What Is Abnormal Uterine Bleeding?

Menstrual duration is too long or too much or both; menstrual frequency; non-menstrual or inter-menstrual bleeding; or postmenopausal bleeding (any bleeding 6 months after the last normal menstruation at the time of menopause)

Menstrual duration is too long or too much or both; menstrual frequency; non-menstrual or inter-menstrual bleeding; or postmenopausal bleeding (any bleeding 6 months after the last normal menstruation at the time of menopause)

Chinese name

Abnormal uterine bleeding

Foreign name

Abnormal uterine bleeding, AUB

Department

Gynecology

Abnormal uterine bleeding

The increase in total is called hypermenoeehea (menorrhagia).

Excessive menstruation (polymenorrhea), which is defined as the interval between menstrual cycles is too short (% 26lt; 21 days).

Too little menstruation (oligomeoeehea) refers to the feature that the menstrual cycle interval is too long.

Hypoomeorrhea means a marked decrease in the amount of menstrual blood flowing out.

Uterine bleeding (metrorrhagia) refers to any bleeding or spotting between menstruation.

Post-menopausal bleeding (postmeopausalbleeding) refers to uterine bleeding that occurs more than one year after menopause. It is an abnormal phenomenon and requires immediate diagnosis and treatment.

Abnormal cycle of abnormal uterine bleeding

Normal menstruation. The cycle of normal menstruation is a complex series of hormones that mediate the functions of the hypothalamus, pituitary, ovary and uterus.

The hormonal environment caused by ovarian follicle maturation and ovulation can cause a series of changes in the endometrium to facilitate the implantation of fertilized eggs. Normal menstrual bleeding occurs because there is no implantation of fertilized eggs in the endometrium. Menstrual bleeding indicates the loss of thickened endometrium and is also the result of hormonal changes when there is no pregnancy.

The regular menstrual cycle has a normal interval of 21 to 35 days, and the normal menstrual blood flow lasts 2 to 7 days. The actual total menstrual loss is 20 to 50 ml.

The periodicity of menstruation is related to egg maturation, discharge, and pregnancy. In fact, it is a reproductive cycle. According to the egg growth process, menstruation is generally divided into menstrual period (ie menstrual bleeding) and follicular period (10-12 days). Ovulation period (1-2 days), luteal phase (about 14 days), this is the entire menstrual cycle, which starts and ends again. It is only possible to conceive on the day of ovulation when it is close to ovulation. At other times, there is no egg, even if Sexual behavior, without pregnancy will not be pregnant.

Introduction to Abnormal Uterine Bleeding

Abnormal bleeding in the genital tract is the most common complaint of women of any age when seeking treatment from a gynecologist. However, after a proper assessment, only a quarter of women have an anatomical or organic lesion as the cause of abnormal bleeding. The remaining three quarters of women can be classified as dysfunctional uterine bleeding, referred to as DUB for short. This indicates that under the control of the hypothalamus-pituitary-ovarian axis, the hormonal balance is unstable.

Patients with abnormal uterine bleeding must be diagnosed by a doctor. A clinician must also thoroughly examine the cause of abnormal bleeding.

Organic uterine abnormal bleeding accounts for about 25% of patients, and the rest is due to dysfunction of the hypothalamic-pituitary-ovarian axis (dysfunctional uterine bleeding). Age is the most important factor; organic diseases, including Gynecological tumors increase gradually with age. Dysfunctional uterine bleeding is the most common cause of abnormal uterine bleeding.

Newborn baby girls may see a small amount of red for a few days. This is because the endometrium is stimulated by placental estrogen when the fetus is in the womb. Any other reproductive tract bleeding in childhood is rare, and the cause should be looked for The most common cause is accidental trauma to the vulva and vagina. Vaginitis (often due to foreign bodies), urethral prolapse, and gynecological tumors can also cause bleeding. Ovarian tumors generally do not cause bleeding unless they have endocrine activity. Childhood bleeding must take into account precocious puberty and can often be identified due to the development of secondary sexual characteristics. The cause of bleeding is unknown in many cases, but may be due to medication, central nervous system damage, hypothyroidism or adrenal glands, or ovarian tumors.

80% of vaginal and cervical vaginal adenopathy and clear cell adenocarcinoma are manifested by bleeding and increased vaginal discharge. These lesions are related to the use of diethylstilbestrol by the mother while the fetus is in the womb, and can be diagnosed by cell smear and biopsy directly on the suspicious area with a colposcopy. Most lesions do not require treatment unless there is a malignant change, but should be treated Periodic inspection.

Reproductive age In the reproductive years, primary or secondary blood disorders with abnormal blood coagulation can cause abnormal bleeding. Adolescents and women suspected of having blood coagulation disorders should undergo a hematological examination. For example, dysfunctional uterine bleeding in Women's von Willebrand disease is the most common symptom.

The most common organic cause of abnormal bleeding in women of reproductive age is complication of pregnancy. Almost half of bleeding women with pregnancy symptoms or confirmed early pregnancy will spontaneously abort the fetus. Important differential diagnosis includes ectopic pregnancy (see Section 252) and gestational trophoblastic disease (see section 241). Infection with retention of pregnancy products and endometritis often bleed shortly after delivery or after miscarriage, but sometimes 2 weeks later.

Abnormal uterine bleeding

Bleeding caused by vaginal lesions includes vaginal adenopathy and malignant changes. Bleeding caused by vaginitis is more common in children and postmenopausal women because their vaginal mucosa is thin. However, if the inflammation is severe, it can also cause a small amount of redness in the reproductive years. Granulation tissue (especially hysterectomy) formed after surgery can cause bleeding. Biopsy may be required to rule out malignant changes. Although silver nitrate cautery or cryotherapy can stop bleeding in most cases, large lesions may require Surgical resection.

Bleeding caused by cervical lesions includes cervical cancer, benign cervical lesions, cervicitis (rarely causes bleeding, unless accompanied by cervical eversion, but may cause bloody discharges), cervical or endometrial polyps (causing bleeding after intercourse), Submucosal fibroids (causing bleeding during menstruation, excessive menstruation, or frequent menstruation) and genital warts.

Uterine muscular adenopathy (endometrial benign invasion of the muscularis) is a common disease that causes symptoms in only a small number of patients, and often in the later years of reproductive years. Menstruation and intermenstrual bleeding are the most common complaints. It is pain in the pelvis and frequent urination and severe after urgency. During the gynecological examination, you can feel the uterus enlarged, round, slightly softer than normal, and may be accompanied by fibroids. MRI before surgery to help make the diagnosis. If the diagnosis is correct, hysterectomy Can relieve symptoms in all patients. Contraceptive steroids and GnRH analogs are not very effective.

Forty-year-old women, 40% have fibroids and only a few who have symptoms need treatment. They can cause any type of bleeding.

Functional ovarian cysts are more common, and> 50% of patients have abnormal menstruation, ranging from amenorrhea to more menstrual. In young women, cystic appendage masses can disappear naturally. Attachment masses> 5cm and persist for> 1 month, requiring surgical exploration To exclude tumors. Any ovarian tumor can cause uterine bleeding, but bleeding often only exists in tumors with endocrine activity.

Thyroid dysfunction can be associated with abnormal menstruation. It can cause more menstruation, but more commonly, less menstruation and amenorrhea.

Abnormal uterine bleeding menopause

Gynecological malignancies must be ruled out for any postmenopausal woman. The most common benign diseases that cause postmenopausal bleeding are atrophic vaginitis, atrophic endometrium, endometrial polyps, and endometrial hyperplasia. Atrophic endometrium The cause of bleeding is not clear. Endometrial polyps do not need to be treated after diagnostic curettage, but they must be observed for recurrence. Hyperintimal hyperplasia should be treated with progestin or hysterectomy.