Menorrhagia

　　1. Etiology of Menorrhagia

　　The cause of abnormal uterine bleeding in women with ovulatory function without organic disease may be due to slight abnormalities in ovulatory function, caused by irregular endometrial maturation or shedding, or improper proportions of estrogen and progesterone.

　　Second, Pathogenesis

　　1. From the perspective of endocrinology, abnormal uterine bleeding can be caused by the following conditions, and the mechanism of bleeding is as follows:

　　(1) Estrogen withdrawal bleeding: Women who have had their ovaries removed will experience uterine bleeding after stopping the appropriate dose and course of estrogen treatment, or reducing the estrogen dose by more than half, which is known as 'estrogen withdrawal bleeding'. However, if the dose of estrogen given is too low, the course is too short, or the reduction in estrogen dose is too small, there may be no uterine bleeding. Postmenopausal women also have fluctuations in blood estrogen concentration at a low level, but there is no menstrual onset. This is because bleeding occurs only when the endometrium proliferates to a certain thickness and loses hormone support. Some scholars have proposed it as 'the estrogen endometrial bleeding threshold; bleeding will occur if the estrogen stimulation is reduced to below this threshold after exceeding it; conversely, if the estrogen stimulation intensity is below this threshold and fluctuates at this level, bleeding will not occur'.

　　(2) Estrogen breakthrough bleeding: The long-term action of a relatively high concentration of estrogen without the opposing effect of progesterone can cause excessive proliferation of the endometrium to varying degrees. Without the stimulation of estrogen, it directly acts on the blood vessels to reduce vascular tension; stimulates the expression of VEGF in the stroma, reduces the production of PGF2a and AngⅡ, promotes the production of nitric oxide (NO), PGE2, and PGI2, causing vasodilation, increased blood flow, or due to the different development of endometrial stroma, vessels, and glands, excessive development and instability of lysosomes, releasing hydrolytic enzymes, causing increased or continuous, unpredictable bleeding, known as 'estrogen breakthrough bleeding'.

　　(3) Progesterone breakthrough bleeding: An excessive ratio of progesterone to estrogen concentration in the body cannot maintain the integrity of the secretory endometrium, causing bleeding. The specific mechanism is not yet clear. Fraser et al. (1996) summarized the research results on the mechanism of breakthrough bleeding after the use of single progesterone contraceptives, such as norplant, and long-acting medroxyprogesterone acetate, and believed that the clinical characteristics of progesterone breakthrough bleeding are irregular, continuous, and small bleeding; there must also be the influence of continuous low-level estrogen at the same time; the endometrium is in a suppressed secretory or atrophic phase with focal, patchy shedding; hysteroscopy can show superficial vessel dilation in the uterine cavity, thin vessel walls, increased microvessel density and fragility, and the appearance of ecchymosis; hemodynamic disorders, increased infiltration of leukocytes, and other changes. These changes are of reference value for the natural occurrence of ovulatory dysfunctional uterine bleeding. There are also studies suggesting that increased local MMP expression, abnormal function of vascular endothelial cells, VEGF, and other angiogenesis factors, or altered function of migrating leukocytes may lead to endometrial disintegration and abnormal repair, which may be related to this type of bleeding.

　　(4) Other: Localized uterine bleeding can also be caused by abnormal local blood vessels, such as arteriovenous fistulas; systemic hemostasis, and abnormal coagulation function, etc.

　　2, Pathogenesis of heavy menstrual flow:Comparing the dynamic changes of serum LH, FSH, E2, and saliva P concentrations, and the endometrial tissue morphology between women with ovulatory heavy menstrual flow and those with normal menstrual flow, no differences were found. There was also no significant difference in the scores of estrogen and progesterone receptor content in the endometrium (single antibody immunohistochemistry). However, there is a large variation in the content of these receptors among different individuals. But Gleeson (1993) and others reported that the endometrial ER and PR in women with heavy menstrual flow were higher than normal (single antibody solid phase immunization method). Reports have shown that the plasma and menstrual blood of women with heavy menstrual flow have normal coagulation factors and uterine vascular density. In recent years, research has found positive factors related to the pathogenesis from the following aspects:

　　(2) Imbalance in the ratio of different PGs in the endometrium: It is known that different PGs have opposite effects on vascular contraction and platelet function. Prostacyclin (PGI2) can dilate blood vessels and inhibit platelet aggregation; thromboxane A (TXA2), on the other hand, causes vasoconstriction and promotes platelet aggregation. Both PGE2 and PGF2 can promote platelet activity, but the former dilates blood vessels, while the latter constricts them. Studies have shown that the ratio of PGE2/PGF2a produced by the endometrium in women with heavy menstrual flow is increased, and the ratio of the respective metabolites of PGI2 and TXA2, -6-keto PG-TXB2, is also increased. The imbalance in the production of these two pairs of PGs leads to a tendency for vascular dilation and inhibition of platelet aggregation, resulting in increased menstrual flow.

　　(1) Endometrial fibrinolysis system hyperactivity: The uterine muscle layer and endometrium contain a large amount of tissue-type plasminogen activator (tPA). Studies by Gleeson (1994) show that the tPA activity of normal female endometrium begins to rise from the late secretory phase, reaching a peak on the second day of the next menstrual cycle. For women with heavy menstrual flow, the tPA activity in the endometrium begins to rise from the mid-secretory phase, and it is significantly higher than normal in the late secretory phase and on the second day of the next menstrual cycle, both in the endometrium and menstrual blood. There is a strong positive correlation between the tPA activity in the endometrium on the second day of the cycle and the amount of menstrual blood loss. It may be due to the excessively high activity of endometrial tPA, leading to hyperactivity of the fibrinolysis system, causing unstable or recanalized thrombi for hemostasis, severe degradation of extracellular matrix collagen and adhesion proteins, extensive and persistent endometrial shedding, leading to heavy menstrual flow.

　　(3) Other: Increased VEGF and NO expression in the endometrium during the follicular phase leads to increased blood flow, decreased ET release and bFGF receptor in the endometrium, resulting in increased infiltration of leukocytes, and overexpression of genes related to endometrial bleeding factors, etc.

　　It may be accompanied by anemia, secondary infection, psychological burden, endometrial hyperplasia or adenocarcinoma, etc.

　　Menstrual hyperemia may not necessarily be a problem with the reproductive organs themselves, but rather a sign of a blood disease. Since menstruation, like other human bleeding phenomena, is regulated by the body's own coagulation system. If there is an abnormality in the coagulation system, such as: hemophiliacs with congenital deficiency of certain coagulation factors, due to the blood not clotting easily, they experience heavy menstrual flow and prolonged bleeding duration. Sometimes, menorrhagia is the only manifestation in female hemophiliacs!

　　In patients with ovulatory dysfunctional uterine bleeding with excessive menstrual bleeding, the amount of menstrual blood loss in each menstrual cycle is more than 80ml. There is a significant difference in the subjective judgment of the amount of bleeding among patients, and only 40% of patients with a subjective complaint of excessive menstrual bleeding have more than 80ml of blood loss when objectively measured. Although the menstrual cycle of patients with excessive menstrual bleeding due to ovulatory dysfunctional uterine bleeding is irregular, it often has a regular pattern.

　　Generally, the frequency of changing sanitary napkins can be used to estimate the amount of bleeding. If you are used to using thicker sanitary napkins and changing them frequently, it indicates that the amount of bleeding is high.

　　The first cause of menstrual irregularity: stress

　　Experts analyze that women of childbearing age who are under long-term stress can suppress the function of the pituitary gland, causing the ovaries to stop secreting female hormones and not ovulating, leading to menstrual irregularity. Similarly, long-term depression, bad temper, or emotional problems can also affect menstruation.

　　Warm tips

　　To relieve mental stress, you can engage in some whole-body exercises such as swimming and running, one to two times a week, for 30 minutes each time.

　　Eat more dishes that can reduce stress, such as bananas, cabbage, potatoes, shrimps, chocolate, ham, corn, and tomatoes.

　　The second cause of menstrual irregularity: catching a cold

　　Experts analyze that cold during the menstrual period can cause vasoconstriction in the pelvic cavity, leading to ovarian dysfunction, which can cause excessive menstrual bleeding or even amenorrhea.

　　Warm tips

　　During the menstrual period, it is necessary to avoid cold and dampness, avoid getting wet, wading, swimming, drinking cold drinks, and especially prevent the lower body from getting cold, and pay attention to keeping warm.

　　You can add foods such as scallions, beans, pumpkins, garlic, ginger, chestnuts, and oranges to your diet; in addition, vinegar, soy sauce, vegetable oil, chili, pepper, and other spices, as well as beef and chicken broth, have a certain effect on menstrual irregularities caused by this condition.

　　The third cause of menstrual irregularity: electromagnetic waves

　　Experts analyze that various household appliances and electronic devices produce different electromagnetic waves during use, which can have a bad effect on women's endocrine and reproductive function if they act on the human body for a long time, leading to endocrine disorders and menstrual irregularities.

　　Warm tips

　　When operating the computer daily, protection should be taken.

　　Installing a hands-free earpiece on the phone is a relatively safe choice. Of course, it is best not to use the phone for a long time.

　　Reduce the use of microwave ovens, and do not place refrigerators in the bedroom. Pay attention to the scientific use of electrical appliances, try to avoid using multiple appliances simultaneously, and do not use them for too long or too frequently.

　　Eating more foods rich in vitamin A, C, and protein such as carrots, sprouts, tomatoes, lean meat, and animal livers, and regularly drinking green tea can effectively prevent and alleviate the harm of electromagnetic pollution to the human body.

　　The fourth cause of menstrual disorders: constipation

　　Expert analysis: Constipation may cause menstrual disorders in women. After the rectum is overly full of feces, the cervix will be pushed forward, and the uterus body will tilt backward. If the uterus retroversion occurs repeatedly for a long time, the veins in the broad ligament will be compressed and not unobstructed, the uterine wall will become congested and lose elasticity. If the uterus remains in a retroverted position for a long time, it will cause back pain and menstrual disorders.

　　Warm tips

　　1, Sweet medicine: Take one spoon of sesame oil and one spoon of honey, mix them well and take them, which can moisten the intestines and promote peristalsis.

　　2, Drinking a bowl or two of hot vegetable soup on an empty stomach in the morning can have a significant therapeutic effect on constipation.

　　3, Eucommia tea is a good drink for constipation patients, which can relieve constipation and reduce fat. Drinking lemon juice in the morning and evening or after meals can enhance gastrointestinal digestion, aid in weight loss, and have a soft stool effect.

　　4, Walnuts, yogurt, and dried plum are snacks that can moisten intestines and relieve constipation; eating less coffee and more bananas can also promote defecation, but overeating can backfire.

　　The fifth cause of menstrual disorders: overuse of medicine

　　Expert analysis: The abuse or frequent and excessive use of antibiotics can lead to menstrual disorders, anovulation, and amenorrhea in women. This may be due to the drug's suppression and injury to the body's own resistance, leading to dysfunction of the body.

　　Warm tips

　　1, Good personal immunity can help you resist minor diseases.

　　2, Do not arbitrarily upgrade antibiotics. Once you use advanced antibiotics, lower-grade ones will not work because bacteria have developed resistance to them. Therefore, you should consult a doctor for medication, and be cautious about upgrading.

　　The sixth cause of menstrual disorders: going to discos

　　Expert analysis: Noise can lead to female dysfunction, which has adverse effects on menstruation and fertility.

　　Warm tips

　　Try to choose quiet places for gatherings and reduce exposure to noise. You can shorten the time spent at discos or hold parties at home.

　　The seventh cause of menstrual disorders: smoking

　　Expert analysis: Nicotine in tobacco can reduce the secretion of sex hormones, thereby interfering with physiological processes related to menstruation, causing irregular menstruation. Women who smoke more than one pack a day have three times the irregular menstruation rate as non-smoking women.

　　Warm tips

　　1, Change bad living habits and quit smoking resolutely.

　　2, Appropriately supplement vitamin C. Vitamin C can alleviate the harm of smoking to the body, and some tablets can be taken, or more fruits such as tangerines, oranges, kiwis, etc. can be eaten.

　　Routine blood test, hormone level detection, coagulation function, platelet adhesion and aggregation function test, measure BT, and choose a time for endometrial or blood progesterone determination.

　　Hysteroscopy, laparoscopy, B-ultrasound, uterine artery angiography examination.

　　One, Dietetic recipe for excessive menstrual bleeding

　　1, One white pomegranate peel, one white lotus seedpod, decocted in water.

　　2, Fresh celery 30 grams, fresh Selaginella tamariscina 30 grams, eggs 2. Boil the eggs, peel them and put them in an earthen pot. Add celery and Selaginella, cover with fresh water to submerge the medicine residue, and boil until done. Remove the medicine residue and eat the eggs, drink the soup. Take 1 dose daily, for 2-3 doses consecutively.

　　3. Black fungus 20 grams, jujube 30 pieces, brown sugar 20 grams, cook and eat, once a day.

　　4. Pork skin 1000 grams, add water and simmer over low heat until tender, add 250 milliliters of yellow wine, 250 grams of brown sugar, mix well, bring to a boil, pour into a bowl, chill into a gel, and cut into slices to eat. It has the effects of nourishing yin and blood, stopping bleeding, and moistening the skin. Regular consumption can treat anemia, emaciation, excessive menstrual bleeding, metrorrhagia, and various bleeding symptoms.

　　5. Fresh shrimp 30 grams, walnut kernel 50 grams, pork kidney (cut and washed clean) 2 pieces. Stir-fry and eat, 1-2 times a day.

　　6. Chicken soup or lean pork soup in appropriate amounts, boil, add 250 grams of fresh oyster meat, and boil slightly. Season with salt and monosodium glutamate and eat.

　　7. Dried celery and chrysanthemum 30 grams. Boil and drink as tea.

　　8. Fresh rehmannia 30 grams,粳米60 grams. Cook into porridge and eat.

　　9. Lotus root 250 grams, lean pork 100 grams. After boiling, eat (suitable for those with blood heat).

　　10. Black-bone chicken 500 grams, huangqi 50 grams, aiye 30 grams. After boiling, eat the meat and drink the soup.

　　11. Black soybeans 30 grams, brown sugar 30 grams, dangshen 10 grams. Take the decoction (suitable for those with Qi deficiency).

　　12. Motherwort 60 grams, eggs 6 pieces. After boiling, eat (suitable for those with blood stasis).

　　13. The preparation and efficacy of plum syrup and pills. Preparation: Take ten pounds of plump plums, cook until extremely soft, remove the kernel, filter, and then boil again to concentrate into a thick syrup, which is plum syrup. Knead into pills the size of soybeans, which are plum pills.

　　Two: What is good for women with excessive menstrual bleeding to eat

　　1. During the menstrual period, it is advisable to eat more scallion whites, mushrooms, peanuts, walnuts, jujube, longan, and rose.

　　For those with heat syndrome, wheat, millet, red beans, mung beans, and green beans can be selected. For those with blood stasis, wine and vinegar can be used appropriately.

　　2. The main components of blood include plasma proteins, potassium, iron, calcium, magnesium, and other inorganic salts. This means that each menstrual period will result in the loss of some protein and inorganic salts. Therefore, in principle, after menstruation, it is advisable to supplement proteins, minerals, and other nutrients, as well as taking some blood tonics. During this period, foods and medicines that can nourish the skin, beautify the complexion, and promote blood circulation can be chosen, such as milk, eggs, quail eggs, beef, lamb, pork pancreas, chufa, spinach, cherry, longan meat, lychee meat, carrot, apple, angelica, safflower, peach blossom, prepared rehmannia, and Polygonatum.

　　3. During menstruation, it is also recommended to supplement foods that are beneficial for the flow of 'menstrual fluid', such as lamb, chicken, jujube, bean curd skin, apple, coix seed, milk, brown sugar, motherwort, angelica, longan, and other warm-nourishing foods. When there are symptoms such as poor appetite and back pain, it is advisable to choose nutritious, stomach-soothing, and easily digestible foods, such as jujube, noodles, and coix seed porridge. To maintain a balanced diet, fresh vegetables and fruits should be consumed at the same time. Foods should be fresh, not only delicious and easy to absorb but also with less nutritional damage.

　　Three: Foods that should not be eaten by women with excessive menstrual bleeding

　　1. Salt: Eating salty foods before the onset of menstruation is harmful to women. Overly salty foods can increase the storage of salt and water in the body, causing headaches, irritability, and mood swings before menstruation.

　　31. Avoid cold and raw foods in the diet: Traditional Chinese medicine believes that blood moves when it is warm and stagnates when it is cold. During menstruation, eating cold and raw foods can hinder digestion, damage the body's Yang Qi, lead to internal cold, stagnation, and affect the smooth flow of menstrual blood, causing oligomenorrhea or dysmenorrhea. Even in the hot summer, it is not advisable to eat cold drinks during menstruation. It is advisable to eat cooked and warm foods during menstruation, and a little mutton, chicken, longan, and other warming foods can be eaten in winter.

　　30. Avoid drinking strong tea: Tea, in addition to having certain nutritional value, also has the effect of preventing and treating diseases. However, the special physiological factors during a woman's menstrual period determine the need to avoid drinking strong tea. Because strong tea contains a high amount of caffeine, which stimulates the nervous and cardiovascular systems, causing excitement, increasing the basal metabolic rate, and easily leading to dysmenorrhea, prolonged menstruation, and excessive menstrual blood. At the same time, tannins in strong tea combine with iron in food in the intestines, causing precipitation, hindering the absorption of iron, and leading to iron-deficiency anemia.

　　29. People with blood heat should avoid spicy foods, scallions, garlic, ginger, mustard, fennel, Sichuan pepper, and other fiery foods; those with deficiency and cold should avoid cold fruits and vegetables and cold foods.

　　26. To regulate work and rest, one should actively engage in physical and mental labor, but avoid overexertion and intense exercise, as excessive effort can damage the spleen Qi, leading to malfunctions and insufficient metabolism, causing menstrual disorders.

　　25. To regulate reproduction and sexual abstinence, it is important to pay attention to the节制 of reproduction and sexual abstinence to prevent disease, avoiding excessive and frequent childbirth (including abortion) and sexual intercourse during menstruation and postpartum. Otherwise, it may damage the Chong and Ren Channels, vital essence, and kidney Qi, leading to menstrual disorders. Attention should be paid to these aspects in daily life, and even more so during menstruation and postpartum, which can help reduce or prevent the occurrence of this disease.

　　24. To adapt to cold and heat, one should adjust clothing and bedding according to changes in climate and environment, avoiding excessive cold or coolness to prevent external pathogens, damage to Qi and blood, and causing menstrual disorders.

　　23. To regulate diet, it is important to eat at regular intervals and in appropriate amounts. Avoid overeating or consuming excessive fatty, sweet, greasy, cold, and spicy foods to prevent damage to the spleen and stomach, leading to insufficient metabolism or the accumulation of dampness and phlegm, or cooling and burning the blood, causing menstrual irregularity.

　　22. To maintain emotional well-being, avoid melancholy, anger, and damage to the liver and spleen, or excessive emotions, five passions transforming into fire, disturbing the Chong and Ren Channels, leading to menstrual disorders.