课件3妇产科学16.16.1disorders of menstruation

1、Disorders of menstruationZhou Wei Disease of reproductive endocrineDysfuctional uterine bleedingAmenorrheaPolycystic ovarian syndromeDysfuctional uterine bleedingAbnormal uterine bleeding induced by neuroendocrine dysfunction Anovulatory DUB 85% ovulatory DUBAnovulatory DUBNo ovulation adolescence &

2、 perimenopause HPOA abnormalCharacter of endometriumEndometrium is fragile than normalEndometrium ablates pletelyAbnormality of blood vesselBlood coagulation & anticoagulationBlood vessel relax factor (PGE2)Pathological change of endometriumEndometrial hyperplasiaProliferative phase endometriumAtrop

3、hic endometriumSimple hyperplasiaComplex hyperplasiaAtypical hyperplasiaClinical manifestationAbnormal bleedingMenorrhagia the cycle is regularly, duration 7 days or bleeding volume80mlpolymenorrheaCycle21 dayslMenometrorrhagiathe cycle is irregular, duration 7 days or bleeding volume80mlMetrorrhagi

4、a cycle is irregular， duration prolonged Diagnosis HistoryPhysical examination & pelvic examinationAuxiliary examinationDilation & curettageUltrasonographyHysteroscopyPregnancy testDetermination of sexual hormoneCoagulation testBasal body temperature test BBTDifferential diagnosisBleeding related to

5、 pregnancyGenital tumorGenital infectionHormone medicine or IUDSystematic diseaseTreatment Treatment of anemia & infectionMedicine (sexual hormone drug)Adolescence & reproductive age woman hemostasis; adjust cycle; promote ovulationPerimenopausal transition period hemostasis; adjust cycle ;decrease

6、bleeding volume ; prevent malignant diseaseTreatment hemostasis OCP Estrogen Progesterone-medical curretage Androgen Treatment adjust cycle Estrogen & progesterone sequential or combined Progesterone Treatment Hormone releasing IUDPromote ovulation Treatment Surgical treatment CurretageEndometrial a

7、blationhyterectomyOvulatory DUBLuteal phase defect LPDFSH follicle hypoevolutism E2 LHLH receptor defectPathology Gland dysplasia Secretory phase secretory reaction delayed about 2 daysClinical manifestationMenstrual cycle shorten Infertility or recurrent spontaneous abortionTreatment Low dosage est

8、rogen HCGProgesterone replacementIrregular shedding of endometriumEtiologyPathology the 5th-6th day, mixing endometrium of proliferative and secretory phase Clinical manifestation menstrual duration prolonged 9 daysIrregular shedding of endometriumDiagnosis Treatment progesteroneAmenorrhea Amenorrhe

9、a is a common symptomMenstruation cessation or no menstruation at allClassificationPrimary amenorrheaSecondary amenorrheaClassificationphysiology amenorrhea lactitionPathological amenorrhea Circumstance outside CNSHypothalamus antepituitaryovaryuterine月 经LHFSHGnRHEP区区区区5%20%20%55%Uterus amenorrheaDi

10、sease of uterineThe sexual hormones of ovary and the secondary sexual characteristics are normal Failure of uterine responseAsherman syndromeMullerian agenesis syndromeOvarian amenorrheaThe steroid hormones of ovary The secondary sexual characteristics are abnormal Failure of uterine responseTurner

11、syndrome (45, xo)Premature ovarian failureOvary destroyed Ovarian androblastomaPCOSPituitary amenorrheaSheehan syndromePituitary tumorEmpty sella syndromepostpartum hemorrhage , amenorrhea, trichomadesis, hypothyrosis, hypoadreniasella turcicadestroyed or defect cerebrospinal fluid (CSF) flow into s

12、ella pituitary atrophyHypothalamus amenorrheaIdiopathic Psychogenic stressLoss of body weightStrenuous exercise Drugs causeDiagnosis History Physical examination Menstrual historyReproductive historyFamily historyOthers Auxiliary examinationUterine exmination Diagnostic curettageHysteroscopyHysteros

13、alpingography (HSG) Auxiliary examinationDrug withdraw test Progestational challenge E & P sequential trial Auxiliary examinationOvarian function test BBTCells shedding from vaginaE , P, T Ultrasonography ovulationCervical mucous test under microscopy Auxiliary examinationPituitary test FSH , LH, PRL (prolactin)Pituitary activity test (GnRH stimulating test)CT ,MR of sella turcica TSH, CRH Auxiliary examinationPituitary activity test LHRH 100g i.v. Detect LH on 15, 30, 60, 120 min LH increase 2-4 times within 60 min Treatment General tr