月经失调PPT课件.ppt

月经失调月经失调Abnormal Menstrual CycleDysfunctional uterine bleeding(DUB)功能失调性子宫出血功能失调性子宫出血Amenorrhea 闭经闭经PCOS 多囊卵巢综合征多囊卵巢综合征Dysmennorrhea 痛经痛经Premenstrual syndrome(PMS)经前期综合征经前期综合征Perimenopausal period syndrome 围绝经期综合征围绝经期综合征Dysfunctional uterine bleeding(DUB)Anovulatory dysfunctional bleeding 无排卵性功能失调性子宫出血无排卵性功能失调性子宫出血Ovulatory menstrual dysfunction 排卵性月经失调排卵性月经失调normalnormalDysfunctional uterine bleeding(DUB)Anovulatory dysfunctional bleedingCauses:local or systemic,including psychogenicPathologic physiology withdrawal bleeding or breakthrough bleeding 撤退出血或突破出血撤退出血或突破出血 1.adolescence 2.postmenopausal vaginal bleedingDysfunctional uterine bleeding(DUB)Anovulatory dysfunctional bleedingEndometrial changes 1.endometrial hyperplasia 子宫内膜增生症子宫内膜增生症 （1）simple hyperplasia单纯型增生单纯型增生 （2）complex hyperplasia 复杂型增生复杂型增生 （3）atypical hyperplasia不典型增生不典型增生 2.proliferative phase endometrium增生期子宫内膜增生期子宫内膜 3.atrophic endometrium萎缩型子宫内膜萎缩型子宫内膜Dysfunctional uterine bleeding(DUB)Anovulatory functional bleedingClinic manifestation irregular vaginal bleeding 1.menorrhagia月经过多月经过多 2.hypermenorrhea经量过多经量过多 3.menometrorrhagia子宫不规则过多出血子宫不规则过多出血 4.metrorrhagia子宫不规则出血子宫不规则出血Dysfunctional uterine bleeding(DUB)Anovulatory functional bleedingDiagnosis according to 1.history of present illness现病史现病史 2.menstrual history月经史月经史 3.physical examination体格检查体格检查 4.other adjuvant examinations辅助检查辅助检查 Dysfunctional uterine bleeding(DUB)Anovulatory functional bleedingDiagnosis 4.other adjuvant examinations including D&C诊刮诊刮,B ultrasonography超声超声,uterus microscopy宫腔镜宫腔镜,measurement of BBT and hormone,etc.基础体温及激素水平测定等基础体温及激素水平测定等 Dysfunctional uterine bleeding(DUB)Anovulatory functional bleedingDysfunctional uterine bleeding(DUB)Anovulatory functional bleedingDysfunctional uterine bleeding(DUB)Anovulatory functional bleeding BBT of Anovulatory functional bleedingDysfunctional uterine bleeding(DUB)Anovulatory functional bleedingDifferential diagnosis鉴别诊断鉴别诊断 abnormal pregnancy and pregnancy complications 异常妊娠或异位妊娠并发症异常妊娠或异位妊娠并发症 tumor of reproductive tract生殖道肿瘤生殖道肿瘤 infection of reproductive tract生殖道感染生殖道感染 unsuitable use of hormone and IUD 激素使用不当或宫内节育器所致出血激素使用不当或宫内节育器所致出血 systemic disease全身性疾病全身性疾病 Dysfunctional uterine bleeding(DUB)Anovulatory functional bleedingDysfunctional uterine bleeding(DUB)Anovulatory functional bleedingTreatment 1.general therapy一般治疗一般治疗 (1)enough nutrition and rest营养和休息营养和休息 (2)antibiotics for the one of long time bleeding 流血时间长者给予抗生素流血时间长者给予抗生素 Dysfunctional uterine bleeding(DUB)Anovulatory functional bleedingDrugs:first-line therapy 一线治疗一线治疗 1.hemostasia止血止血 combinative use of sex hormone 性激素联合用药性激素联合用药 estrogen雌激素雌激素 progestin孕激素孕激素 andrin雄激素雄激素 other hemostatic drugs其他其他Dysfunctional uterine bleeding(DUB)Anovulatory functional bleedingDrugs 2.adjustment of menstruation调整月经周期调整月经周期 estrogen-progestin sequential therapy 雌、孕激素序贯法雌、孕激素序贯法 estrogen-progestin combinative therapy 雌、孕激素联合法雌、孕激素联合法 use of progestin in latter period of the cycle 后半周期疗法后半周期疗法 Dysfunctional uterine bleeding(DUB)Anovulatory functional bleedingDrugs 3.levonorg-estrel-releasing IUD 宫内孕激素释放系统宫内孕激素释放系统 4.induced ovulation促排卵促排卵Dysfunctional uterine bleeding(DUB)Anovulatory functional bleedingSurgical therapy uterus curettage刮宫术刮宫术 endometrial ablation子宫内膜切除术子宫内膜切除术 uterotomy子宫切除术子宫切除术 Dysfunctional uterine bleeding(DUB)Ovulatory menstrual dysfunctionLuteal phase defect(LPD)黄体功能不足黄体功能不足Irregular shedding of endometrium 子宫子宫内膜不规则脱落内膜不规则脱落Dysfunctional uterine bleeding(DUB)Ovulatory menstrual dysfunctionLPD Pathogenesis Pathology Clinical manifestation polymenorrhea,infertility,early abortion 月经频发，周期缩短，不孕，早期流产月经频发，周期缩短，不孕，早期流产 Diagnosis TreatmentDysfunctional uterine bleeding(DUB)Ovulatory menstrual dysfunction LUP Dysfunctional uterine bleeding(DUB)Ovulatory menstrual dysfunctionIrregular shedding of endometrium Pathogenesis Pathology Clinical manifestation normal menstrual cycle,月经周期正常 elongated duration of episode,经期延长 excessive in amount出血量多 Diagnosis Treatment Dysfunctional uterine bleeding(DUB)Ovulatory menstrual dysfunctionIrregular shedding of endometrium