Patient's question:
Discovered irregular vaginal bleeding for nearly a year, initially mistaking it for contact bleeding caused by cervical inflammation and not taking it seriously. Later, it developed into postmenstrual spotting, and taking drugs like Gongxuening showed some improvement. Over the past four months, vaginal bleeding has started in the middle of the menstrual cycle, with dark, dirty-colored discharge that lasts a week before the regular menstruation begins. The menstruation is dark and clotted, without a noticeable odor. Basal body temperature measurement shows a biphasic pattern, with a clear temperature drop during ovulation and menstruation. She had taken short-acting birth control pills and intramuscular injections of 10mg progesterone for 10 days after ovulation, which worsened the symptoms. The hospital prescribed Ilkang and Xueshe capsules, but the symptoms did not improve.Doctor's answer:
After suffering from functional uterine bleeding, it is important to rest appropriately, avoid mental stress, excessive fatigue, or strenuous exercise. If the bleeding is heavy, bed rest should be taken to reduce pelvic bleeding, and uterine contraction drugs and hemostatic drugs should be taken as emergency measures, such as ergometrine, oxytocin, or tranexamic acid, as well as herbs like Polygonum aviculare and vitamin K. If drug treatment is ineffective, a dilation and curettage (D&C) procedure can be considered. In about half of the cases, symptoms often improve after a D&C. For women in menopause, if drug and D&C treatments are ineffective, hysterectomy or radioactive menopause (uterine placement of radium 1500-1800 mg/hour) may be considered. Radioactive menopause destroys the endometrium, hardens blood vessels, and achieves hemostasis. Alternatively, small-dose deep X-ray irradiation can be applied to the ovaries to damage ovarian function, resulting in permanent menopause. However, this method has a significant impact on overall metabolism and should not be used unless absolutely necessary.