婦產(chǎn)科學(xué)課件：功能失調(diào)性子宮出血(英文版)

1、Dysfunctional uterine bleeding (DUB)Dysfunctional uterine bleedinPatterns Menorrhagia(hypermenorrhea)月經(jīng)過多Hypomenorrhea(cryptomenorrhea)月經(jīng)過少M(fèi)etrorrhagia(intermenstrual bleeding)子宮不規(guī)則出血Polymenorrhea 月經(jīng)頻發(fā)（月經(jīng)過頻）Oligomenorrhea 月經(jīng)稀發(fā)Menometrorrhagia子宮不規(guī)則出血過多Contact bleeding(postcoital bleeding)接觸性出血、性交后出血P

2、atterns Menorrhagia(hypermenoDefinitionIrregular bleeding, unrelated to anatomic lesions of the uterus, exclusion of pathologic causes of abnormal bleeding, is referred to as dysfunctional uterine bleeding. Disturbance of endocrineMost common at the reproductive ageReview the normal menstruationcycl

3、e 21-35, period 2-8, amount 20-60mlDefinitionIrregular bleeding, 婦產(chǎn)科學(xué)課件：功能失調(diào)性子宮出血(英文版)PathogenesisPathogenesisClassification Anovulatory: 85%Ovulatory: 15%Incidence IncidenceClassificationClassification IncidenceClassiIntroduction Breakthrough bleeding: only estrogen stimulate endometrium, no proges

4、teroneLow plasma concentrations of estrogens infrequent and light bleedingChronic stimulation of endometrium from increased plasma concentrations of estrogens frequent and heavy bleedingWithdrawal bleeding: single estrogen influent endometrium, atresia of follicles estrogen bleedingAnovulatory dysfu

5、nctional bleedingIntroduction Anovulatory dysfPathological changes of endometriumHyperplasia of endometriumsimple hyperplasiacomplex hyperplasiaatypical hyperplasia: not belong to DUB, glandular epithelium hyperplasia, polarity of cell disappear, size enlarged, dark and large nucleus, karyokinesis P

6、roliferative phase of endometriumAtrophic endometriumPathological changes of endomeClinical findings Irregular uterine bleedingPatterns:Menorrhagia（月經(jīng)過多）Metrorrhagia(子宮不規(guī)則出血)Menometrorrhagia （子宮不規(guī)則出血過多）Polymenorrhea（月經(jīng)過頻）No abdominal pain and discomfortableAnemiaPelvic exam: uterine size is normalCl

7、inical findings Irregular utDiagnosis Exclude anatomic causes of abnormal uterine bleedingHistoryAge, menses, marital, contraceptive, treatmentPhysical exam:General: exclude systemic diseases Pelvic: exclude genital diseaseLab examUltrasound: uterine size, shape, endometriumUrine or serum HCGDiagnos

8、is Exclude anatomic cauCytologic exam of cervix: cervical cancerDetermination of ovarian functionBBT: monophaseSerum hormones: progesterone is lowerHysteroscope: pathologic changes of cavityCytologic smear of vaginal shed cell: anovulatory periodic changesCervical mucosa: 1-2 days before uterine ble

9、eding , fernlike pattern (羊齒狀結(jié)晶) (picture) Coagulation function, blood cell countCytologic exam of cervix: cervSampling of endometriumD&C(診刮) hemostasis and finding causesbefore menses or within 6 hours of menstrual onsetFractional D&C: different cervix and corpusproliferative or hyperplasia, no sec

10、retory changesBiopsy of endometriumSampling of endometriumDifferential diagnosisAbnormal pregnancy or complications of pregnancy: abortion, ectopic pregnancy, retained placentaSystemic disease:hematopathy , failure of liver or kidney, hyperthyroidism or hypothyroidismrectal or urologic disordersDiff

11、erential diagnosisAbnormalGenital tumors: carcinoma of endometrium, cervix, myomas, ovarian tumorGenital infection: endometritis, salpingitis, cervical and endometrial polypsMisuse of sexual hormone, IUDGenital tumors: carcinoma of eIn different age, the differential diagnosis is differentPuberty he

12、mologic system diseaseReproductive age pregnancy induced diseasePremenopause tumorIn different age, the differenTreatments General treatmentIron, vitamine C, protein, antibiotic, restMedicine : the first-line therapySurgeryHysterectomy: medicine is no effectEndometrial ablation: laser, roller ball,

13、necrosis of endometrium, premenopause, no desire of reproduction in young womenUse danazol, gestrinone or GnRHa before operationTreatments General treatmentNotice some key pointsIn diagnosis, must exclude pathologic causesIn hemostasis, rapidly stop hemorrhage and regulate cycles, choice the most su

14、itable drugs and usageTo young women, the cured indications are recovering ovulationNotice some key pointsOvulatory menstrual dysfunctionOvulation, abnormal of corpus luteumTwo typesLuteal phase defect (LPD)Irregular shedding of endometriumOvulatory menstrual dysfunctioLuteal phase defect (LPD)Patho

15、logySecretory reaction of endometrium but luteal phase defect, corpus luteum secrete inadequate progesterone, derangement of gland and interstitium, less edema of interstitium Clinical manifestationShortening of cycles, luteal phase7dDiagnosisSymptoms BBT: double phase, decrease slowlyD&C: the 5th o

16、f menses, mixed endometriumTreatmentProgesterone12days after ovulation or 1014 days before next menses, MPA 10mg for 10 daysHCGCOCClinical findingsSummary of diagnosis and therapyhistory, PE, labno systemic and genital disease35 ybiopsy of endometriumproliferativeatypical hyperplasiahysterectomymedi

17、cinedesire of fertility no desire of fertilityhysteroscope, D&Chysteroscope, D&C, ablationfurther therapyno effectAUBSummary of diagnosis and theraThank you Thank you 婦產(chǎn)科學(xué)課件：功能失調(diào)性子宮出血(英文版)High phase11daysHigh phase96 hours, complicating other diseaseHemostasisCombined useSlight bleeding: combination

18、 low-dose oral contraceptive, the first day of menses21daysSevere bleeding: combination monophasic oral contraceptive, 1 2pill/812 hours, 3 days after bleeding stop, reduce 1/3 dose every 3 days, maintain 1pill for total 21 day. Such as MarvelonCommonly used in reproductive age or premenopause Combi

19、ned useEstrogenRecovery endometriumAcute severe bleeding: benzestrofol（苯甲酸雌二醇）: 34mg/d, adjust according to bleeding, total dose80g/L17-Hydroxyprogesterone（羥孕酮）, norethindrone（炔諾酮）: 5mg once every 8 hours, 3 days after bleeding stop, reduce dose, maintain dose 2.55mg/d to 21days after bleeding stop

20、D&C: acute severe bleeding, risk factorProgesterone (ablation of endoAdjuvant treatmentTranexamic Acid(氨甲環(huán)酸)、etamsylate(酚磺乙胺)、VitKTestosterone propionate （丙酸睪丸酮）Correct anemiaAntibioticAdjuvant treatmentRegulate cycles: 36 coursesEstrogens followed by progesteroneCombination ( oral contraceptives)Pr

21、ogesterone alonePromote ovulation (CC, HMG, HCG, GnRH-a)IUDRegulate cycles: 36 coursesEstrogens followed by progesteroneLower estrogenConjugated estrogen 1.25mg or estradiol 2mg qd 21days, 10 days later adding MPA10mg 10dEstrogens followed by progesteCombinationHigh estrogen and premenopauseOral con

22、traceptive: the 5th day of menses, every night 1 pill for 3 weeks, stop for 7 days Progesterone aloneAdolescence or premenopauseThe 1625 days of menses, MPA 10mg/d or progestin IM 20mg/d or dydrogesterone 1020mg/d or micronize progesterone 200mg for 1014 daysCombinationHigh estrogen and pNumber of glandsGlandular cavity enlarged, size is irregular, glandular epithelium is simple columnar or pseudostratified, no heteromorphism,interstitium hyperplasia Simple hyperplasiaNormal glandinterstitiumEnlarged glandNumber of glandsSimple hyperplGland hyperplasia are obvious, crowding, close to