Lectures of menorrhagia of childbearing age

2021-03-18 12:00 AM

In the elderly, if there is small physical damage, not worth the surgery, high doses of progestin can be used to induce menstruation in 3 to 4 months.

Menstruation

Menstruation is much more than normal periods, or is accompanied by menorrhagia. If the bleeding is too much, more than 200ml / day, affecting the whole condition, rapid pulse, drop in blood pressure is called menstruation.

Reason

The main reason is due to physical damage to the uterus such as uterine fibroids, uterine polyps, endometriosis in uterine muscle, making the uterus unable to contract, making the uterine lining difficult to regenerate. difficult to stop bleeding. It may also be due to an underdeveloped uterus, a posterior uterus causing venous stasis and heavy bleeding. Medical conditions can also cause seizures such as high blood pressure, blood clotting disorders, and kidney disease. Muscle hyperactivity is less common. May be caused by hemolysis, local fibrinolysis.

Treatment

In young people, if menstruation due to poor uterine contraction, uterotonic drugs such as ergotamine, prostaglandin sublingual. If menstrual periods are due to poor uterine development, they will return to normal after childbirth. If there is no pregnancy, estrogen can be combined with progesterone as a contraceptive pill. If you are afraid that birth control pills will cause artificial infertility for the patient after long-term treatment, you can give birth control pills in the second half of the cycle.

In the elderly, if there is small physical damage, not worth surgery (small uterine fibroids, small endometriosis), high doses of progestin can be used to cause amenorrhea in 3-4 consecutive months. .

For people over 40 years old, if drug treatment does not work, it is possible to raise the problem of hysterectomy.

Menopause due to pre-menstrual bleeding

Before a full menstruation, a woman has bleeding a few days, the amount of blood is less, making her period longer. Thus the cycle seems to be shortened.

It is caused by physical damage such as polyps of uterine lining of the uterus. But it can also be due to the early stage of atrophic luteum, progesterone decreases rapidly. Detected by taking baseline body temperature in the early mornings, body temperature decreased early.

Treatment: For people over 35 years old, should curettage of the uterus because curettage itself can also cure the patient, as in the case of quadrilateral mucositis, and at the same time get a piece of mucus. The endometrium poured out pathological anatomy, assessed physical damage if any, and examined the malevolent soldiers.

Treatment with drugs, using progeslin from the 20th - 26th day of the period, 10mg Duphaslon per day. It is also possible to use a combination of estrogen and progestin such as the combined oral contraceptive Ovidon, Eugynon, Rigevidon, Choice, marodon because in the second half of these cycles not only lack of progesterone but also lack of estrogen, the results are similar.

Menorrhagia due to bleeding after menstruation

After the period has been cleared for 1-2 days, the woman has bleeding again for a few days, with little bleeding. Entity causes are not rare (may be inflammation of the lining of the uterus, fibroids of the uterus, polyps of the uterus, malignancies in the uterus ...). Mechanical causes may be due to the uterine lining having areas of slow flaking or areas of slow regeneration. Slowing down is due to the slow regression of the corpus luteum, so the estrogen and progesterone decline slowly. Slow regeneration is due to the follicle's lack of adequate estrogen secretion. Distinguish by taking your body temperature early in the morning. If you see a persistent high temperature curve, progesterone drops slowly. If seen while the blood regains, the low temperature is caused by a lack of estrogen.

Treatment: Must first rule out the actual cause. If there is an entity cause then resolve the entity cause. If the corpus luteum is prolonged, give progestin or estrogen combined with progestin on days 20-25 of the menstrual cycle. After stopping the drug for a few days, the uterine lining will collapse and no menstruation. If due to slow regeneration of the uterine lining, Mikrofollin can be given 0.05mg, 1-2 tablets per day in the 3-8 days of the menstrual cycle.

Menorrhagia due to overproduction of the uterine cyst

Menstruation is slow, bleeding a lot and lasts long. The uterine lining is sometimes up to 3 - 5 mm thick, with small, long papillae or polyps-shaped bulges, which look velvety. Through microscopy, there is no picture of secretion of the uterine lining, lacking the spongy layer (pars spongiosa) of the mucosa. The glands are straight, sometimes with large bulges that look like cut cheese (with holes). In connective tissue there are large fibers. There is no glycogen in the glands. The blood vessels have only one layer of the endoderm, the veins that dilate the sinus walls, compressing the glandular ducts, causing them to swell. The spiral arterioles also increase. Because the venous systems are enlarged, it gives the uterine lining a cavity shape.

Reason

Long-acting estrogen was found to lead to a cavernous appearance of the uterine lining. When estrogen levels fluctuate or sensitivity to estrogen is no longer enough to maintain the uterine lining, it causes uterine mucosa to peel off, causing bleeding, long-term bleeding, and menorrhagia. Because the uterine lining has many sinuses, bleeding a lot.

Examination of the ovaries shows no corpus luteum. Long-acting estrogen is associated with folliculopathy (folliculus persistent).

Treatment

Most certainly is curettage of the uterine lining. Up to 50% get it over a long period of time. The remainder must continue to undergo drug treatment.

For people over 40 years old can try to use testosterone injection 25 mg/day for 8-10 days, can atrophy uterine lining (castration with hormones).

X-rays to shrink the ovaries are no longer available today. In all cases, progestin should be tried on a constant basis in the second half of the cycle, from the 16th day of the cycle (possibly from 14-15), every 3 months. Vacation medicine, follow up for a few months. If you see normal menstruation, stop using the drug. If no results, use again. However, long-term drug therapy should not be used for those over 40 years of age who should be indicated for hysterectomy, if after two years of conservative treatment there is no result.