Menopausal dysfunctional uterine bleeding

　　Dysfunctional uterine bleeding, abbreviated as 'DUB', is a common gynecological disease. Women during menopause with DUB show irregular uterine bleeding, menstrual cycle disorders, varying lengths of menstrual periods, varying amounts of bleeding, sometimes with uterine bleeding lasting for several months, accompanied by anemia. BBT is uniphasic, and vaginal shedding cells are mainly basal cells, or middle and low layer cells. The cervical mucus crystallization shows poorly developed fern-like shapes, and the endometrium presents with cystic adenomatous hyperplasia or adenomatous hyperplasia. Blood endocrine examination shows elevated FSH and decreased E2. After women enter menopause, the ovarian function begins to decline, the hormone level of the ovaries decreases, and the feedback effect on the hypothalamus and pituitary gland is lost, causing the pituitary to secrete sex hormone-binding globulin at varying degrees. Although the remaining follicles in the ovary also develop, they do not ovulate. The endometrial glands show a continuous proliferative response under the long-term action of estrogen, which can lead to mild hyperplasia, cystic hyperplasia, or adenomatous hyperplasia. When the estrogen level fluctuates greatly, the endometrium does not completely shed, resulting in irregular uterine bleeding. According to traditional Chinese medicine, women's 'Jing' ceases at the seventh seven days, kidney Qi is weakened, and the Chong and Ren channels are depleted, mainly due to kidney deficiency. Due to the gradual decline of kidney Qi in menopausal women, the function of the viscera and bowels is impaired, spleen Qi is weak, and often there is no control over the blood, leading to metrorrhagia and hemoptysis. Therefore, menopausal DUB is more often manifested as spleen deficiency and blood disorder, with symptoms such as sudden or continuous metrorrhagia, pale and thin blood, lack of strength and shortness of breath, pale complexion, puffy eyelids, pale and fat tongue, and thin and weak pulse. Treatment should focus on invigorating Qi and strengthening the spleen, and consolidating the Chong and Ren channels.

　　The diseases that can be triggered by functional uterine bleeding during menopause are as follows:
　　1. Ovarian dysfunction:Patients with menstrual irregularity or excessive menstrual bleeding may also have concomitant organic lesions.
　　2. Adenomatous hyperplastic endometrium or endometrial adenoma:Patients with irregular bleeding due to long-term anovulation, or those who have been treated with estrogen for a long time, should pay attention to the changes in the endometrium, whether it develops into adenomatous hyperplastic endometrium or endometrial adenoma FK1.
　　3. Uterine fibroids:Complications such as anovulatory functional uterine bleeding are another type of functional uterine bleeding that needs attention, especially common during menopause. If diagnosed early, treatment for menopausal functional uterine bleeding can prevent patients with uterine hypertrophy or small fibroids from undergoing surgery, and can also provide better conditions for those who must undergo surgery.

　　Functional uterine bleeding during menopause can manifest in two situations:(1) Excessive bleeding volume and long duration; (2) After a period of menopause, sudden heavy bleeding. Experts remind women in menopause that when uterine bleeding symptoms occur, it is necessary to first undergo examination to rule out organic lesions, and then carry out gestational hormone treatment, while supplemented with blood-boosting and other treatment measures.

　　Daily precautions for functional uterine bleeding during menopause:
　　1. Pay attention to menstrual hygiene:In addition to preventing the occurrence of systemic diseases, attention must also be paid to menstrual hygiene, washing the perineum 1-2 times a day, and changing menstrual pads and underwear frequently; moderate work and rest, and try to avoid excessive mental stress.
　　2. Pay attention to diet:Diet should be light, but ensure sufficient nutrition, and eat more foods rich in vitamin C.
　　3, Improve anemia:Avoid spicy and stimulating foods; use iron pots to cook vegetables, and take iron-containing drugs such as ferrous sulfate oral solution to increase iron and improve anemia.
　　4, Precautions:Pay attention to not wading through water in the rain, and change wet clothes and pants in time. Avoid the invasion of cold evil, prevent blood stasis due to cold, and block the冲任 to cause excessive bleeding or unclean bleeding.
　　5, Do not abuse estrogen:Although estrogen can alleviate many symptoms, it must be taken under the guidance of a doctor.

　　The clinical examination of climacteric dysfunctional uterine bleeding is specifically:
　　One, Detailed medical history
　　1, Ask in detail about the age of onset, menstrual cycle, changes in menstrual period, duration of bleeding, amount of blood loss, nature of bleeding, duration of illness, and accompanying symptoms, and compare them with the menstrual cycle before onset.
　　2, Whether endocrine treatment has been received before consultation.
　　3, Whether there is amenorrhea before bleeding, and whether there are early pregnancy reactions.
　　4, If the bleeding time is too long or the amount of bleeding is too much, ask whether there are symptoms of anemia.
　　5, Understand the history of pregnancy and childbirth, contraception, and whether there are adverse mental stimuli.
　　6, Understand whether there are chronic diseases such as liver disease, hypertension, hemophilia, etc.
　　Two, Physical examination:Including general examination, gynecological examination, etc., to exclude systemic diseases and organic lesions of the reproductive tract. Gynecological examination generally has no special findings, sometimes the uterus is slightly enlarged, or the enlarged ovary can be palpated.
　　Three, Auxiliary diagnosis:
　　1, Blood routine, coagulation time, and platelet count: Can understand the degree of anemia and exclude blood diseases.
　　2, Diagnostic curettage: It is mainly used for married women. In order to exclude endometrial lesions and achieve hemostasis, a full curettage of the entire uterine cavity is necessary. During curettage, attention should be paid to the size and shape of the uterine cavity, whether the uterine wall is smooth, the nature and quantity of the刮出物. In order to determine ovulation or luteal function, curettage should be performed before menstruation or within 6 hours after menstruation; curettage can be performed at any time for irregular bleeding. Endometrial pathological examination shows hyperplastic changes or hyperplasia without secretory phase.
　　3, Basal body temperature measurement: It is a simple and feasible method to determine ovulation. The basal body temperature curve of anovulatory dysfunctional uterine bleeding is monophasic; the basal body temperature curve of ovulatory dysfunctional uterine bleeding is biphasic.
　　4, Hysteroscopy: Under hysteroscopy, the endometrium can be seen to be thickened, but may not be thickened, with a smooth surface, no tissue protuberances, but with congestion. Under direct vision of hysteroscopy, the lesion area is selected for biopsy, which is more valuable than blind endometrial biopsy in diagnosis, especially in improving the diagnosis rate of early uterine cavity lesions such as endometrial polyps, submucosal uterine fibroids, and endometrial cancer.
　　5, Cervical mucus crystalline examination: The appearance of fern-like crystals before menstruation suggests the absence of ovulation.
　　6, Hormone measurement: To determine whether ovulation has occurred, serum progesterone or urinary pregnenolone can be measured. In medical history, menstrual cycle shortening, infertility, or early pregnancy with abortion are often reported. Gynecological examination of the reproductive organs is within the normal range. Basal body temperature is biphasic, but the temperature rises slowly after ovulation, with a low rise amplitude, and the rise time only maintains for 9-10 days before descending. The endometrium shows poor secretory response.
　　7. Vaginal shedding cell smear examination: The smear generally shows moderate to high estrogen influence.
　　8. Hysterosalpingography: Can understand uterine cavity changes, exclude organic changes.

　　Dietary and food recommendations for menopausal dysfunctional uterine bleeding: food should be light and fresh fruits and vegetables rich in vitamin C should be eaten more, such as spinach, rapeseed, kale, tomatoes, etc. These foods are rich in iron and copper, and also contain folic acid, vitamin C, and carotene, which have a good effect on treating anemia and assisting in hemostasis. Avoid overeating and drinking, as this may damage the spleen and stomach. Avoid cold and cool foods and foods with刺激性 spices and flavorings, as strong刺激性 foods can increase menstrual flow.

　　Traditional Chinese medicine believes that menopausal dysfunctional uterine bleeding belongs to the category of 'metrorrhagia', and the etiology and treatment principles are basically the same as those of adolescent dysfunctional uterine bleeding. However, due to the gradual decline of kidney qi in menopausal women, the loss of zang-fu function, and the weakness of the spleen qi, there is often a loss of control, leading to metrorrhagia. Functional uterine bleeding is closely related to the kidney and is related to the liver and spleen. Representative formulas for treating functional uterine bleeding include Gu Ben An Gong Zhi Xue Decoction, etc., and patients can choose to use them according to their own conditions. The common pathogenesis of menopausal dysfunctional uterine bleeding in clinical practice is:
　　1. Deficiency of liver and kidney:Deficiency of the liver and kidney essence due to pre-natal deficiency or injury to the essence due to sexual overexertion, early marriage and early childbirth, excessive abortions, etc., which leads to deficiency of the liver and kidney yin fluid. Yin deficiency leads to internal heat, heat burns the Chong and Ren meridians, and blood flows wildly, causing functional uterine bleeding.
　　2. Deficiency of spleen and kidney yang:Deficiency of spleen and kidney yang in the constitution or due to long-term illness, dietary and physical exhaustion, etc., which damages the spleen and kidney. The spleen controls blood, and yang deficiency leads to loss of control; kidney yang deficiency leads to the failure of the function of closure, resulting in the instability of the Chong and Ren meridians and causing functional uterine bleeding.
　　3. Blood stasis:Blood stasis due to cold conglomeration, blood stasis due to qi stagnation. Blood stasis blocks the Chong and Ren meridians and uterus, new blood cannot return to the meridians, so it does not follow the usual path and appears as functional uterine bleeding. Long-term internal retention of blood stasis can transform into heat, burn the blood vessels and cause unceasing bleeding, or be accompanied by blood clots.