What Is an Open Uterus?

Functional uterine bleeding, referred to as dysfunction, is a non-organic lesion of abnormal uterine hemorrhage caused by abnormal neuroendocrine caused by abnormal regulation of the hypothalamus-pituitary-ovary (HPO) axis. Dysfunction is a common gynecological disease, accounting for about 10% of gynecological outpatients. This disease is clinically divided into two types, namely anovulatory dysfunction and ovulatory dysfunction. The former, often occurs in adolescent and menopausal women. Functional uterine bleeding during adolescence is caused by hypodevelopment or delayed maturation of the neuroendocrine center. The dysfunction in menopausal women is mainly due to hypothalamic-pituitary-ovarian axis hypofunction, which is caused by the continuous decline of ovarian function.

English name: Functional uterine bleeding
Visiting department: Gynecology
Common causes: Non-organic lesions of abnormal uterine bleeding due to neuroendocrine abnormalities due to abnormal regulation of the hypothalamic-pituitary-ovary (HPO) axis

Clinical classification: Anovulatory dysfunction and ovulatory dysfunction

Pathogenesis of functional uterine bleeding

It is generally believed that many factors inside and outside the body, such as excessive mental stress, fear, sadness, sudden changes in the environment and climate, overwork, and other systemic diseases, can affect the interaction of the hypothalamus-pituitary-ovarian axis through neurotransmitters in the cerebral cortex. Regulation, resulting in ovarian dysfunction and menstrual disorders. Malnutrition, anemia, and generational disorders can also affect hormone synthesis, transport, and effects on target organs, leading to menstrual disorders.

Egg-free dysfunction is caused by hormones that cause changes in the endometrial microenvironment (including growth factors, cytokines, vasoactive substances, extracellular matrix, etc.). Changes in the microenvironment of the endometrium lead to uncontrolled repair of the endometrium, pathological changes, and the occurrence of ovarian dysfunction.

For puberty, dysfunction is due to lack of progesterone resistance and glandular secretion; increased PC; lack of coagulation factors V, VII, X, XII, etc .; and the role of spiral arterioles and lysosomes in endometrial spiral arterioles and lysosomes. The abnormal structure and function of the enzyme body affects the intimal shedding and the repair of vascular epithelium.

Functional uterine bleeding diagnosis

In clinical practice, the accurate diagnosis of dysfunction is not easy. Some organic lesions have been reported to be hidden, with a slow course and misdiagnosed as dysfunction. The first step in diagnosing dysfunction is to exclude organic lesions. There are many types of organic lesions, such as thrombocytopenia, aplastic anemia, hypothyroidism, hyperthyroidism, taking sex hormones, contraceptives, genital trauma, foreign bodies, ectopic pregnancy, threatened abortion, uterine leiomyoma and sarcoma, and uterine glands. Myopathy, endometrial cancer, endometritis, endometrial polyps, lupus erythematosus, etc. Second, long-term dysfunction may be transformed into organic, and there is no absolute limit between the two. For example, patients with anovulatory dysfunction and blood transfer to endometrial polyps and endometrial cancer due to the effect of high estrogen in the recipient. Patients with recurrent abnormal uterine bleeding are more common clinically. The pathology of the early postoperative diagnosis and curettage is the proliferative membrane. Due to the failure to revisit and correct treatment on time, the pathological diagnosis of the postoperative diagnosis and curettage is endometrial cancer. Third, organic lesions and dysfunctions that cause abnormal uterine bleeding may coexist. Patients with dysfunction may have other diseases at the same time, such as dysfunction and endometritis, dysfunction and uterine fibroids, dysfunction and endometriosis.

At present, the methods to assist the examination of functional uterine bleeding include diagnostic curettage, ovulation and luteal function tests (including basal body temperature measurement, vaginal cytology and cervical mucus function tests, hormone measurements, ultrasound tests), blood and coagulation fibrinolysis function Examination, liver function examination.

The main points of the diagnosis of dysfunctional blood: should accurately collect the medical history, inquire about the history of menstruation and bleeding in detail, take contraceptives and sex hormone drugs recently, and judge the type of bleeding in abnormal menstruation. Gynecological examination can exclude bleeding caused by cervical disease and vaginal disease, and clear uterine cavity bleeding. Women of childbearing age examine human chorionic gonadotropin to exclude pregnancy-related diseases. Ultrasound imaging examination excluded organic lesions of the reproductive system. Diagnostic curettage excludes endometrial hyperplasia or precancerous lesions. Hysteroscopy and endometrial biopsy are effective diagnostic methods.

Functional Uterine Bleeding Treatment

The general treatment principle of dysfunction and blood is to stop bleeding quickly and effectively at the bleeding stage. After hemostasis, an appropriate regimen should be selected to prevent recurrence. After a few months of medication, short-term drug withdrawal can be considered to observe whether the body can naturally adjust and restore function. If dysfunctional blood recurs, timely medication can be surely controlled. For patients in areas without follow-up conditions, more hysterectomy is considered. Hemostasis methods include curettage, progesterone endometrial shedding, estrogen endometrial growth, and synthetic progesterone endometrial atrophy.

Western medicine treatment of functional uterine bleeding

For clinical treatment of dysfunction, western medicine mainly adopts curettage and hormone drugs.

For married women, curettage is often used. Through curettage, the purpose of rapid hemostasis can be achieved, and the scraped material can be used as a pathological test specimen for dual effects. Sex hormones can also be used to play a role in hemostasis. Currently used hormones include estrogen, androgens and progestins.

For adolescent dysfunction and anemia (Hb> = 80g / L), a large dose of estrogen can be applied. Estrogen can stimulate endometrial hyperplasia and repair the wound, but it can cause more severe bleeding after stopping the drug. And the gastrointestinal reaction is more serious. Progesterone is suitable for all types of bleeding, and can promote synchronized secretion of the endometrium to achieve the purpose of hemostasis. Drug curettage is suitable for patients with dripping hemorrhage without major bleeding. The endometrium is secreted and concentrated in a short period of time by using progesterone. Those who take the above progestin need to start menstruation from the fifth day of withdrawal bleeding. Androgen is used as an adjuvant therapy of estrogen and progestin to stop bleeding. The purpose is anti-estrogen, reduce pelvic congestion, increase uterine muscle tension and reduce bleeding volume, but cannot shorten the bleeding time and completely stop bleeding. Drug therapy includes hemostatic drugs, antifibrinolytic drugs, to resist fibrinolysis and inhibit plasminogen activating factor to achieve hemostasis, prostaglandin synthase inhibitors, inhibit prostaglandin production, and resist prostaglandin to promote bleeding Mechanism; using clotting factors such as fibrinogen and platelets. In addition to the hemostatic methods described above, you can also adjust the menstrual cycle to rebuild regular menstruation, or you can use ovulation-promoting therapy to avoid recurrence of dysfunction.

For the treatment of ovulation-type dysfunction, androgen therapy, progesterone cycle therapy, etc. are used clinically to suppress menstruation and assist luteal function, such as progesterone therapy.

Traditional Chinese medicine treatment of functional uterine bleeding

In addition to the above-mentioned western medical methods, Chinese medicine has its superiority in the treatment of functional uterine bleeding. Chinese medicine believes that dysfunction is a "collapse". Women who are absent from menstruation during the vaginal bleeding suddenly, or dripping blood continuously, are called "collapse", the former is called "collapse", and the latter is called "leakage". If the menstrual period is prolonged for more than 2 weeks, the category of current collapse is called "menstrual collapse" or "menstrual leak". The disease of collapse is based on a certificate. The lighter is the one that is leaked, and the other is the collapse. It is caused by Chongren's loss of solidarity, mostly due to blood heat, qi deficiency, blood stasis, etc. Qi deficiency includes kidney qi deficiency and spleen qi deficiency, and the spleen controls blood. Clinically, cold, heat, deficiency, and solidness are distinguished based on the color, quantity, and qualitative changes of menstrual blood and systemic symptoms. Treatment should be based on the severity of the illness and the long duration of bleeding, and adopt the principle of "emerging the symptoms while treating the symptoms, then treating the symptoms with the symptoms."

For the blood-heat-type collapse, the main formula is Qingre Gujing Decoction; the blood-stasis type is Zhuyu Zhiken Decoction; the spleen-deficiency type is Gu Chong Decoction; the kidney-deficiency type is Dabuyuan Jian. Fu's differentiation and treatment of childbearing age collapse, blood-heat type belongs to deficiency fever, the two parties should choose the addition and subtraction of the two places; The type of prescription is to add and subtract Xuefu Zhuyu Decoction.

In addition to drug treatment, patients should pay attention to diet and rest. The combination of diet and medicine is of great significance for the recovery of the disease.

Functional uterine bleeding

Patients with poor curative effect or unsuitable medication and no fertility requirements can be treated with surgery. There are two main types of surgery: endometrial removal and hysterectomy.