Dysfunctional uterine bleeding during adolescence

　　The causes of anovulatory functional uterine bleeding are mainly due to incomplete or delayed development of the hypothalamus-pituitary-ovary axis during adolescence, and the establishment of a perfect positive feedback regulatory mechanism between the hypothalamus and the ovary has not been achieved. Under the action of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), the follicles develop and secrete estrogen, but estrogen has not yet formed a positive feedback on the hypothalamus, so although there is follicular development in the ovary, ovulation cannot occur.

　　There are four causes of functional uterine bleeding caused by ovulatory dysfunction:

　　1. Inadequate corpus luteum function.During the menstrual cycle, there is follicular development and ovulation, but insufficient progesterone secretion or early regression of the corpus luteum can lead to poor endometrial secretion.

　　2. Incomplete endometrial shedding.Due to incomplete regression of the corpus luteum, estrogen and progesterone cannot decline rapidly, and the endometrium cannot shed regularly due to imbalanced hormone levels, causing prolonged bleeding period and increased blood volume.

　　3. Prolonged endometrial repair.Due to the incomplete shedding of the endometrium during the menstrual period, the development of new follicles in the next cycle is delayed or poor, resulting in insufficient estrogen secretion. This leads to the endometrium not being able to regenerate and repair on schedule, causing prolonged menstruation.

　　4, Ovulatory period bleeding.Due to the temporary drop in hormone levels during the ovulatory period, the endometrium loses hormone support and part of the endometrium is shed, causing withdrawal bleeding. When estrogen secretion reaches a sufficient amount, the endometrium is repaired and bleeding stops.

　　Adolescent functional uterine bleeding patients often have a lot of bleeding and a long duration, often complicated with anemia. Some may have thyroid function abnormalities, adrenal cortex hyperplasia, and polycystic ovary syndrome, etc.

　　Adolescent functional uterine bleeding has many clinical symptoms, mainly the following characteristics:

　　1, Irregular uterine bleeding, with varying blood volume, or sudden increase. Longer amenorrhea, more bleeding, and may continue for several months without stopping, with a cycle shorter than 21 days, intermittent bleeding.

　　1, The reproductive organs are normal, or both ovaries are symmetrically slightly enlarged.

　　2, Basal body temperature is unimodal.

　　4, Excessive bleeding can cause anemia, and severe cases may appear symptoms such as dizziness, palpitations, shortness of breath, fatigue, edema, and decreased appetite.

　　5, Clinical symptoms such as breast tenderness, lower abdominal distension, and emotional excitement due to excessive hormone excretion.

　　In the prevention of adolescent functional uterine bleeding, attention should be paid to the following points:

　　1, It is necessary to popularize health knowledge of adolescence

　　To make adolescent girls understand the normal growth and development process during adolescence. Most girls start menstruating between the ages of 13 and 16, and most of them can establish a normal menstrual cycle quickly after their first menstruation, menstruating monthly; a few may experience menstrual irregularities due to incomplete maturation of their endocrine function. Excessive tension, fatigue, malnutrition, and other factors can trigger such phenomena. Therefore, adolescent girls must arrange their studies and life well, pay attention to the combination of work and rest, and ensure sufficient intake of nutrition (proteins, vitamins, iron), avoid cold and cold foods, eat more fish, meat, poultry eggs, milk, vegetables, and avoid spicy and stimulating foods. Taking iron-containing drugs such as ferrous sulfate oral solution can increase iron intake and improve anemia.

　　2, Prevent infection

　　During bleeding, the uterine cavity is connected with the outside, and bacteria, due to a good growth environment, will rapidly multiply and cause disease. Therefore, not only should the occurrence of systemic diseases be prevented, but attention must also be paid to menstrual hygiene. Pay attention to the cleanliness of the vulva during bleeding, and clean the perineum 1 to 2 times a day to remove blood stains, and frequently change menstrual pads and underwear. Some vulva cleansers can be used, as well as warm water for cleaning, but avoid taking a bath in a basin. Married women should avoid sexual intercourse during the period of bleeding.

　　3, Other

　　If the amount of bleeding is large, it can lead to anemia and reduced body resistance, so it is necessary to strengthen hemostatic measures and consider antiseptic treatment to prevent inflammation and acute infectious diseases. Pay attention not to wade through water in the rain, and change wet clothes and pants in time to avoid the invasion of cold evil, prevent blood stasis due to cold, and prevent excessive bleeding or unclean bleeding.

　　The main examination methods for functional uterine bleeding during adolescence are as follows: four kinds of examination methods

　　1. Diagnostic curettage

　　For married patients with heavy or persistent bleeding, diagnostic curettage should be used first to stop bleeding and to explore the uterine cavity to determine the presence of organic diseases. The pathological examination of the endometrium shows that the endometrium of anovulatory uterine bleeding is proliferative changes, or adenocystic, adenomatous hyperplasia, which can develop into atypical hyperplasia or endometrial cancer without treatment; for ovulatory bleeding, it is 'secretory phase changes' or 'poor secretion'. If secretory phase endometrium can still be scraped out on the 5th day of bleeding, it indicates incomplete corpus luteum regression.

　　2. Cervical mucus crystals

　　The presence of fern-like crystals in cervical mucus before bleeding suggests an anovulatory bleeding pattern.

　　3. Hysteroscopy

　　Hysteroscopy can help find small uterine cavity lesions such as small uterine polyps and submucosal fibroids, and can perform biopsy under direct vision, which increases the detection rate of such organic diseases.

　　4. Ultrasound examination

　　Examination can find small uterine fibroids (interstitial), or small ovarian tumors, or no ovarian cystic enlargement, and can find uterine cavity lesions and measure the thickness and texture of the endometrium. Under B-ultrasound monitoring, saline infusion can increase the contrast of the sonogram, which can improve the diagnostic rate of small uterine cavity lesions such as polyps and submucosal fibroids.

　　Therapeutic diet for functional uterine bleeding during adolescence:

　　1. Stewed lean meat with corn silkThis recipe is suitable for blood heat type uterine bleeding. Take 30 grams of corn silk, 120 grams of lean meat, an appropriate amount of salt, and a little monosodium glutamate. Cut the lean meat into pieces and put it in an earthen pot with corn silk, add 500 milliliters of water, cover it with a lid, and steam it until the meat is cooked. Add salt and monosodium glutamate and take it while hot. Corn silk has the effect of cooling blood and hemostasis, and is commonly used in folk medicine to treat 'red崩'. Lean meat can replenish blood, and when combined, they have a significant therapeutic effect on blood heat type 'uterine bleeding'.

　　2. Stewed chicken with cuttleboneThis recipe is suitable for blood deficiency type uterine bleeding. Take 30 grams of cuttlebone, 30 grams of angelica sinensis, 100 grams of chicken meat, an appropriate amount of salt and monosodium glutamate. Cut the chicken into pieces, slice the angelica sinensis, crush the cuttlebone, and put them in an earthen pot with 500 milliliters of water, an appropriate amount of salt, and steam them in a steamer. Take once a day. Generally, 3 to 5 times can see results. Cuttlebone has the effect of hemostasis, and both angelica sinensis and chicken meat are good for replenishing blood. They are particularly effective for blood deficiency type 'uterine bleeding'.

　　3. Stir-fried mustard greens with motherwortThis recipe is suitable for uterine blood stasis. Take 30 grams of fresh motherwort, 30 grams of fresh mustard greens, and an appropriate amount of vegetable oil. Wash and chop the fresh motherwort and mustard greens. Place a wok on a strong fire, add vegetable oil, and stir-fry the fresh motherwort and mustard greens until they are cooked. It can be eaten as soon as it is cooked. Take twice a day until the bleeding stops. Motherwort has the effects of promoting blood circulation, breaking blood stasis, and regulating the menstrual cycle. Mustard greens contain mustard acid, which can shorten the bleeding and clotting time, thus achieving the purpose of hemostasis, and is particularly effective for blood stasis type 'uterine bleeding'.

　　4. Stewed dried lychees with lotus seeds: This formula is suitable for the spleen deficiency type of uterine bleeding. Take 20 dried lychees and 60 grams of lotus seeds. Remove the shell and kernel from the dried lychees and the core from the lotus seeds, wash them clean, and place them in a ceramic pot with 500 milliliters of water. Steam over medium heat in a steamer until cooked and then serve. Dried lychees are rich in nutrition and can nourish the blood and invigorate the spleen. The main effect of lotus seeds is to strengthen the spleen and astringe the intestines. When used together, they are appropriately matched and are often used to treat the spleen deficiency type of 'gongxue'.

　　Functional uterine bleeding belongs to the category of 'metrorrhagia' in traditional Chinese medicine, and the main treatment methods are as follows:

　　1. Stop by clearing, used for the heat syndrome of metrorrhagia.Symptoms include profuse bleeding, bright red blood. The heat symptoms of metrorrhagia are often related to Yin deficiency of the liver and kidney, excessive相 fire, and disturbance of the blood sea. Treatment should use cooling and nourishing herbs such as peony, raw rehmannia, white peony root, and Sanguisorba officinalis. Herbs such as coptis, phellodendron, and gardenia should be used with caution to avoid injury to Yin from bitter and cold properties.

　　2. Stop by warming, used for metrorrhagia due to deficiency and cold.Symptoms include slight bleeding, pale color, and accompanied by cold pain in the lower abdomen. Herbs that should not be used are those that are acrid, slippery, dry, and hot, and instead, herbs such as donkey-hide gelatin, morinda, eucommia, cistanche, ginseng, and astragalus, which tonify yang and invigorate the body, should be used. If cold is severe, add herbs such as evodia, dry ginger, huoxiang, and cyperus to warm the meridians, invigorate the qi, and stop bleeding.

　　3. Stop by supplementation, used for metrorrhagia due to disharmony of qi and blood and deficiency of the conception and governing vessels.Clinical manifestations include irregular menstrual bleeding, persistent and profuse, accompanied by fatigue, frequent dreams, poor appetite, and other symptoms. Generally, it is more common to have both liver and kidney deficiency or spleen and kidney deficiency. Treatment for liver and kidney deficiency focuses on nourishing the liver and kidney and harmonizing yin and yang, with herbs such as eucommia ulmoides, rehmannia, psoralea, eucommia, etc. In cases of spleen and kidney deficiency, it is generally not advisable to use herbs like cimicifuga and bupleurum, as they may shake the root and disturb the floating yang.

　　4. Stop by purgation, used for metrorrhagia with qi and blood stasis.Clinical symptoms include chest and abdominal distension and pain, dark blood with clots. Treatment should be to activate blood circulation and resolve blood stasis, and to use such herbs as red peony root, salvia miltiorrhiza, milk vetch root, trichosanthes, curcuma, panax notoginseng, etc.