15-2功血精要.ppt

Dysfunctional Uterine Bleeding (DUB)功能失调性子宫出血 Definition Dysfunctional uterine bleeding (DUB): Abnormal uterine bleeding with no demonstrable organic causes. A diagnosis of exclusion The normal menstrual cycle Menstruation is triggered by a sudden decrease in progesterone and estrogen secretions. After menstruation, the increased secretion of estrogen causes cellular growth and the regeneration of the endometrium. After ovulation, the secretion of progesterone stops the growth of the endometrium, turning the proliferative phase into the secretory phase. If conception does not occur, the corpus luteum (黄体) regresses causing declines in estrogen and progesterone production, thus the next menstruating begins. Classification Anovulatory bleeding (无排卵性DUB) DUB that occurs without ovulation Ovulatory bleeding (排卵性DUB) DUB that involves ovulation Anovulatory bleeding Etiology About 85% of all DUB In adolescents Immaturity of the hypothalamic-pituitary-ovarian axis. Especially, low response of hypothalamus and pituitary gland to positive feedback from estrogen. In transitional period to menopause Remaining follicles not responsive to gonadotropins. Women of reproductive age Stress, fear, etc. interferes with ovulation Pathophysiology 1. Patterns of bleeding Withdrawal bleeding Decrease in estrogen Breakthrough bleeding Low level of estrogen High level of estrogen 2. Mechanism of the bleeding Lack of progesterone causes defects in the self-limiting mechanism of menstruation 1) Friability of tissue Lack of stromal support. 2) Incomplete shedding of endometrium Not enough stimulation for epithelial regeneration. (Complete loss of tissue is an effective stimulant  for epithelial regeneration.) 3) Abnormal structure and function of blood vessels Lack of spiralization of the arteries. 4) Abnormal production of vascular factors PGE2?, PGI2 ? cau