(1) Lifestyle management: change the risk behavior factors such as smoking, drinking, unreasonable meals, and sedentary lifestyle, prevent irregular vaginal bleeding caused by menstrual disorders, and prevent the occurrence of diseases.
(2) Regular physical examination: regular physical examination for gynecological examination and ultrasonic examination is conducive to early detection of abnormal uterine structure diseases, early treatment and prevention of bleeding.
(1) Medical history: General information: age, menstrual history, marriage and childbearing history;
Conditions related to recent bleeding: the amount, frequency, duration of bleeding, and whether there is bleeding in other parts (such as gingival bleeding);
Past illness: whether you have chronic diseases (such as hypertension, thyroid disease, kidney disease, etc.), bleeding diseases, coagulation dysfunction, etc.
(2) Physical examination: gynecological examination: help to determine whether the bleeding comes from the uterine cavity;
Systemic examination: it is helpful to determine whether there are other system diseases.
(3) Auxiliary examination: the purpose is to determine the cause and severity of bleeding and determine whether other diseases are combined.
① Blood sampling examination: blood routine examination, blood coagulation function, thyroid stimulating hormone determination, prolactin, estradiol, follicle stimulating hormone, luteinizing hormone, etc;
② Pregnancy test: blood or urine hCG excluded pregnancy;
③ Uterine examination: ultrasonic examination, hysteroscopy, endometrial biopsy.
Irregular vaginal bleeding is the main problem (chief complaint) of the patient. The corresponding disease can be diagnosed according to the medical history, physical examination and auxiliary examination to determine the cause of bleeding. It can be divided into two categories and nine types, as shown in Table 1. These may exist alone or together to cause irregular vaginal bleeding. The first task of diagnosing diseases is to determine the bleeding mode of irregular vaginal bleeding, and finally determine the diagnosis according to the bleeding mode and auxiliary examination.
Etiology of irregular vaginal bleeding Diseases with structural abnormalities | Disease without structural abnormality |
Endometrial polyps | Systemic coagulation related diseases |
Adenomyosis | Ovulation disorder |
Leiomyoma of uterus | Local abnormality of endometrium |
Malignant change and atypical hyperplasia of endometrium | Iatrogenic abnormal uterine bleeding Unclassified abnormal uterine bleeding |
The purpose of treatment is to treat the cause of disease. After the diagnosis is clear, the corresponding specific plan needs to be formulated. The general principle is to stop bleeding and adjust the menstrual cycle. If anemia occurs, anemia should be corrected. Treatment methods include medication and surgery.
Drug treatment: it is applicable to diseases without structural abnormality, and the purpose is to make the patients return to normal menstrual cycle.
(1) Hormone drugs: including estrogen and progesterone, used alone or in combination.
Estrogen is effective in treating acute hemorrhage. The cause of uterine bleeding is endometrial shedding. The role of estrogen is to stimulate the growth of endometrium so as to stop bleeding. After stopping bleeding, the amount of medication should be gradually reduced. Patients with anovulatory bleeding should be treated with progesterone after correcting moderate and severe anemia. If the dose of estrogen in the extended treatment period is high, we should be alert to the occurrence of thromboembolism and strengthen observation.
Progesterone is very effective in the treatment of anovulatory bleeding, including medroxyprogesterone acetate, megestrol acetate, levonorgestrel intrauterine device (Menyuele), etc. It is forbidden in pregnancy, undiagnosed vaginal bleeding, breast cancer, deep vein thrombosis, pulmonary embolism, active or recent stroke or myocardial infarction, and liver function damage. Progesterone should be administered continuously or periodically to inhibit endometrial growth in luteal phase and prevent recurrence. Periodic oral progesterone does not inhibit ovulation.
The combined hormonal contraceptives have a good effect on irregular vaginal bleeding, can also improve adolescent acne, and can improve menopausal syndrome such as hot flashes caused by decreased estrogen in perimenopausal patients.
(2) Non steroidal anti-inflammatory drugs: Prostaglandins on the endometrium of women with severe irregular vaginal bleeding are at a high level. The role of non steroidal anti-inflammatory drugs is to inhibit the production of prostaglandins and reduce bleeding. Drugs include ibuprofen, aspirin, naproxen, etc. This kind of medicine is prohibited for those with abnormal platelet, and is not recommended for those with kidney disease, heart failure, liver cirrhosis or those who are using diuretics.
(3) Antifibrinolytic drugs: The level of plasminogen activator on the endometrium of women with severe irregular vaginal bleeding is high. Plasminogen activator is an enzyme that is not conducive to blood coagulation. Antifibrinolytic drugs can promote the formation of blood clots, thereby reducing the amount of bleeding. The representative drug is tranexamic acid, which is prohibited for those with coagulation risk, but long-term use will not increase the risk of thrombosis.
Surgical treatment: It is applicable to diseases with ineffective drug treatment or structural abnormalities.
Irregular vaginal bleeding can be caused by many reasons. Drug treatment can effectively control the bleeding caused by most non structural abnormalities. Drug treatment includes hormone and/or non hormone treatment. It should be tailored for patients according to the side effects and contraindications of various treatments. Non hormone therapy such as NSAIDs and antifibrinolytic drugs are also effective, and can be used in combination with hormone therapy or instead of hormone therapy. Irregular vaginal bleeding caused by structural abnormalities can benefit from drug treatment, but its structural abnormalities (such as polyps, fibroids, etc.) may require surgical treatment. [1]
