and insulin resistance at the same time.The diagnosis and treatment of endometrium malignant tumors refer to related clinical guides.

Systemic coagulation-related diseases (AUB-C)

Including regenerative anemia, various types of leukemia, various coagulation factors abnormalities, and various reasons such as platelet reduction mechanisms such as platelet reduction mechanism abnormalities.It is reported that about 13%of women who have passed more menstruation have systemic coagulation abnormalities.

[Symptoms] There are many menstrual passage, meridian bleeding or extension of menstruation.There are also bleeding tendencies (skin, mucous membranes, joints, muscles, etc.) in other parts. In severe cases, symptoms such as anemia and fever can occur.

[Diagnosis] Any 1 positive patients in the following three items prompts that there may be abnormal coagulation.

(1) There are more moon starting on the beginning of the tide;

(2) Have one of the following history: previously available, postpartum surgery, or bleeding related to dental operations;

(3) There are two or more symptoms in the following symptoms: 1 to 2 bruises per month, nasal bleeding 1 to 2 per month, frequent gum bleeding, and family history of bleeding.

[Treatment] It should be jointly negotiated with the blood department and other related departments. In principle, the treatment measures of blood department should be mainly based on the treatment of menstrual bleeding.The preferred drug treatment of gynecology is the main measure of high -dose high -efficiency synthetic progesterone endometrium endometrial atrophy treatment. Sometimes propyate testosterone is used to reduce pelvic organ congestion.Ammonia methamphetamine and short -acting oral contraceptives may also help.When the drug treatment fails or the primary disease may not be cured, surgical treatment can be considered after the blood department controls the condition and improves the whole body.Surgical treatment includes endometrial resection and uterine full resection.

Ovulation disorders (AUB-O)

Ovulation disorders include scarcity ovulation, ovulation-free, and lack of luteal function. It is mainly caused by abnormal dysfunction of hypothalamus-pituitary-ovarian axis. It is common in adolescence and pending periods.Caused by thyroid disease.

[Symptoms] Often manifested as irregular menstruation. The menstrual volume, period length, cycle frequency, and regularity can be abnormal, and sometimes cause major bleeding and severe anemia.

[Diagnosis] The most commonly used method for ovulation is the basis of basal body temperature (BBT) and luteal medium -term hemorrhage levels.Ultrasonic monitoring, etc.

[Treatment] The principle is to stop bleeding and correct anemia during the bleeding period. After the blood stops, adjust the cycle to prevent endometrial hyperplasia and AUB recurrence.The method of hemostasis includes the endometrium shedding method of progesterone, large -dose estrogen endometrial repair method, short -acting oral contraceptives, or efficient synthetic hyperemia endometrial atrophy and diagnosis.The method of adjusting the cycle is mainly the treatment of progesterone in the second half of the period. Patients with adolescence and fertility age should choose natural or close to natural progesterone (such as ground spleen), which is conducive to the establishment or recovery of ovarian axis function.

Short -acting oral contraceptives are mainly suitable for women with contraceptive requirements.LNG-IS can be placed for those who have completed fertility or have not fertilized plans for nearly a year, which can reduce the amount of bleeding from patients with ovulation-free patients and prevent endometrial hyperplasia.Patients who have completed fertility, drug treatment or taboos can consider endometrial sketching or resection of the uterus.Promoting ovulation treatment is suitable for patients who have no fertility requirements for ovulation, and can also correct AUB at the same time. The specific method depends on the cause of ovulation -free.

Endometrial local abnormalities (Aub-E)

When AUB occurs in regular and ovulation cycles, especially when other reasons can be explained after investigation, it may be caused by local abnormalities in the uterine endometrium.

[Symptoms] There are many menstrual passage, meridian bleeding or extension of menstruation.

[Diagnosis] At present, there is no different way to diagnose local abnormalities in the uterine endometrium, which is mainly determined based on the elimination of other clear abnormalities on the basis of ovulation and menstruation.

[Treatment] There are many menstrual menstruation caused by such non -organic diseases. It is recommended to treat drug treatment first. The recommended drug treatment order is:

(1) LNGIUS is suitable for those who have no fertility for more than one year;

(2) Anticate anti -fibrosis treatment or non -steroidal anti -inflammatory drugs (NSAID), which can be used for those who do not want or cannot use sex hormones or want to be pregnant as soon as possible;

(3) Short -effect oral contraceptives;

(4) Endometrial atrophy of the uterine uterine uterine, such as 5mg of olite 3 times a day, starting from the 5th day of the cycle, continuously take 21D.Umills are only used for emergency hemostasis and pathological examinations.For those without fertility, conservative surgery can be considered, such as endometrial resection.

Medicine AUB (AUB-I)

Medical interventions such as hormone therapy or in -the -uterus condiments can cause irregular AU bleeding and hormone contraceptives. It is usually called "breakthrough bleeding (BTB)" and is the main cause of such diseases.If the amount is small, you can continue to take it. If necessary, you can add small doses of estrogen. If the amount is large, the drug is discontinued, which is deemed to be this menstrual period.Related to hyperthyroidism, the treatment of anti-fiber-soluble drugs for treatment; women with LNG-IS or buried in the treatment often appear within 6 months. The treatment can be treated symptomatically or in short-term observation, and some can also be used as short-acting contraceptives at the same time.

Uncategorized AUB (AUB-N)

Individual patients of AUB may be related to other rare factors, such as dynamic varicose veins, uterine scar defects after cesarean section, and hypertrophy of the uterine muscle layer.Category (Aub-N).

The cause of AUB caused by dynamic vein malformation is congenital or obtained (uterine trauma, postpartum section after cesarean section, etc.), and mostly manifests a large number of uterine bleeding. The diagnosis of the preferred vaginal ultrasound examination, other examination methods also include uterine blood vessels, as well as uterine blood vessels.CT CT, pelvic CT and MRI examinations. In terms of treatment, there are fertility requirements. When the amount of bleeding is not much, oral contraceptives or expectations are expected to be treated. Those with severe bleeding can maintain stable signs of life.The pregnancy rate is low. In addition to the uterine embolism of the uterine blood vessels without fertility, uterine resection can be used.

AUB caused by uterine scar defects after cesarean section is often extended by menstrual periods. The diagnostic method is vaginal ultrasound examination, and the best is hysteroscopic examination.You can use oral contraceptives to shorten the bleeding time. If the drug treatment effect is poor, surgical treatment can be considered, including the uterine incision divertication of the uterine laparoscopy, an abdominal or undergoing laparoscopic scar tissue resection or repair.

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