Progress in the treatment of functional uterine bleeding during menopausal transition

The endometrium of functional uterine bleeding during the menopausal transition period may become cancerous, so the principle of treatment for functional uterine bleeding during this period is to stop bleeding, reduce menstruation, or promote amenorrhea to prevent endometrial cancer.

In principle, the lowest effective hormone dose should be used to reduce the side effects of the drug in patients with less bleeding during the menopausal transition period. For patients with more bleeding, the effect of sex hormones should be seen within 8 hours, and the bleeding should basically stop within 24 to 48 hours. If the bleeding continues for more than 96 hours, the diagnosis of functional uterine bleeding should be reconsidered. In recent years, with the development of contraceptives, the emergence of third-generation contraceptives, which contain highly selective progestins, can be used to treat functional uterine bleeding during the menopausal transition period. In addition, mifepristone is a progesterone antagonist at the receptor level, which can reduce menstrual volume and promote amenorrhea. In clinical treatment, the most appropriate means should be selected according to individual differences, and targeted treatment should be given.

Endometrial shedding method is used for patients with functional uterine bleeding during the menopausal transition period due to the lack of progesterone in the endometrium. A sufficient amount of progesterone is given to convert the endometrium into the secretory phase, and then the progesterone is discontinued. After discontinuation of the drug, the endometrium is exfoliated and bleeding occurs, and the purpose of hemostasis is achieved, which is also called drug-induced curettage. Commonly used is progesterone 20mg intramuscular injection once a day for 3 to 5 consecutive days. Because the withdrawal bleeding after discontinuation of the drug is large, it is not suitable for patients with severe anemia. It is only suitable for patients with mild anemia and long-term bleeding.

The principle of endometrial atrophy hemostasis is that a large dose of synthetic progesterone inhibits the secretion of gonadotropin by the pituitary gland through negative feedback, thereby inhibiting the secretion of estrogen by the ovaries, causing the endometrium to atrophy and achieve the purpose of hemostasis. Fukang tablets 2.5-5 mg/d, Angong progesterone 20 mg/d, gradually reduce the dosage after the bleeding stops and continue to use the medicine for about 21 days. It is suitable for women with severe anemia and heavy menstrual flow.

In recent years, studies have shown that mifepristone regulates epidermal growth factor receptors and indirectly inhibits the activity of endometrial aromatase, which interferes with the proliferation and differentiation process of the endometrium and inhibits the proliferation of endometrial cells. In the observation of the effects of mifepristone on uterine fibroids and endometrial ultrastructure, it was found that taking a small dose of mifepristone can lead to amenorrhea. Therefore, it is used in the treatment of functional uterine bleeding during the menopausal transition period, and the effect is obvious. The dosage ranges from 5 to 25 mg. Studies have explored the therapeutic effect of low-dose mifepristone and found that continuous treatment of 2.5 mg/d for 3 to 6 months also has a good effect. Some data show that women in the near-menopausal period can achieve amenorrhea in advance after taking mifepristone. Small doses of mifepristone have good effects on hemostasis and amenorrhea in the treatment of functional uterine bleeding during the menopausal transition period, and are also effective for simple endometrial hyperplasia.