Adolescent Uterine Dysfunction

Introduction Dysfunctional uterine bleeding occurs in adolescence called puberty dysfunctional uterine bleeding, which refers to abnormal uterine bleeding characterized by menstrual disorders caused by dysfunction of the HPOU axis rather than genital tract lesions. Among them, anovulation is more common, accounting for 80% to 90% of dysfunctional uterine bleeding. Often manifested as the menstrual cycle lost normal law, excessive menstrual flow, prolonged menstruation, and even irregular vaginal bleeding. Any factor inside or outside the body affects the regulation function of any part of the hypothalamic-pituitary-ovarian axis, which can lead to menstrual disorders.

Cause

In prepubertal, when the hypothalamic-pituitary-ovarian axis function is not yet mature and perfect, factors such as mental stress, irritation, overwork, obesity, etc. can affect any one or more links, resulting in ovulation. Adolescent dysfunctional uterine bleeding is clinically characterized by irregular menstruation, such as early or wrong time, more or less bleeding, an amount of more can lead to anemia, referred to as puberty dysfunctional uterine bleeding.

Dysfunctional uterine bleeding (DUB), referred to as dysfunctional uterine bleeding, refers to abnormal uterine bleeding characterized by menstrual disorders caused by dysfunction of the HPOU axis rather than genital genital changes.

Cause of dysfunctional uterine bleeding

First, systemic factors include adverse trauma, stress, malnutrition, endocrine and metabolic disorders such as iron deficiency, anemia, aplastic anemia, blood and bleeding, diabetes, thyroid and adrenal diseases.

Second, HPO axis dysfunction includes reproductive hormone release rhythm disorder, feedback dysfunction, ovulation and corpus luteum dysfunction.

Third, uterine and endometrial factors including spiral arterioles, microcirculatory vascular bed structure and dysfunction, endometrial corpus callosum receptor and lysosomal dysfunction, local coagulation mechanism abnormalities, and prostaglandin TXA2, PGI2 secretion disorders.

Fourth, iatrogenic factors include steroidal contraceptives, intrauterine devices interfere with normal HPOU axis function. Certain systemic diseases (especially in the mind, nerves) can be converted to normal menstrual function via neuroendocrine machines.

an examination

Auxiliary inspection

1. The basal body temperature is measured as a single phase type. Because most patients have late stage maturation of the hypothalamus, the hypothalamic pituitary ovary can only establish negative feedback, but can not establish positive feedback. Therefore, there is no LH peak in the middle menstrual period, which prevents the ovulation of mature follicles, so it is anovulatory. Type dysfunctional blood.

2. Vaginal secretion smear examination on the one hand can understand estrogen levels and periodic changes, because the patient's ovary does not ovulate, there is no progesterone effect, no periodic changes; on the other hand can also rule out rare malignant tumors.

3. Estrogen and progesterone were measured without periodic fluctuations, especially progesterone levels remained at the proliferative stage.

4. Diagnostic curettage diagnostic curettage can understand the endometrial response, except for intrauterine lesions and the purpose of achieving hemostasis. Adolescent patients with organic disease or malignant disease are rare, generally do not need to use diagnostic curettage to assist in the diagnosis; unless severe bleeding or drug treatment is not effective, the need for diagnostic curettage. The curettage is the most rapid and effective method of stopping bleeding. According to statistics, there are a certain number of patients who can stop bleeding immediately after curettage and naturally heal. If the curettage is used for diagnosis, the time of curettage should be performed within 1-2 days before the bleeding or within 12 hours after the bleeding.

5. Laboratory check blood routine, platelet count and bleeding, clotting time to determine the degree of anemia and the presence or absence of blood diseases.

6. Others should routinely measure thyroid, adrenal gland and liver function to exclude anovulatory dysfunctional uterine bleeding caused by these diseases.

Differential diagnosis

Differential diagnosis of dysfunctional uterine bleeding :

(1) Various uterine bleeding related to pregnancy Adolescent dysfunctional uterine bleeding often occurs for a period of time and then uterine bleeding; various uterine bleeding related to pregnancy, such as miscarriage, ectopic pregnancy, abortion of the mole, etc. also have a history of menopause. However, various uterine bleeding related to pregnancy, in addition to menopause history, there are pregnancy reactions, and pregnancy test, ultrasound examination are helpful to identify; if the identification is indeed difficult or major bleeding can be diagnosed by the use of diagnostic curettage, the internal cavity Scrape the tissue and send a pathological examination to help confirm the diagnosis.

(B) Injury bleeding Because of the girl's good activities, bleeding caused by injury is also more common. There was a history of injury during the inquiry, and the local pain of the vulva was felt after the injury. Examination of the vulvar hematoma, vulvar skin laceration, and even vaginal mucosa laceration.

(C) severe vaginitis can cause bleeding, but often increased vaginal discharge, purulent or bloody, stench. During the examination, it was found that there were inflammations and even ulcers in the vulva and vaginal opening.

(D) ovarian gonadal stromal tumors such as granulosa cell tumor and ovarian cell tumor, can cause precocious puberty and dysfunctional uterine bleeding. Gynecological examination can affect ovarian tumors (see Section 57.3, Ovarian cord (glandular) tumors).

(5) Thrombocytopenic purpura often begins with a lot of menstruation, but the difference between the disease is:

1 In addition to the monthly menstruation. There are other parts of the bleeding, such as nasal discharge, bleeding gums, etc.;

2 thrombocytopenia;

3 bleeding time is prolonged, beam arm test is positive;

420% of cases have mild splenomegaly; 5 bone marrow megakaryocytes increase, maturity disorder.

(6) Aplastic anemia This disease can also occur in other parts except for menstruation. In addition to pale complexion, the surrounding blood is characterized by the appearance of "three less than one more", that is, the number of red blood cells, granulocytes and platelets is reduced, lymphocytes are relatively increased, and bone marrow puncture can assist diagnosis.

(7) Chronic self-blood disease may show more menstruation or prolonged menstruation, but there are fever, weakness, progressive anemia and other parts of the body bleeding, weight loss, extreme splenomegaly in the course of the disease. The characteristics of blood is that the total number of white blood cells is extremely increased, and various types of granulocytes appear. Bone marrow puncture can help confirm the diagnosis.

(8) acute leukemia The onset of this disease is urgent, clinical manifestations in addition to bleeding, often accompanied by fever, severe anemia and infiltration of blood cells (including liver, spleen and / or lymphadenopathy, sternal tenderness). In addition to red blood cells and hemoglobin reduction, blood cells often have thrombocytopenia and poorly differentiated leukemia cells. Bone marrow aspiration can be diagnosed, and the number of primitive and naive (early and young) cells is significantly increased. In addition to anemia, dysfunctional uterine bleeding, no thrombocytopenia and leukemia cell infiltration, bone marrow puncture is helpful for diagnosis.

(9) thyroid function is mildly low, such patients can also have uterine bleeding, should pay attention to identification.

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