How to treat functional endometrial bleeding?

In clinical practice, there is a disease specific to women called functional uterine bleeding, the full name of which is functional uterine bleeding. Moreover, this disease is also very common in gynecology. One in ten women suffers from functional uterine bleeding. Strictly speaking, functional uterine bleeding is divided into two types: the first is anovulatory type, and the second is ovulatory type. So, how to treat functional endometrial bleeding?

Pathogenesis

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

Dysfunctional uterine bleeding is caused by changes in the endometrial microenvironment (including growth factors, cytokines, vasoactive substances, extracellular matrix, etc.) under the regulation of hormones. Changes in the endometrial microenvironment lead to uncontrolled endometrial repair, pathological changes, and the occurrence of azoospermia.

As for adolescent functional uterine bleeding, it is due to the lack of progesterone antagonism and glandular secretion; elevated PC; deficiency of coagulation factors V, VII, X, XII, etc., and abnormal structure and function of spiral arterioles and lysosomes in the endometrium, which affect endometrial shedding and repair of vascular epithelium.

Western medicine treatment of functional uterine bleeding

In clinical practice, Western medicine mainly uses curettage and hormone drugs to treat functional uterine bleeding.

For married women, curettage is often used as a treatment method. Curettage can quickly stop bleeding, and the scrapings can be used as specimens for pathological examination, thus achieving a dual effect. Sex hormones can also be used to stop bleeding. Currently commonly used hormones include estrogen, androgen, and progesterone.

For adolescents with functional uterine bleeding and mild anemia (Hb>=80g/L), large doses of estrogen can be used. Estrogen can stimulate endometrial hyperplasia and repair the wound, but stopping the drug can cause more severe bleeding and more serious gastrointestinal reactions. Progesterone is suitable for all types of bleeding and can promote the synchronous secretion of the endometrium to achieve the purpose of hemostasis. Medical curettage is suitable for patients with spotting bleeding but no heavy bleeding. By using progesterone, the endometrium can be secreted and retreated in a concentrated manner in a short period of time. Those who take progestins mentioned above all need to start menstrual regulation treatment from the fifth day of withdrawal bleeding. Androgens are used as an adjuvant therapy for hemostasis with estrogen and progesterone. Their purpose is to resist estrogen, reduce pelvic congestion, enhance uterine muscle tension and reduce bleeding volume, but they cannot shorten bleeding time or completely stop bleeding. Drug therapy includes hemostatics, antifibrinolytics, which are used to resist fibrinolysis and inhibit plasminogen activators to achieve the purpose of hemostasis, prostaglandin synthetase inhibitors, which inhibit the production of prostaglandins and resist the mechanism of prostaglandins promoting bleeding; and the use of coagulation factors such as fibrinogen and platelets. In addition to the above-mentioned methods of hemostasis, you can also regulate the menstrual cycle and restore regular menstruation, or use ovulation induction therapy to avoid the recurrence of functional uterine bleeding.

For the treatment of ovulatory functional uterine bleeding, androgen therapy, progesterone cyclic therapy, etc. are used clinically to suppress menorrhagia; and to assist luteal function, such as progesterone therapy.