Common examinations for menopausal functional uterine bleeding

Due to the gradual degeneration of ovarian function, menopausal women cannot produce mature follicles and ovulate, thus losing the normal cyclical changes of female hormones and causing irregular vaginal bleeding, which is called menopausal functional uterine bleeding. Women before and after menopause should go to the hospital for examination in time if they have irregular vaginal bleeding. Common examinations include:

(I) Detailed medical history:

(1) Inquire in detail about the age of onset, menstrual cycle, menstrual changes, duration of bleeding, amount of blood loss, nature of bleeding, duration of the disease, and associated symptoms, and compare them with the menstrual cycle before the onset of the disease.

(2) Whether the patient had received endocrine therapy before consultation.

(3) Whether there was amenorrhea or early pregnancy symptoms before bleeding.

(4) If the bleeding time is too long or the amount of bleeding is too much, you should ask whether there are any symptoms of anemia.

(5) Understand pregnancy and delivery history, contraceptive status, and whether there is any adverse mental stimulation.

(6) Find out whether the patient has any chronic diseases such as liver disease, hypertension, hemophilia, etc.

(ii) Physical examination:

It includes a full-body examination and a gynecological examination to exclude systemic diseases and organic lesions of the reproductive tract. Gynecological examinations generally do not reveal any special findings, except that the uterus may be slightly enlarged or enlarged ovaries may be palpable.

(III) Auxiliary diagnosis:

(1) Check blood routine, coagulation time, and platelet count: to understand the degree of anemia and exclude blood diseases.

(2) Diagnostic curettage: Mainly used for married women. In order to exclude endometrial lesions and achieve the purpose of hemostasis, a comprehensive curettage must be performed to scrape the entire uterine cavity. During the diagnostic curettage, attention should be paid to the size and shape of the uterine cavity, whether the uterine wall is smooth, and the nature and amount of the scraped material. In order to determine ovulation or corpus luteum function, curettage should be performed before menstruation or within 6 hours of menstruation; those with irregular bleeding can have a curettage at any time. Endometrial pathological examination can show changes in the proliferative phase or excessive hyperplasia, without the appearance of the secretory phase.

(3) Basal body temperature measurement: It is a simple and feasible method to measure ovulation. The basal body temperature measurement of anovulatory functional uterine bleeding shows a monophasic curve; the basal body temperature measurement of ovulatory functional uterine bleeding shows a biphasic curve.

(4) Hysteroscopy: Under hysteroscopy, the endometrium may or may not be thickened, with a smooth surface and no tissue protrusions, but with congestion. Biopsy of the lesion area under direct hysteroscopy has a higher diagnostic value than blind endometrial sampling, and can especially improve the diagnosis rate of early uterine cavity lesions such as endometrial polyps, submucosal uterine myomas, and endometrial cancer.

(5) Cervical mucus crystal examination: The presence of fern-like crystals before menstruation indicates anovulation

(6) Hormone measurement: To determine whether ovulation has occurred, serum progesterone or urine pregnanediol can be measured.

(7) Vaginal exfoliated cell smear examination: The smear generally shows moderate to high estrogen influence.

(8) Hysterosalpingography: It can be used to understand uterine cavity lesions and exclude organic lesions.