*For medical professionals reading only
There are physiological and pathological
Today's case
Ms. Liao has been very worried in the past six months. She originally had a good appetite and had a "overweight" weight, but she couldn't eat and couldn't sleep well. My aunt had just left for ten days, but she was bleeding a little. Could it be that the detoxification is not completely exhausted? She went to a health club and received various "detoxification" treatments, but still failed to solve the problem. She finally walked into Dr. Xiaoye's clinic. Considering that Ms. Liao is 47 years old and is overweight, after careful examination, we also performed an endometrial scraping on her. Finally, the cause of the bleeding was found: endometrial cancer. Fortunately, the tumor was still in its early stages when it was discovered.
Like Ms. Liao, most women have more or less encountered abnormal vaginal bleeding in their lives, but it is definitely not like a tumor that is caused by bleeding, nor is it called "poor detoxification".
In order to prevent the sisters from continuing to get into the trap, Dr. Xiao Ye has sorted out N possibilities for abnormal vaginal bleeding. Which one are you?
North possible vaginal abnormal bleeding
1, pregnancy and other systemic diseases
First of all, we must rule out bleeding related to pregnancy, such as miscarriage and ectopic pregnancy . Systemic diseases, such as coagulation dysfunction, or taking a large dose of anticoagulant can also cause abnormal bleeding.
2, uterine structural abnormalities
Myometrial lesions: such as uterine fibroids, adenomyomas, adenomyosis, etc.
Endometrial lesions: includes benign lesions such as polyps, endometritis, malignant lesions such as endometrial tumors, etc., especially , hemorrhage after menopause, which is closely related to endometrial cancer; or uterine cavity adhesions, sisters who have multiple abortions or other uterine cavity operations should pay special attention; as well as primary endometrial dysfunction, the principle is relatively complex, and they are abnormal molecular and cellular mechanisms responsible for regulating blood loss during menstruation.
3, cervical and vaginal structural lesions
Cervical lesions: is common to bleeding after sexual intercourse, benign lesions such as cervicitis , cervical polyps ; there are also malignant lesions such as cervical cancer .
Vaginal lesions: common vaginal intraepithelial lesions, or vaginal wall cysts, vaginal mediastinum, etc.
4, hormone-related issues
Use drugs that may affect the normal release of estrogen and progesterone: For example, long-term medication is used due to diabetes , liver and kidney, thyroid , and adrenal abnormalities.
Other factors affecting estrogen production and metabolism: such as Emotional or physical stress , and significant changes in body weight will also interfere with the pituitary gland's release of gonadotropin and prevent ovulation, resulting in menstrual disorders and abnormal bleeding.
Abnormal bleeding during puberty and menopause: is usually related to abnormal ovulation. Patients may have non-ovulation or have thin ovulation, which leads to abnormal secretion of estrogen, especially the deficiency of progesterone, which leads to drip bleeding or large amounts of bleeding. Women over 45 years old will experience menstrual fluctuations in ovarian function. If you can't tell whether you have any problems, it's more reliable to consult a doctor, because the hormone levels in women in these two periods fluctuate greatly and are more likely to experience breakthrough bleeding.
5, iatrogenic factors
Commonly used are intrauterine birth control rings, or oral gonadal steroids (especially preparations containing progesterone only, such as emergency contraceptive pill , etc.).
6, nonspecific
uterine cesarean section incision diverticulum can also cause abnormal bleeding, and the occurrence of diverticulum increases as the number of cesarean section increases.
7, trauma
Common ones include vulva cross-border injury and severe vaginal abrasions or lacerations during sexual intercourse.
8. Physiological reasons
About 9% of women of childbearing age have abnormal bleeding between the two menstruation, which may be related to the decrease in the level of estradiol shortly after ovulation, so it is also called ovulation bleeding . Generally, the amount of bleeding is small, the duration is short, and it can heal itself. What should I do if I have abnormal bleeding in
?
First, pregnancy must be ruled out, and then gynecological examinations are required. If necessary, imaging examinations are required to evaluate whether there are endometrial polyps , scar defects in cesarean section and abnormal uterine structure. Patients with irregular bleeding often have abnormal ovulation, and they should also understand whether thyroid function, prolactin and ovarian function are abnormal.
For non-pregnant patients, if there are obesity or other high-risk factors for endometrial lesions, endometrial sampling is required; even if there are no high-risk factors, endometrial sampling is required, even if there are no high-risk factors, repeated abnormal bleeding or postmenopausal bleeding is required. If it is contact bleeding, such as bleeding after having sex or after gynecological examination, beware of cervical lesions and seek medical treatment as soon as possible.
For acute major bleeding, pubertal girls mainly use hormone hemostasis. For menopausal women, endometrial diagnosis and scraping are generally preferred to stop bleeding. At the same time, endometrial samples can be collected to eliminate endometrial lesions. After that, long-term follow-up is also required to monitor the potential risks and sequelae of aovulation bleeding.
There are many possible cases of abnormal vaginal bleeding, both physiological and pathological, and the problems can be big or small. But all sisters should pay attention to their physical changes and seek medical treatment in time if necessary.
Expert Profile
Yedan Expert profile yexinhong General gynecology, associate chief physician Yedan, attending physician, specializing in cervical lesions, infertility , polycystic ovarian syndrome , uterine fibroids, ovarian cysts, pelvic inflammatory disease and other common diseases. Published several foreign SCI articles in the domestic core journal , and published nearly 10 points in the past five years.
professionally specializes in:
endometriosis , cervical lesions, infertility, polycystic ovary syndrome, uterine fibroids, pelvic inflammatory disease, menopausal syndrome and other common gynecological diseases.
Source of this article: Obstetrics and Gynecology Affiliated to Fudan University
Author: Ye Dan
Editor in charge: Sweet
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