Patient's question:
I have a small amount of bleeding. Is it menstruation or a ruptured corpus luteum? Onset and duration of this condition: Since November 24th after my period until nowDoctor's answer:
The ovary forms a corpus luteum after ovulation. A normal mature corpus luteum has a diameter of 2 to 3 cm. If there is a large amount of fluid accumulation in the luteal cavity, causing the cavity diameter to exceed 3 cm, it is referred to as a corpus luteum cyst. Corpus luteum cysts can be caused by certain factors or etiologies that lead to cyst rupture and bleeding. In severe cases, they may cause acute abdominal symptoms. China Medical Health Network1. Etiology Due to the influence of the autonomic nervous system, ovarian function changes or the ovarian enzyme system becomes excessively active, leading to a disorder in the coagulation mechanism and a tendency toward bleeding. Trauma, direct or indirect external force on the ovary, pelvic inflammation, ovarian-uterine congestion, and other factors or etiologies can also lead to corpus luteum cyst rupture.
2. Medical History and Symptoms It can occur in both married and unmarried women, being most common in women of reproductive age. Generally, between days 20 to 27 of the menstrual cycle, sudden lower abdominal pain, nausea, vomiting, and frequent urination and defecation may occur. In severe cases, symptoms such as dry mouth, palpitations, dizziness, blurred vision, and fainting (shock symptoms) may appear. In some cases, abdominal pain may occur during the mid-cycle or between days 30 to 40.
Physical Examination Anemia, rapid pulse rate, and decreased blood pressure. Lower abdominal tenderness and rebound tenderness, positive shifting dullness. Cervical motion tenderness, a full and tender posterior fornix. A poorly defined, tender mass may be palpated on one side of the uterus.
3. Auxiliary Diagnosis
(1) Blood tests show a decrease in hemoglobin.
(2) Blood or urine β-HCG tests are negative. However, if the corpus luteum ruptures during pregnancy, β-HCG may be positive.
(3) Ultrasound shows an enlarged ovary on the affected side and peritoneal fluid accumulation.
(4) Posterior fornix aspiration yields dark red blood that does not coagulate.
(5) Laparoscopy reveals active bleeding from an ovary rupture.
4. Treatment
(1) Conservative treatment is suitable for cases with minimal bleeding, with the main measures being bed rest and the use of hemostatic drugs.
(2) Surgical treatment is suitable for cases with significant bleeding. If shock occurs, surgical treatment should be performed while actively managing shock. The principle of surgery is to preserve ovarian function as much as possible, and an ovarian wedge resection may be performed.