Anovulatory uterine bleeding

Anovulatory dysfunctional uterine bleeding, referred to as “blood Anovulatory Gong”, is due to the regulation of reproductive endocrine system disorders caused by irregular bleeding. More common in adolescence and menopause. Gong adolescent blood hypothalamus is due to a pituitary axis of a premature ovarian or delayed, resulting in the ovarian follicles despite the growth and development, but not a result of ovulation. Gong blood is due to menopause ovarian natural aging, the lack of follicles, ovarian dysfunction, reduce the sensitivity of the pituitary gonadotropin, which can not ovulation and cause irregular bleeding. Chinese medicine will be called the disease “Metrorrhagia.”
[Clinical]
Typical Anovulatory Gong before the menstrual blood in a few weeks or months of amenorrhea, and then a large number of vaginal bleeding, often sustained a few days later to Lin Li vaginal bleeding, or less, for a long time, the flow at the time, sustained varying duration, While short days, long days, dozens or more than a few months. With secondary anemia, flustered dizziness, shortness of breath fatigue, swelling, loss of appetite, and so on. Or with breast pain, lower abdomen Zhuizhang, emotional, and so on.
[Diagnosis]
1. With typical symptoms of irregular menstruation, menopause and sometimes not, sometimes more than bleeding, such as the collapse or the amount, or less if the leakage, Metrorrhagia turn.
2. Gynaecological examinations and uterine slightly larger than the soft, non-organic lesion.
3. Single-phase based on body temperature.
4. Cervical mucus for the crystallization of dentate crystallization of the sheep, no oval body.
5. Hormone Testing:-H, LH can understand the determination of the hypothalamus of a pituitary axis of ovarian function of a state of estrogen and progesterone determination to learn whether ovarian function and ovulation.
6. Diagnostic curettage: endometrial pathological examination in various degrees of proliferation of endometrial: If proliferative, proliferative, hyperplasia, the capsule of the gland hyperplasia, adenomatous hyperplasia, or atypical hyperplasia.
7. B-normal pelvic examination, although ovulation monitoring follicular development, without the advantage of a follicle, no signs of ovulation.
8. Differential Diagnosis
(1) and pregnancy-related bleeding: blood work often for a period of time and the bleeding stopped, and various pregnancy-related bleeding such as abortion, ectopic pregnancy, abortion and other mole also stopped by history, but with pregnancy reaction, And pregnancy test positive, B-ultrasound examination help to identify. If identification can be difficult to identify with the diagnosis of curettage.
(2) choriocarcinoma: multiple secondary to abortion or childbirth, sustained irregular vaginal bleeding, early pregnancy or positive blood H (X) continued positive. B-, hysteroscopy, pelvic angiography and so help to identify.
(3) of endometrial polyps, submucosal fibroids: for the performance of increased menstrual extended, but the normal cycle, the temperature based on two-phase, the uterus and fallopian tubes lipiodol contrast official endoscopic examination can be identified.
(4) of cervical cancer: as well as irregular vaginal bleeding, often contact bleeding and bloody Leucorrhea, with gynaecological examinations, cervical scratch-resistance, and the examination can be diagnosed.

(5) of endometrial cancer: irregular uterine bleeding, in less time for a long time, the official endoscopic examination and diagnostic curettage can be confirmed.
(6) systemic diseases: If blood disease, liver disease and thyroid disease can also be associated with irregular vaginal bleeding, asked about the history, physical examination and laboratory tests can be confirmed.
[Treatment]
1. Western medicine treatment
(1) to stop bleeding
① progesterone drugs: progesterone 20 mg / day, intramuscular injection three days, the Palace progesterone 8-16 mg / day, UNIFEM Tablet 4-8 mg / day or UNIFEM Tablet 2.5-5. Omg /, a total of five days, oral. Amenorrhea than the long, thick endometrium, and also used testosterone propionate one, the young are 25 mg / day, the older 50 mg / day, 3-5 days intramuscular injection. Applies to more than six grams hemoglobin and blood work with menopause.
② estrogen formulations: diethylstilbestrol 2 mg, every hour, 6-8, blood only three days after decreasing 1 / 3 volume, volume of O. 5mg / day, only after the blood to 20 days. Or estradiol benzoate 2 n Meng, an intramuscular injection every 6-8 hours, and decreasing law ibid., blood only after the switch to oral diethylstilbestrol. Applicable to acute bleeding and anemia significantly adolescent patients with blood work.
③ other bleeding drugs: Tongxinluo such as the blood-bleeding, bleeding-acid, vitamin K, such as, but not effective, it’s only as a supplementary measure to stop bleeding.
(1) adjusting the menstrual cycle (blood only after the application).
① cycle of treatment (see the lean period).
② estrogen and progesterone combination therapy: general use of oral contraceptives, Fufa with contraception, applicable to the requirements of child-bearing age are without birth.
③ progesterone treatment: bleeding before the next 1-2 days or Jianxue after intramuscular progesterone 20 mg / day, a total of three days, or the Palace of oral progesterone, Mount films such as UNIFEM. Gong for menopause blood, the linked three cycles.
(3) restore ovulation function, the treatment of adolescent fertility and ovulation period of five blood work and the fundamental measures.
① Keluo Mi phenol (see frequent menstruation).
② tamoxifen (see frequent menstruation).
③ hCG; menstrual cycle in the first 16-18 days, each 5000-10000 IU, the next day muscle Zhu 1, a total of 2 times.
④ gonadotropin-releasing hormone: in the mid-consecutive menstrual pulse administration, the daily 5 mg, a total of three days.
(4)-induced amenorrhea: older women with menopause and methyl-testosterone 5-10 mg / day, or inhibit endometrial gossypol medicines, so that fewer menstrual gradually until menopause.
(5) hysterectomy: for conservative treatment is invalid and without patients with severe birth.