##Gynecological emergency department: menstruation delayed but not pregnancy?

National Day, on duty.Dr. Fu Hong watched three emergency doses successively.

Ms. Wang, 28 years old, was reading in the library. She suddenly had lower abdominal pain and questioned the medical history. Ms. Wang was plain menstrual rules. At the age of 13, 6-7/30 days, there was no dysmenorrhea in the past 1 year.The last menstruation: October 2, 2019, that is, today’s menstruation, 12 noon, so far, there is no nausea, vomiting, and no anal swelling.History of sexual life.

"National Day, didn’t go out to play?" I asked.

"There is a test after the festival, so I came to the library to read the book today. Who knows that I have a stomachache as soon as I read a book, and it’s okay to go out to play." Ms. Wang said helplessly.

Examination: normal body temperature, blood pressure, and pulse normal.The abdomen is soft, no tenderness, reflection pain and muscle tension.Gynecological examination: a small amount of vaginal bleeding.

"Because you have sex, you also need to check the urine pregnancy test to exclude pregnancy." I said as I said.

Ms. Wang took the test sheet.

Urine pregnancy test (-), diagnosis: dysmenorrhea.

During the occurrence of dysmenorrhea is the treatment of symptomatic pain and relief treatment. I prescribed Ms. Wang for the ibuprofen sustained release capsule.And instructed Ms. Wang to avoid the same room during the treatment, pay attention to rest, prohibit spicy stimulation and cold food, and keep her mood comfortable.If abdominal pain is not relieved, or other discomfort appears.If the dysmenorrhea gradually worsen, considering secondary dysmenorrhea, non -menstrual gynecological examinations need to be further checked in the admission.

Ms. Li, 32 years old, with irregular vaginal bleeding for 1 day.Ms. Li is plain menstrual rules, 13 years old, 5-6/30 days, with a small amount, no dysmenorrhea, last menstruation: September 13, 2019.There was no obvious cause of vaginal bleeding 1 day ago.History of sexual life.

"Dr. Fu, am I bleeding during ovulation?" Ms. Li asked.

"You need to check it to confirm the diagnosis." I answered.

Examination: normal body temperature, blood pressure, and pulse normal.The abdomen is soft, no tenderness, reflection pain and muscle tension.Gynecological examination: vaginal bleeding the same period of menstruation.

Reward test results: Urine pregnancy test (-), pelvic cavity B ultrasound: 5mm thick endometrium, obvious abnormalities in uterus and accessories are obvious.Diagnostic: Anomaly uterine bleeding: Perficion of ovulation bleeding?

Treatment is to stop bleeding at the right, avoid the same room during treatment, pay attention to rest, prohibit spicy stimulation and cold food, and keep your mood comfortable.If bleeding increases, or other discomfort appears.

Ms. Li is not currently bleeding, and it is possible to ask for observation.

Ms. Liu, 44, stopped menstruation for more than January, with a small amount of vaginal bleeding for 1 day.

"Dr. Fu, I have given birth to 2 babies. I have experience. I want to know if I have won the bid again?" Ms. Liu was a little anxious.

Ms. Liu’s menstrual rules, 7/25 days, in quantity, dysmenorrhea, last menstruation: August 24, 2019, no fever, no abdominal pain, nausea, vomiting, and anal fall.Given 5 for pregnancy, the last flow of people in 2012, the last cesarean section: 2015.

Examination: normal body temperature, blood pressure, and pulse normal.The abdomen is soft, no tenderness, reflection pain and muscle tension.Gynecological examination: a small amount of vaginal bleeding.

Reward test results: Urine pregnancy test (-), pelvic cavity B-ultrasound: 9mm thick endometrium, left ovarian 31*24mm no echo.

Diagnosis: Stopping through menstrual vaginal bleeding to be examined?Left ovarian cyst.

"Dr. Fu, do I have no pregnancy?" Ms. Liu asked.

"The current laboratory inspection prompts you not pregnancy, and the temporary disorder of menstruation causes the possibility of delay of menstruation. You have little bleeding at present and no other discomfort. You can continue to go home to observe.If you have more bleeding, abdominal pain or other discomfort, you need to go to the doctor in time. "I explained.

"Listening to your meaning, I haven’t completely excluded pregnancy? Isn’t the result of B -ultrasound without pregnancy?" Ms. Liu was puzzled.

"B-ultrasound reminds the thickness of the endometrium of the uterus 9mm. This thickness is possible to menstruation or early pregnancy. Therefore, if you want to completely exclude pregnancy, you need to check the blood β-HCG or review the urine pregnancy test after 1 week." I said that I saidEssence

"Dr. Fu, and my ovarian has a tumor on the ovaries. Do you need treatment?" Ms. Liu continued.

"The left ovarian 31*24mm has no echo considering ovarian cysts. At present, it can be observed. Generally, the physiological cysts will disappear from a 1 to 3 month cycle, and uncomfortable follow the clinic." I continued to answer.

The other precautions of Ms. Liu are to pay attention to rest, prohibit spicy stimulation and cold food, and keep their mood comfortable.

About dysmenorrhea:

Primary pain often develops within 1 to 2 years after the first tide; the pain has been more painful since the menstrual tide, and the earliest appeared in the first 12 hours of menstruation. The pain on the first day of menstruation was severe.It is usually located on the lower abdomen pubic bone, which can be radiated to the lumbosacral and inside of the thighs. It can be accompanied by symptoms such as nausea, vomiting, diarrhea, dizziness, and fatigue.

Gynecological examination is not abnormal.The disease is mainly related to the increased prostaglandin content during menstruation.

For primary dysmenorrhea, sufficient rest, sleep, regular and moderate exercise, smoking quitting can help to relieve pain, and it can be supplemented by drug treatment when pain cannot stand it.The first -line drug is a non -steroidal anti -inflammatory drug like ibuprofen, and the second -line drug is oral contraceptive.

Menstruation, for girls with dysmenorrhea, it is recommended to start taking medicine after pain appears, and take 2 to 3 days.Because prostaglandin (PG) was released the most in the first 48 hours of menstruation, the purpose of continuous medication was to correct the biochemical disorders of PG excessive synthesis and release in the blood.

If it was not for continuous administration in the first 48 hours, but the temporary dose of the temporary time in pain, it would be difficult to control the pain.If there is still a certain degree of pain in the first few hours after taking the medicine, it shows that the first dose of the next cycle of medication should be doubled, but the maintenance amount remains unchanged.

The choice of drugs can be selected.

Secondary dysmenorrhea often occurs after several years after the first tide, which is often related to pelvic cavity quality diseases, such as endometriosis, uterine adenoisotomy, pelvic infection, uterine endometrial polyp, lower mucosal fibroids, uterine cavity, uterine cavityAdhesive, in -palace, health device, etc.For the first time in the first few years, the age of fertility is more common, and the symptoms are different. It is often obvious with abdominal distension and lower abdomen. The pain often occurs before the menstrual tide.

The pelvic examination and other auxiliary examinations are often positive. The cause of secondary dysmenorrhea can be found. The treatment is mainly for the treatment of the cause.

About ovulation bleeding:

That is, the feed ovulation bleeding mainly refers to bleeding caused by endocrine factors that occur during ovulation.

At this time, the E2 (estradiol) is "evacuated" too fast, and the support for the endometrium is relatively insufficient. The endometrium of the uterine will "make a temper" that partly shed bleeding. This is the perinatal bleeding.In addition, endometrial hemostasis dysfunction, abnormal molecular mechanism of endometrial repair, endometrial polyps can affect endometrial repair, and patients with adenoma and uterine fibroids can also be manifested as ovulation bleeding.In addition, mental factors and psychological stress also occupy a place during ovulation bleeding.

Will bleeding during ovulation affect pregnancy?Generally speaking, the amount of bleeding during ovulation is not much, and the duration is short. Sometimes it is even only blood wire in the leucorrhea, and there is no need to use a sanitary pad.This situation will not affect sexual life, nor will it affect pregnancy.

Is bleeding in the middle of menstrual period a period of ovulation bleeding?

NO!For the normal menstrual cycle and bleeding in the middle of menstrual period, first confirm ovulation, such as monitoring large follicles of 18-20 mm of ovarian through pelvic B-ultrasound, or basic body temperature monitoring, according to the next 5-9 days of menstruation, monitoring progesterone monitoring.Essence

It is also necessary to exclude the following diseases: 1. Except pregnancy -related bleeding; 2. vaginitis, cervicitis, and cervical lesions;

3. Blood in the process of taking contraceptives or sex hormones.

4. Endometritis, endometrium polyps, endometriosis (vaginal rectal diaphragm), adenomy muscle;

5. Clicter section of scar defects: hysteroscopy can prove the diagnosis;

6, ovarian dysfunction -lack of luteal function or thin ovulation.

The diagnosis of perpronive ovulation hemorrhage is established, and treatment problems.

Ovus bleeding does not necessarily require treatment.

1. If a small amount of occasional ovulation bleeding occurs occasionally, the small master can temporarily look forward to observation.

2. The more amount of bleeding affects the quality of life and can be appropriately treated.

① For small masters without fertility, small doses of estrogen oral or short -acting contraceptives can be used, and short -acting contraceptives take into account the adjustment and contraception.

Small doses of estrogen orally for 5 to 7 days. Because the mechanism of bleeding at this time is estrogen retreat, it is necessary to supplement estrogen treatment.

Or eliminate drug taboos, oral low -dose compound short -acting contraceptive treatment. From the fifth day of menstruation, compound contraceptives inhibit the gland axis, inhibit ovulation, without ovulation, no ovulation bleeding will occur.

② There are small masters with fertility requirements and infertility. When doctors adjust the menstrual cycle, B -ultrasound monitors ovulation. If necessary, combined with ovulation treatment, such as Cromifen to promote ovulation treatment.

③ Heart disease must also be medicine.The small master encounters such as emotional setbacks, pressure on work, changes in the environment, disputes, and distress of pregnancy, etc., which will affect menstruation.At this time, the decompression of the mood is also important.

About menstruation delay:

Normal menstruation is periodic.The first day of bleeding is the beginning of the menstrual cycle, and the interval between the first day of menstruation is called a menstrual cycle.It is generally 21 to 35 days, with an average of 28 days.Each menstrual duration becomes menstrual period, generally 2 to 7 days, with an average of 4 to 6 days.

For small masters who do not come and have sexual life, doctors will first check the urine pregnancy test, blood βhcg, and pelvic B ultrasound.

After the pregnancy, the sudden or long -term mental depression, anxiety, environmental changes, excessive fatigue, emotional changes, etc. can cause nerve endocrine disorders and cause menstrual delay, or even amenorrhea.

In addition, menstrual scarcity is ≥35 days, which can also be seen in the following factors: polycystic ovary syndrome (PCOS), premature ovarian aging, hyperdoma (PRL) hemophilia, decreased weight, etc.

Relatively speaking, too thin is more impact on menstruation.Generally speaking, the impact of fat on menstruation is very important. The body fat content cannot be menstruation <17%, and <22%cannot maintain normal menstruation.

There is a often postponement of menstruation. The original screening was that female friends measuring the basic body temperature at home or 5-9 days before the next menstruation measured to see whether there was ovulation.Menstruation with ovulation is normal menstruation. Menstruation without ovulation is not menstruation. It belongs to the category of abnormal uterine bleeding, or our commonly known menstruation.

At the same time, if necessary, you need to check blood hormones and thyroid dysfunction 2 to 4 days of menstrual period to eliminate whether the above -mentioned polycystic ovary syndrome (PCOS), premature ovarian aging, hyperculin (PRL) hemophilia and other diseases, andDue to treatment.

If the measurement results have ovulation, but there is no fertility requirements, it is only delayed menstruation. This part of female friends can observe.If there is a fertility requirement, when she cannot conceive her baby as scheduled, she needs to monitor ovulation and help her ovulation when ovulation disorders to achieve the purpose of conception.

Don’t worry about the red dust, go out to soak a glass of wolfberry.

Good mood can have good bodies, good moods have good menstruation!

Pay attention to "Dr. Fu Hong" with one click and care for your menstruation!

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