Patient's question:
I don't have any symptoms, but I was diagnosed with mental tension, malnutrition, metabolic disorders, and environmental and climatic factors during the vaginal secretion test on April 24 at the hospital.Doctor's answer:
Dysfunctional uterine bleeding (DUB) is a term used in modern medicine to describe abnormal uterine bleeding caused by ovary dysfunction, commonly referred to as "DUB." It often manifests as irregular menstrual cycles, excessive menstrual flow, prolonged menstrual periods, or even irregular vaginal bleeding. Any internal or external factors that affect the regulatory function of the hypothalamic-pituitary-ovarian axis can lead to menstrual disorders.Guidance:
1. General Treatment
Patients often have poor physical health and appear anemic. Nutritional support should be strengthened to improve overall condition. Iron supplements, vitamin C, and protein can be provided. In severe cases of anemia, blood transfusions may be necessary. During bleeding, excessive fatigue and strenuous exercise should be avoided to ensure adequate rest. For prolonged bleeding, antibiotics should be administered to prevent infection, and anticoagulants can be used to reduce blood loss.
2. Medication Treatment
Hormonal therapy is highly effective but requires different approaches depending on the patient's age. For adolescent girls, the primary goals are to stop bleeding, regulate cycles, and promote ovulation. For women in perimenopause, the focus is on stopping bleeding and reducing menstrual flow after hemostasis. When using sex hormones, a well-planned and rational regimen should be established, using the lowest effective dose while closely monitoring to avoid inappropriate use leading to bleeding.
(1) Hemostasis
For patients with heavy bleeding, hormonal therapy should take effect within 6 hours, with bleeding stopping within 24–48 hours. If bleeding persists for more than 96 hours, organic lesions should be considered.
1) Progestogens
Anovulatory DUB is caused by estrogen stimulation alone. Progestogen supplementation converts the proliferative-phase or hyperproliferative endometrium to the secretory phase, leading to withdrawal bleeding after drug discontinuation. This thorough endometrial shedding is also referred to as "pharmacological curettage." It is suitable for patients with a certain level of estrogen in their bodies. Synthetic progestogens are divided into two categories: 17-hydroxyprogesterone derivatives (e.g., medroxyprogesterone, megestrol) and 19-norandrostenedione derivatives (e.g., norethisterone, ethynodiol diacetate). A high-estrogen-acting norethisterone (e.g., Femanone) 5–7.5 mg orally every 6 hours can be used. After 4 doses, bleeding significantly decreases or stops. The frequency can then be reduced to every 8 hours, followed by gradual dose reduction (decreasing by one-third every 3 days) until a maintenance dose of 5 mg daily is reached. The medication should be continued for about 20 days after bleeding stops, followed by withdrawal bleeding 3–7 days later.
2) Estrogens
High-dose estrogen rapidly increases estrogen levels in the blood, promoting endometrial growth and short-term wound healing to stop bleeding. It is suitable for patients with insufficient endogenous estrogen, primarily used in adolescent DUB. Currently, conjugated estrogens 1.25–2.5 mg every 6 hours are commonly used. After bleeding stops, the dose is reduced by one-third every 3 days until a maintenance dose of 1.25 mg daily is reached. Alternatively, diethylstilbestrol 1–2 mg every 6–8 hours can be used, with a similar reduction schedule after bleeding stops, maintaining a dose of 1 mg daily. The disadvantage of diethylstilbestrol is severe gastrointestinal reactions and slow absorption, making it less effective. In such cases, micronized 17β-estradiol, conjugated estrogens, or ethyl estradiol can be administered intramuscularly for rapid hemostasis. Regardless of the estrogen used, progestogen should be added 2 weeks after bleeding stops to promote endometrial transformation. For example, medroxyprogesterone 10 mg orally daily for 10 days can be used, followed by withdrawal bleeding 3–7 days after stopping both estrogen and progestogen.
3) Androgens
Androgens can reduce blood flow and thus bleeding. However, during heavy bleeding, androgens cannot immediately alter the endometrial shedding process or promote rapid wound healing, making them ineffective when used alone.
4) Combined Therapy
Since combined sex hormone therapy is more effective than single-agent therapy, the following regimens are recommended:
a) For adolescent DUB, during progestogen-induced hemostasis, a low-dose estrogen is added to overcome the limitations of single progestogen therapy, reducing progestogen dosage and preventing breakthrough bleeding. A progestogen-dominated oral contraceptive (e.g., one tablet) can be used every 6 hours. After bleeding stops, the dose is reduced as described above to a maintenance dose of one tablet daily for 20 days, then discontinued.
b) For perimenopausal DUB, estrogen and androgen are added after progestogen-induced hemostasis. A triphasic hormone injection (progesterone 12.5 mg, estradiol 1.25 mg, testosterone 25 mg) 2 ml intramuscularly every 12 hours can be used. After bleeding stops, the dose is reduced to once every 3 days for 20 days.
5) Prostaglandin Antagonists
Taking prostaglandin synthetase inhibitors such as flurbiprofen 200 mg three times daily during bleeding can reduce blood loss by altering the balance between thromboxane A? and prostacyclin. Thromboxane A? is a precursor of platelet aggregation and a smooth muscle contraction substance, while prostacyclin is a potent smooth muscle relaxant and antiplatelet aggregator.
6) Other Hemostatic Agents
Antianxins and tranexamic acid can reduce microvascular permeability, while aminocaproic acid, tranexamic acid, and tranexamic acid have in reducing blood loss but cannot be relied on alone to stop bleeding.