What Are the Most Common Uterus Problems?

Uterine disease refers to various lesions that occur in the uterine region, such as inflammation, injury, tumors, and precancerous lesions. It is one of the most common diseases in women. Uterine diseases include endometritis, endometriosis, uterine hypertrophy, uterine polyps, uterine fibroids, uterine cysts, uterine prolapse, and endometrial cancer. The causes of uterine diseases include abortion, intrauterine operation such as placing rings, and infections.

Uterine disease

Definition of uterine disease

Endometritis

Uterine disease acute endometritis

Endometritis

Sudden abdominal pain, increased vaginal discharge, fever, and increased pulse. During the gynecological examination, a large amount of pus and bloody secretions leaked out of the cervix, the cervix was painful, and the uterine body was slightly larger.

Endometritis

Women often feel a dull or swollen lower abdomen, pain in the lumbar muscles, increased leucorrhea, watery, pale yellow or purulent, bloody. And accompanied by irregular vaginal bleeding or prolonged periods, dysmenorrhea, and amenorrhea. The uterus is spherically enlarged, tender, and tender, with bloody and purulent discharge.

Causes of Uterine Diseases

The infection can be caused by sexually transmitted diseases, but sometimes it can be without obvious causes. Mainly bacterial infections, the types of bacterial infections are: Staphylococcus, E. coli, Streptococcus, anaerobic bacteria, Neisseria gonorrhoeae. There are also infections with pathogens such as mycoplasma. Can be divided into tuberculosis and non-tuberculous according to the pathogenic bacteria.

Uterine fibroids

Uterine fibroids, also known as "uterine leiomyomas", are the most common benign tumors of female genitalia. Most are asymptomatic, and a few are vaginal bleeding, abdominal masses, and compression symptoms. If pedicle twisting or other conditions can cause pain, multiple uterine fibroids are common.

Cause

Chinese medicine believes that uterine fibroids are caused by internal injuries, dysfunction of internal organs, and qi stagnation and blood stasis. Uterine fibroids Modern medical research has found that the amount of estrogen receptors in fibroid tissue is more than that in normal uterine muscle tissue. It is suggested that the occurrence of uterine fibroids is related to long-term excessive estrogen content leading to endocrine disorders. At the same time, hormone metabolism is regulated by the high-level nerve center, so nerve center activity may also play an important role in promoting the disease. In addition, cytogenetic studies have shown that some fibroids have cytogenetic abnormalities.

Endometriosis

Causes of Uterine Diseases

1. Menstrual disorders

The menstrual cycle is shortened, frequent, large, menstrual periods are too long, and dysmenorrhea, etc., leading to increased opportunities for menstrual reflux and endometrial fragmentation.

2, menstrual intercourse

During menstruation, if you don't pay attention to conditioning your emotions, excessive anxiety, fear or overwork, strenuous exercise will lead to menstrual reflux and endometriosis, especially during intercourse.

3. Multiple abortions

Repeated abortions caused endometrial debris to enter the pelvic cavity through the fallopian tube, leading to the formation of endometriosis.

4, improper uterine position

Normal uterine forward leaning and forward flexion will help menstrual blood flow, such as uterine backward leaning and backward flexion, easy menstrual blood flow is not smooth, resulting in menstrual reflux.

5, abnormal reproductive organs

Congenital developmental abnormalities, such as vaginal septum, hymen atresia, etc .; Acquired abortion, uterine cavity surgery, etc., can lead to menstrual reflux. ^[1]

Uterine Disease Treatment

^[2] First, hormone therapy

1. Danazol: a derivative of the synthetic steroid 17-acetylene testosterone. Its main role is to inhibit the production of GnRH in the hypothalamus, thereby reducing the synthesis and release of FSH and LH, leading to the suppression of ovarian function. Can also directly inhibit the synthesis of ovarian steroid hormones or competitively bind to estrogen and progesterone receptors, resulting in ectopic endometrial atrophy, anovulation and amenorrhea.

2. Nemestran: It is 3 dinornolone (R2323), which is a 19-nortestosterone derivative. It has high antiprogestin activity and moderate anti-estrogen effect, inhibits FSH and LH secretion, and makes the body Estrogen levels decrease, and the ectopic endometrium shrinks and is absorbed.

3. GnRHa agonist (GnRHa): Meldtum and Lemay reported in 1982 that the application of LHRHa in the treatment of endometriosis achieved good results. LHRH has a biphasic effect on the pituitary. The continuous application of a large number of LHRHs causes the pituitary cells to show a down-regulating response, that is, the pituitary cell receptors are full of hormones and cannot synthesize and release FSH and LH, which plays an anti-regulatory role. Side effects were hot flashes, vaginal dryness, headache, and a small amount of bleeding from the vagina.

4. Tamoxifen (TMX): It is a bisstyrene derivative. The dose was 10 mg × 2 / d. The menstruation started on the fifth day, and 20 days was a course of treatment.

5. Synthetic progesterone: It can be treated with norethisterone, norethisterone or medroxyprogesterone (progesterone), etc. for periodic treatment to degenerate the ectopic endometrium. From the sixth day to the twenty-fifth day of the menstrual cycle, 5 to 10 mg of one of the above-mentioned drugs is taken orally daily. The course of treatment depends on the treatment effect, this method can inhibit ovulation. Therefore, for those who wish to have children, ethinolone or norethindrone 10mg can be applied daily from the 16th day to the 25th day of the menstrual cycle. This can control endometriosis without affecting ovulation. Some cases have serious side effects during the treatment period, such as nausea, vomiting, headache and swelling, uterine cramps, breast pain, and excessive weight gain due to water retention and improved appetite. A salt diet can reduce it.

6, testosterone: This disease also has a certain effect. The application dose should be determined by the patient's tolerance. It is best to start with a dose of 10 mg twice daily, orally starting 2 weeks after the menstrual cycle. This dose rarely affects the menstrual cycle and virilizing side effects. But to achieve the purpose of analgesia often takes several cycles. After that, the dose can be reduced and the maintenance treatment should be stopped for a period of time. If pregnant, the disease can be cured.

Second, surgical treatment

Surgical treatment is the main method of endometriosis, because the scope and nature of the lesion can be basically clarified under direct vision, and it has a good effect on relieving pain and promoting fertility. The short course of treatment is especially for severe patients, fibrosis, adhesion Closely, the drug is not easy to work. Large ovarian endometrioid cyst, drug treatment is not effective, surgery may still retain effective ovarian tissue. Surgery can be divided into conservative surgery, semi-radical surgery and radical surgery.

Third, radiation therapy

Although radiotherapy has been used in endometriosis for many years, it has achieved a high curative effect by using a variety of drugs and surgery. Generally, it does not damage ovarian function. The role of radiation therapy in endometriosis is to destroy ovarian tissue. So as to eliminate the effects of ovarian hormones, make the ectopic endometrium atrophy and achieve the purpose of treatment. The radiation has no obvious effect on ectopic endometrium destruction, but it is very difficult for me to not tolerate hormone therapy and because the lesion is located in the intestine, urinary tract and extensive pelvic adhesions, especially with serious diseases such as heart, lung or kidney Individual patients who are afraid of surgery can also use external radiotherapy to destroy ovarian function and achieve therapeutic purposes. Even individuals receiving radiation therapy must first make a clear diagnosis, especially if malignant ovarian tumors cannot be misdiagnosed as endometrial cysts, and even wrong treatment delays correct treatment.

Infertility caused by uterine disease

(1) Uterine deformities

Etiology: 1. Hypoplastic development of the pararenal duct. 2. Impairment of fusion of pararenal duct derivative.

Clinical manifestations: Whether uterine malformations affect fertility depends on the type and degree of malformations. Most of these patients have no obvious conscious symptoms, but often cause infertility due to the impact of fertilized egg implantation. Even if the pregnancy, because the uterine cavity can not be enlarged, abortion and premature birth are prone to occur.

(2) Uterine dysplasia

Uterine dysplasia, also known as immature uterus, generally means that the uterus is still smaller than normal after puberty. A simple uterus is not necessarily the direct cause of infertility. If the ovaries develop at the same time, there is little hope of fertility.

(3) Endometritis

Endometritis can be divided into acute and chronic according to the length of the disease. According to the pathogens they infect, they can be divided into tuberculosis, venereal disease and general bacterial. Among infertile women, endometrial biopsy has found that the incidence of endometritis can reach 9.4%. The most common pathogenic bacteria are Staphylococcus, E. coli, Streptococcus, and anaerobic bacteria. Of course, infections of gonorrhea, mycoplasma, and chlamydia have increased significantly in recent years, and have become major pathogens in some areas. This section discusses general bacterial endometritis.

Clinical manifestations: increased vaginal discharge, irregular uterine bleeding, backache, abdominal distension, often during menstruation. Acute phase manifests fever, vaginal purulent drainage, odor; uterine tenderness; white blood cells rise, and gradually become chronic if not treated thoroughly in time.

Pathological changes: endometrial hyperemia, edema, large amount of inflammatory exudation, and a large number of interstitial plasma cells and lymphocytes. These changes can affect the operation of sperm and the implantation and development of pregnant eggs. Of course, the endometrium cannot provide sufficient nutrition for the implanted eggs during inflammation, and the exudate from inflammation also has the effect of killing sperm, causing infertility.

(4) Uterine fibroids

Uterine fibroids are the most common tumors in women. According to the relationship between fibroids and myometrium, they are divided into intermural fibroids, subserosal and submucosal fibroids. The extent to which fibroids affect conception is related to the location, size, and number of fibroids.

Affect the conception mechanism:

1. Submucosal fibroids growing in the uterine cavity, like foreign bodies in the uterine cavity, mechanically prevent the implantation of fertilized eggs. Such as fibroids show ischemic necrosis, patients with repeated irregular vaginal bleeding, resulting in endometritis and inflammation caused infertility factors.

2. Fibroids growing in the cervix, because of oppression of the cervical canal, yin prevents the sperm from running or changes the position of the cervical canal, causing the neck to deviate from the semen pool of the posterior fornix, which is not conducive to sperm ascending.

3. Fibroids growing in the broad ligament and uterine horn can grow to a certain size and can compress and distort the fallopian tubes, hinder the operation of fertilized eggs and the function of umbrella to cause infertility.

4. Larger intermural fibroids can deform the uterine cavity, which is not conducive to sperm ascending, affecting fertilized egg implantation and fetal development.

5, uterine fibroids often occur simultaneously with endometrial hyperplasia, endometriosis, appendicitis, these complications are also important reasons for infertility.

(5) Uterine cavity adhesion syndrome

Uterine cavity, uterine isthmus, cervical canal, adhesions caused by trauma secondary infection, amenorrhea, oligomenorrhea and infertility clinically appear, called uterine cavity adhesion syndrome, also known as Asherman syndrome.

Etiology and pathology: The front and back walls of the normal uterine cavity are close to each other, but because the endometrium is intact, adhesions are not easy to occur. Even if the endometrial functional layer is peeled off during menstrual tide, the basal layer is still intact and no adhesion will occur. Trauma (scrape, suction) and secondary infections are the main causes of the symptoms. Of course, hysterectomy is also a cause. 56% of the adhesions occurred in the uterine cavity, 24% affected the uterine cavity and cervical canal, and 20% in the uterine isthmus. Intrauterine adhesions cause infertility due to deformation of the uterine cavity or obstruction of the fallopian tube, uterine deformation and insufficient blood supply to the endometrium. Causes miscarriage or premature birth.

(6) abnormal uterine position

The normal position of the uterus is forward, with the uterine body slightly forward and the cervix downward and backward. After sex, semen accumulates in the posterior fornix of the vagina, so the downward cervix is easy to soak in the semen, which is conducive to the sperm moving upstream. However, if the uterus is in a backward tilted position, the cervix is in an upturned state, and it is not easy to soak in the semen, which affects the conception. Of course, excessive anteversion of the uterus is not conducive to pregnancy.

(7) Endometrial insufficiency

Endometrial insufficiency can be divided into three main types: endometrial atrophy, abnormal endometrial hyperplasia, and luteal phase insufficiency.

1. Endometrial hyperplasia or glandular cystic or adenomatic hyperplasia are mostly caused by ovulation dysfunction.

2. Membrane dysfunction during the luteal phase. Such patients have ovulation and can fertilize normally. However, the endometrium of the fertilized egg implantation site is not well developed, and the mechanism that affects pregnancy may be related to the following factors.

3. Endometrial atrophy Because there is no estrogen production in the ovaries or lack of endometrial response to hormones, no development and proliferation of endometrial glands and stroma are seen. This endometrium can be seen in anterior pituitary hypofunction and ovarian dysplasia. ^[3]

How to prevent uterine fibroids

^[4] First, do a good job of cleaning. Keeping the vulva clean and dry and preventing infection is the most basic measure for women to prevent uterine fibroids. Cleaning the vulva can prevent pathogens from entering the uterus and causing uterine fibroids.

Second, active contraception. Induced abortion can seriously damage the uterus and increase the risk of uterine fibroids in women. Therefore, in life, good avoidance measures should be taken to reduce the number of abortions, because the number of abortions will bring certain harm to the patient's uterine repair, stimulate the normal repair of the uterus, and easily lead to the incidence of uterine fibroids.

Third, reduce high-fat diets. Studies have shown that high-fat foods can promote the secretion of female estrogen after entering the human body, cause a certain stimulating effect on the uterus, stimulate the normal repair of the uterus, and cause uterine fibroids. Therefore, female friends should adhere to a low-fat diet in life, drink plenty of water, and avoid spicy and irritating foods.

Fourth, appropriate control of sexual life. Too much indulgence in sexual life will bring hidden dangers to uterine health, especially unclean sex life, which can cause pathogens to enter the uterine cavity through the vagina, causing endometrial infection and causing uterine fibroids.