The shortening of menstrual cycle at 39 years old is not the improvement of ovaries, but the clue of B-ultrasound

The 39 year old lady Liangliang’s menstrual cycle has been shortened in the last three years. She has menstruation once every 20 days. Her menstrual period can only be cleaned up in 7 or 8 days. Her menstrual volume is increasing. She has been feeling dizzy and weak in the last six months. < p > < p > when she came to the Department of Gynecology, Liang Liang was very surprised and asked me: “doctor Fu, we don’t all say that women have less menstruation when they are older. How can my menstruation become more and more active? Originally, I was not a delicate woman, but I was a little flustered and weak from bleeding, so I came to see a doctor. ” < p > < p > after asking about Liangliang’s medical history, I learned that her regular menstruation was normal. It was only in these three years that her menstruation was disordered, her cycle was shortened, her menstruation was prolonged and her menstruation was excessive. She was in good health. She had three pregnancies and one child. She used contraception and denied the history of surgery and trauma. < p > < p > physical examination: her height and weight were normal, her blood pressure was normal, and her anemia appearance was normal. No hirsutism and acne were found in her. Pelvic ultrasound: posterior uterus, size 5.8 × 4.7 × 4.8cm, endometrial thickness about 1cm, echo is not uniform, multiple slightly hyperechoic in uterine cavity, size is about 0.7 × 0.5cm, boundary is not clear, no obvious blood flow signal is found. The echo of myometrium was uniform and the outline of uterus was regular. The size of the left ovary is about 2.5 × 2.0 cm, no echo, clear boundary and poor sound transmission. No obvious tumor is found in the right adnexal area, and the pelvic cavity is 2.1 cm deep with liquid dark area. Ultrasonography: multiple hyperechoic intrauterine polyps? Left ovarian cyst? Pelvic effusion. Results: estradiol: 54.8pg/ml; follicle stimulating hormone: 8.42iu/l; luteinizing hormone: 3.79iu/l; prolactin: 11.54ng/l; testosterone: 0.2ng/ml. The five items of A-gong were normal. < p > < p > bright sex hormone is normal, her current diagnosis: abnormal uterine bleeding, endometrial polyps? Left ovarian capsule? Mild anemia. < p > < p > my answer is that the current analysis of the cause of abnormal menstruation is multiple slightly hyperechoic intrauterine cavity indicated by B-ultrasound. Considering the possibility of endometrial polyps, it is suggested that she should undergo hysteroscopy and surgery, and take oral medication to correct anemia. < p > < p > her B-ultrasound also showed that pelvic effusion was 2.1cm, but combined with Liangliang, there was no other discomfort, and no positive sign was found in physical examination. It was analyzed as physiological pelvic effusion, and no treatment was needed.

the disease occurs in women of childbearing age to postmenopausal age. With age, the incidence rate is increased, about 3% below 35 years old, and 23% above 35 years old. The incidence rate of perimenopausal period is the highest. Endometrial polyps are nodular processes formed by local hyperplasia of endometrium. Polyps can be single or multiple, small only 1-2 mm, large can fill the entire uterine cavity. Single and small polyps usually have no clinical symptoms, and most of them are found by B-ultrasound or hysteroscopy. When there are symptoms, it can be manifested as menorrhagia, prolonged menstruation, abnormal uterine bleeding after menopause, abnormal leucorrhea, infertility, etc. However, it is not clear that there is a relationship between high estrogen and local inflammation. The high risk factors of endometrial polyps include old age, infertility, hypertension, obesity, diabetes, hormone replacement therapy, long-term gynecological inflammatory stimulation, and tamoxifen use after breast cancer surgery. The vast majority of endometrial polyps are benign, and a few will become malignant. The factors associated with malignant transformation included increased age and postmenopausal abnormal uterine bleeding. In addition to the above factors, multiple polyps, obesity, hypertension, diabetes mellitus will also increase the probability of malignant transformation of endometrial polyps. < / P > < p > were mainly abnormal uterine bleeding and infertility. Endometrial polyps can be found in 10-40% of premenopausal women with abnormal uterine bleeding, and the severity of symptoms is related to the number, diameter and location of polyps. < / P > < p > because most polyps are benign and 25% of endometrial polyps subside naturally, especially those less than 10 mm, not all endometrial polyps need treatment. For small, asymptomatic polyps, can not be treated, regular review on OK. Drug treatment mainly includes progesterone drugs, oral contraceptives, levonorgestrel intrauterine contraceptive ring and so on. At present, the research on the use of drugs in the treatment of endometrial polyps mainly focuses on the patients after hysteroscopic polypectomy. For postoperative patients, with drug treatment can reduce bleeding, adjust menstrual cycle, reduce the recurrence rate of polyps. It is suggested that surgical treatment should be performed for patients with obvious prolonged menstrual period, increased menstrual volume and poor treatment effect, endometrial polyps after taking tamoxifen, polyps with postmenopausal bleeding or intrauterine neoplasms that cannot be ruled out as malignant. In addition, if the polyp is larger and the diameter is more than 10 mm, it is recommended to prepare for pregnancy after operation, which can improve the chance of pregnancy. < / P > < p > not required! Hysteroscopic polypectomy is the first choice of treatment. It has high safety and less damage to intima. The benign and malignant polyps can be confirmed by pathology after operation. Some studies have shown that the recurrence rate of endometrial polyps is 2.5% ~ 43.6%. There are many morphological differences of polyps under hysteroscopy. Studies have confirmed that if polyps develop in clusters in a certain area, the recurrence rate is higher. The factors of recurrence may be: 1) the etiology and high risk factors are not removed. 2) The root of the polyp was not cut clean, and the polyp came back. 3) The occurrence of vaginitis and cervicitis causes bacteria and other microorganisms to infect, act on the uterine cavity, cause inflammatory reaction, and stimulate endometrial polyps. 4) Take health products containing estrogen. < / P > < p > for women without fertility requirements, oral contraceptives or levonorgestrel intrauterine contraceptive ring can be used. Progesterone is brought into the uterine cavity through the contraceptive ring, and high concentration LNG is released locally in the uterine cavity. In addition to contraception, it can also inhibit endometrial proliferation and effectively prevent the recurrence of endometrial polyps for a long time. Focus