What Can I Do About Excessive Menstrual Bleeding?

The definition of polymenorrhea is that there is a large amount of bleeding during the menstrual period in consecutive menstrual cycles, but the menstrual interval and bleeding time are regular, no intermenstrual bleeding, bleeding after intercourse, or sudden increase in menstrual blood. Clinically, the bleeding time is compared with the basal body temperature (BBT) curve. Ovulatory dysfunctional uterine bleeding is divided into two types: menstrual volume and intermenstrual bleeding.

Basic Information

English name

menorrhagia

Visiting department

Obstetrics and Gynecology

Common causes

Hypothalamic-pituitary-ovarian axis function is unstable or defective, ovarian luteal function is poor, local reproductive organ inflammation, tumor and abnormal development

Common symptoms

Patient loses more than 80ml per menstrual cycle

Multiple causes of menstruation

Caused by neuroendocrine dysfunction

Mainly the hypothalamus-pituitary-ovarian axis is unstable or defective.

2. Caused by ovarian problems

Women of childbearing age often have irregular menstruation because the ovarian corpus luteum function is not good, and often show more menstrual bleeding.

3. Organic diseases or drugs

Including local reproductive organ inflammation, tumors and abnormal development, malnutrition; intracranial disorders; other endocrine disorders, such as thyroid, adrenal cortical dysfunction, diabetes, Sheehan's disease, etc .; liver disorders; Menstrual episodes can occur with medications, endocrine preparations or intrauterine device contraceptives.

Multiple clinical manifestations

Patients with more menstruation lose more than 80ml per menstrual cycle. The criteria for subjectively determining the amount of bleeding vary greatly from patient to patient. It has been reported that only 40% of patients who complained of heavy menstrual volume lost more than 80ml by objective measurement.

Menstrual check

1. Routine blood test, hormone level test, blood coagulation function, platelet adhesion function and aggregation function test, BBT test, and timing for endometrium or blood progesterone determination.

2. Hysteroscopy, laparoscopy, B-mode ultrasound, uterine angiography.

Multi-menstrual diagnosis

According to the clinical manifestations and the above related examinations, the determination of blood progesterone concentration during the first 5 to 9 days can help determine the ovulation type dysfunctional uterine bleeding.

Menstrual polytherapy

Drug treatment

(1) For patients without contraceptive requirements or unwilling to be treated with hormones, antifibrinolytic drugs: such as tranexamic acid; or anti-PG synthetic drugs: flufenamic acid (flufenamic acid), mefenamic acid ( Mefenamic acid). Adverse reactions may include nausea, dizziness, and headache.

(2) For patients who require contraception, endometrial atrophy can be selected.

(3) Others: Danazol is a derivative of 17a-acetylene testosterone, which can inhibit the secretion of gonadotropin-releasing hormone, inhibit the peak of gonadotropin cycle and the production of ovarian sex hormones, and can reduce blood loss. Damage, androgenic side reactions. Gonadotropin-releasing hormone synergists have a positive effect on suppressing ovarian function. Due to the side effects caused by low estrogen, it can only be used for a short time. Gossypol's atrophic endometrium has a strong effect, and can also directly affect the ovaries. It is necessary to take potassium chloride (sustained release potassium) to prevent hypokalemia. It is suitable for patients who no longer require fertility during the menopausal transition.

2. Surgical treatment

For patients who are ineffective in drug treatment, long lasting, older, and have no fertility requirements, the uterus can be surgically removed. In recent years, transcervical endometrial resection (TCRE) has been used. That is, under hysteroscopy surveillance, hysteroscopy uses laser, microwave, or electrocoagulation to destroy the endometrial functional layer and part of the basal layer. It loses its ability to respond to ovarian sex hormones, thereby reducing menstrual blood loss. The operation time is short, the trauma is small, and the recovery is fast. It can be applied to those who are unfit or unwilling to remove the uterus and have no fertility requirements. It can also remove small submucosal fibroids at the same time. Before surgery, the endometrium was shrunk with a gonadotropin-releasing hormone potentiator.