Do you know about menstrual disorders?

"Doctor, my menstrual flow is too little, will it affect pregnancy?" "Doctor, my menstrual flow is too much, what kind of examination should I do?" "Doctor, my menstrual flow is always delayed, is it time for menopause?" I believe everyone has various questions about menstrual disorders. For the above questions, which situations need us to be vigilant and should we go to the hospital for corresponding diagnosis and treatment? Today, let's make a brief analysis here.

1. Normal menstruation

Normal menstruation includes three elements: menstrual cycle, menstrual period, and menstrual volume. The menstrual cycle refers to the time interval between the first day of menstrual bleeding. It is usually 21-35 days. The menstrual period refers to the duration of each menstrual period, which is usually 2-8 days. The menstrual volume refers to the total blood loss in one menstrual period, which is usually 20-60ml. If any of the above is abnormal, it is necessary to consider the existence of menstrual disorders. The following are common menstrual disorders.

2. Too little

It means that the total amount of bleeding in each menstrual cycle is less than 5ml. Since it is difficult to measure the amount of menstrual flow, 5ml is generally used as the standard to soak a pad. Too little menstrual flow is often accompanied by a shortened menstrual period. The reasons may be: (1) The menstrual blood discharge channel is blocked: such as uterine adhesion or cervical adhesion caused by abortion or curettage, which makes the menstrual blood flow out unsmooth. In this case, surgery is required to separate the adhesions. (2) Endometrial damage: such as damage to the basal layer of the endometrium caused by abortion or curettage, or factors such as uterine infection and tuberculosis. This situation generally causes infertility and requires artificial cycle and anti-tuberculosis treatment. It is very difficult to treat; (3) Decreased ovarian function: When ovarian function decreases, estrogen levels decrease, affecting the growth of the endometrium, and the menstrual flow will decrease. After confirming the diagnosis, hormone replacement therapy can be carried out after six sex hormone tests and AMH on the 2nd to 5th day of the menstrual period; (4) Other factors: polycystic ovary syndrome, abnormal thyroid function, mental and psychological factors, anorexia, etc.

3. Excessive menstrual flow

It means that the total amount of blood loss in each menstrual cycle is more than 80ml. Generally, 10-15ml of menstrual blood can soak a daily sanitary napkin. Some women have prolonged menstruation. The reasons may be: (1) Organic lesions: Submucosal uterine fibroids lead to an increase in the area of ​​the endometrium; adenomyosis leads to uterine enlargement, hypertrophy of the uterine myometrium, poor contraction ability, and poor vascular contraction; endometrial polyps are caused by local hyperplasia of the endometrium; it can also cause infertility, anemia, etc. (2) Pelvic inflammatory disease: Endometritis causes local blood vessels to become brittle, and menstrual blood is not easy to coagulate, resulting in heavy bleeding, often accompanied by lower abdominal pain. (3) Intrauterine ring: Its contraceptive principle is local mechanical damage and chronic inflammation of the endometrium. The rejection and inflammatory reaction caused by it can also lead to increased menstrual volume or lower abdominal pain. (4) Cesarean section diverticulum: After cesarean section, a "small depression" is formed at the cesarean section incision in the lower part of the uterus. This depression is prone to blood accumulation, resulting in continuous menstrual bleeding. Generally, a preliminary diagnosis can be made through vaginal ultrasound. (5) Blood system diseases: thrombocytopenic purpura, leukemia, aplastic anemia, etc.

4. Menstrual cycle disorders

If the number of days in the entire menstrual cycle is less than 21 days, it is called frequent menstruation, and if it is longer than 35 days, it is called oligomenorrhea. (1) Causes of frequent menstruation: decreased ovarian function leads to shortened follicular phase; insufficient luteal function leads to insufficient secretion of progesterone, which makes the endometrial secretion and transformation insufficient, causing shortened luteal phase; psychological factors lead to abnormal secretion of gonadal axis hormones. (2) Causes of oligomenorrhea: if women of childbearing age have delayed menstruation after sexual intercourse, pregnancy should be ruled out first; polycystic ovary syndrome is the most common disease caused by endocrine disorders, and the typical symptoms are oligomenorrhea, high androgen manifestations such as hirsutism, acne, acanthosis nigricans, and infertility; other diseases include rheumatic immune diseases, chronic kidney disease, hypothyroidism; psychological and environmental factors, etc.

5. What should I do if I have menstrual disorders?

Find the cause: For various manifestations of menstrual disorders, trace the root cause, check six sex hormones, coagulation items, pelvic ultrasound, gynecological examination, hysteroscopy, etc.

Targeted treatment: If it is an organic disease, surgical treatment is given. If it is a disease caused by endocrine disorders such as ovarian dysfunction, luteal insufficiency, polycystic ovary syndrome, etc., hemostasis, estrogen and progesterone regulation of menstruation, and pregnancy promotion treatment are given. If it is an inflammatory disease, anti-inflammatory treatment is given.

Daily care: Pay attention to menstrual hygiene, avoid having sex and taking a bath during menstruation, and keep the vulva clean. Choose the right contraceptive method to avoid unwanted pregnancy and abortion. Keep a regular schedule, ensure adequate sleep and a happy mood, and release your own stress.

Author: Li Xiaoyan, Baoding Second Central Hospital, Hebei Province