Diagnosis of menstrual irregularity

Caring for women's health starts with menstrual health. Women's menstruation is a unique physiological phenomenon. If menstruation is irregular, it indicates the occurrence of symptoms. However, this symptom is easy to be ignored, so the examination and diagnosis of irregular menstruation is very important.

TCM classification of irregular menstruation

According to Chinese medicine dialectics, there are several types of menstrual disorders: late menstruation and scanty menstruation, which are often caused by blood loss due to long-term illness or loss of essence and blood after childbirth, or spleen deficiency and blood deficiency; or congenital deficiency, multiple childbirths, loss of kidney essence, and kidney deficiency with Chong and Ren meridians not filled; or eating raw and cold food or feeling cold during menstruation, causing blood to become cold; or depression, emotional distress, qi stagnation and blood stasis.

① Blood deficiency type menstrual irregularity. Symptoms include late menstruation, less amount of light color, thin and clear menstruation, accompanied by dizziness, insomnia, palpitations, pale complexion, fatigue, pale tongue, and weak pulse.

② Kidney deficiency type menstrual disorders. Symptoms include late menarche, delayed menstruation, scanty menstruation, normal or dark color, thin texture, accompanied by backache, normal or pale tongue, and deep pulse.

③ Irregular menstruation of blood cold type. Symptoms include late menstruation, less volume, dark color, clots, or light color and thin texture, accompanied by cold pain in the lower abdomen, preference for warmth and pressure, relieved by heat, or fear of cold and cold limbs, clear and long urine, thin stool, pale tongue, thin white fur, deep and tight pulse or deep and slow pulse. ④ Irregular menstruation of qi stagnation type. Symptoms include late menstruation, less volume, dark color, clots, poor discharge, accompanied by lower abdominal distension and pain, breast distension and flank pain, depression, normal or slightly dark tongue, and stringy pulse.

Differential diagnosis

Premenstrual period

(1) The menstrual cycle occurs more than 7 days earlier, or even more than once every half a month, for more than 3 consecutive menstrual cycles.

(2) If the menstrual cycle is advanced by half a month, it should be differentiated from intermenstrual bleeding, puberty, and early menstruation during menopause.

Late menstruation

(1) The menstrual cycle exceeds 35 days and lasts for more than 3 consecutive menstrual cycles.

(2) Delayed menstruation in women of childbearing age should be differentiated from late menstruation during pregnancy, puberty, and menopause.

(3) Gynecological examination, B-ultrasound or pneumoperitoneumography to rule out organic diseases of the uterus and ovaries.

Irregular menstruation

(1) The period before or after the menstrual cycle exceeds 7 days and lasts for more than 3 consecutive menstrual cycles.

(2) Menstrual cycle disorders should be distinguished from menstrual disorders during adolescence and menopause.

(3) Gynecological examination and B-ultrasound to exclude organic lesions, measure basal body temperature, vaginal smear, and cervical mucus crystal examination to understand ovarian function.

Heavy menstruation

(1) The menstrual cycle is basically normal, the menstrual volume increases significantly to more than 50 ml, or the duration exceeds 7 days.

(2) Gynecological examination and B-ultrasound examination to rule out organic diseases such as uterine fibroids.

(3) Exclude menorrhagia caused by thrombocytopenia and coagulation disorder.

Lack of menstruation

(1) The menstrual cycle is basically normal, with very little menstrual flow, less than 30 ml, or even just a few drops.

(2) This disease should be differentiated from early pregnancy.

(3) Exclude oligomenorrhea caused by tuberculosis.

The differentiation of menstrual disorders is generally based on cold, heat, deficiency and excess. The key points of the differentiation are the period, amount, color, quality, odor of menstruation and other symptoms accompanying menstruation, combined with the shape, qi, color and pulse. The treatment of menstrual disorders is mainly to treat the symptoms and stop bleeding in an emergency, reduce the amount of menstruation, and prevent blood loss and damage to the yin. In normal times, the method of Anchong Guchong is used to treat the root cause.

Menstrual irregularity check

In order to accurately determine the cause, the doctor can choose appropriate examinations according to the patient's condition. Commonly used examination methods are as follows:

(1) Ask about the medical history in detail and look for possible causes. The patient should strive to provide accurate information.

(2) A comprehensive physical examination to determine whether the patient has any serious systemic diseases.

(3) Pelvic examination to initially determine whether the reproductive organs have any deformities, tumors, or inflammation.

(4) Auxiliary examination:

① Examination of irregular menstruation includes B-ultrasound examination, which reflects the condition of the uterus, ovaries and pelvic cavity.

②Cytological examination: check ovarian function and exclude malignant lesions.

③ Biopsy: Determine the nature of the lesion, mostly used for the diagnosis of tumors.

④ Endocrine tests for irregular menstruation: currently, pituitary gonadotropin, prolactin, hormones secreted by the ovaries, thyroid gland and adrenal cortex can be measured. Simple methods commonly used in clinic to understand ovarian function include vaginal smear, cervical mucus, basal body temperature and endometrial biopsy.

⑤ Examination of irregular menstruation includes X-ray examination and hysteriodized oil radiography to understand the condition of the uterine cavity.

Whether there are submucosal fibroids or polyps.

Anteroposterior and lateral sections of the sella turcica can be used to determine whether there is a pituitary tumor.

⑥Hysteroscopy or laparoscopy: observe the lesions of the uterine cavity and pelvic organs.

⑦ Conduct liver and kidney function and blood system examinations as appropriate. Perform chromosome examinations if necessary.

How to determine the amount of menstrual flow

Once women have irregular menstruation, it indicates that their normal physiological processes have also failed. If this continues for a long time, it will accelerate the aging of the face in mild cases and lead to serious gynecological diseases in severe cases. It can be said that irregular menstruation is the first step in female reproductive diseases. In recent years, the proportion of women in their 35s suffering from uterine fibroids and ovarian cysts has increased, and they have previously suffered from various menstrual disease symptoms for a long time - premenstrual syndrome.

Menstruation is a physiological reaction of periodic uterine bleeding. How can we know whether the menstrual flow is too much or too little? Experts say that 30 ml of menstrual flow is too little, and 180 ml is too much. The normal amount should be 60 ml each time. This requires us to pay attention to the amount of sanitary napkins used, and not more than two packs per cycle. If three packs of sanitary napkins are not enough each time, and each sanitary napkin is soaked, it means that the menstrual flow is too much; on the contrary, if one pack cannot be used up every time, it means that the menstrual flow is too little, and you should see a doctor as soon as possible.

The menstrual cycle varies greatly from person to person, with some having as few as 20 days and others as many as 36 days, which are considered normal. According to relevant survey statistics, only about 10% of the respondents actually have their menstruation every 28 to 30 days. As long as the interval between each menstruation is the same, it is normal. Irregular advances or delays are abnormal and may be symptoms of some disease.

Diseases that may be caused by scanty or excessive menstruation

According to experts, excessive or insufficient menstrual flow is not normal, and it is due to poor endocrine function. If the endometrium is overgrown or you have uterine fibroids, your menstrual flow will be heavy. If you take oral contraceptives and your menstrual flow is too light, you should ask your doctor if you need to change your contraceptive method.

How can we know the amount of menstrual flow? Experts say that from a medical point of view, 30 ml of menstrual flow is too little, 80 ml is too much, and the normal amount should be about 60 ml each time. But we can't measure it normally, but sanitary napkins can help. It is normal to change four or five times a day, and no more than two packs per cycle. If three packs of sanitary napkins are not enough each time, and each sanitary napkin is soaked, it is too much menstrual flow; on the contrary, if one pack cannot be used up every time, it is too little menstrual flow. If you belong to one of the above, you should see a doctor as soon as possible.

Irregular menstruation. Previous studies tended to believe that bone loss only occurs after women have menopause. In fact, young women also experience bone loss because their progesterone levels are abnormal, which can lead to osteoporosis in the second half of their lives.

This research result was discovered by Canadian scientists around 1991. The participants of this study were 66 women aged between 21 and 42. After completing the statistical analysis, the researchers found that a short luteal phase or an eggless phase would indicate bone loss. The researchers said that this finding shows that bone growth requires a proper balance between estrogen and progesterone. For women with irregular menstruation, artificial progesterone supplementation should be considered to prevent young women from losing bone. Most previous studies tend to believe that bone loss only occurs after women have menopause. In fact, young women also experience bone loss because these women have abnormal progesterone levels, which can result in osteoporosis in the second half of their lives.

In addition, the normal menstrual cycle should be 20 to 36 days, which varies from person to person. Every woman has her own menstrual cycle, and it is generally believed that the cycle is either 28 days or 30 days. But in fact, everyone's menstrual cycle is very different. According to clinical surveys and statistics from relevant departments, only about 10% of people can actually have menstruation every 28 to 30 days. As long as the interval between each menstruation is the same, it is normal. Irregular advances or delays may be abnormal, and may be symptoms of a certain disease, which requires accurate recording of each time, otherwise it is difficult to infer based on impressions alone.

Irregular menstruation causes headaches in women

Headache is a common disease. The incidence rate of headache in women is higher than that in men. This is related to the unique physiological characteristics of women. Epidemiological survey results show that headaches related to menstruation account for about 20% of headaches in women.

Women often experience headaches before or after menstruation, accompanied by dizziness, palpitations, insomnia, fatigue and other symptoms, which usually disappear or are significantly alleviated a week after menstruation. This is called menstrual headache in traditional Chinese medicine.

Traditional Chinese medicine believes that menstrual headaches are caused by qi and blood deficiency, blood stasis, and excessive liver fire, and qi and blood deficiency is the main pathogenic factor. During menstruation, women lose a large amount of menstrual blood, which leads to qi and blood deficiency. Qi and blood deficiency leads to poor blood and qi circulation, and blood stasis leads to obstruction, which causes pain. If not treated in time, it will turn into periodic or other types of more severe headaches.

Modern medical research has found that when the level of estrogen in the blood drops to a certain level, it will cause headaches, and the level of estrogen will fluctuate with the menstrual cycle.

Measures to be taken for the diagnosis of irregular menstruation

1. Ovarian function test

① Endometrial biopsy; ② Vaginal exfoliated cell examination; ③ Cervical mucus crystal examination; ④ Serum E2 and P measurement; ⑤ Basal body temperature measurement.

2. Pituitary function test:

(1) Direct measurement of blood LH, FSH and PRL levels

(2) Pituitary stimulation test

3. CT scan of the sella turcica to determine whether there is a pituitary adenoma.

4Chromosome examination.

5.B-ultrasound examination to find out whether there are polycystic changes in the ovaries.

Further examination

1. Laparoscopic examination: to understand the status of gonads and whether there are changes such as dysplasia, polycystic ovary, premature ovarian failure, etc.

2 Magnetic resonance imaging: exclude pituitary adenoma.

Special tips:

Many female friends often ask such questions: I haven't had my period for a long time. Is this irregular menstruation caused by some disease? In fact, not all irregular menstruation is a disease. When many women have menstrual disorders, they only consider gynecological diseases such as uterine hypoplasia, acute and chronic pelvic inflammatory disease, and uterine fibroids, but ignore the cause outside the uterus. Little do they know that many bad habits and factors may also cause menstrual disorders.

Abnormal emotions, long-term mental depression, irregular living habits, excessive dieting, and addiction to alcohol and smoking can directly lead to neurological disorders, endocrine disorders, and thus irregular menstruation.

Special topic on irregular menstruation: http://www..com.cn/fuke/yjbt/