Key points for diagnosis of functional uterine bleeding

Dysfunctional uterine bleeding generally does not involve organic lesions of the whole body or reproductive organs, but is caused by dysfunction of the neuroendocrine system. Its diagnosis is mainly based on the patient's medical history, physical examination, ovulation measurement and other auxiliary examinations.

Detailed medical history

This includes the patient's age, menstrual history, marital history, contraceptive measures, and history of chronic diseases such as liver disease, blood disease, and thyroid, adrenal or pituitary diseases. It should also inquire about factors that affect normal menstruation, such as mental stress and emotional shock. Understand the course of the disease, such as the onset time, current bleeding, history of amenorrhea before bleeding, and previous treatment.

Physical examination

It includes systemic examination, gynecological examination, etc. to exclude systemic diseases and organic lesions of the reproductive system.

Aid in diagnosis

1. Diagnostic curettage: In order to exclude endometrial lesions and achieve the purpose of hemostasis, a comprehensive curettage must be performed. 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 the menstrual period or within 6 hours of menstruation; those with irregular bleeding can have a curettage at any time.

2. Hysteroscopic examination: Under hysteroscopy, the endometrium may or may not be thickened. The surface is smooth without tissue protrusions, but there is congestion. The lesion area is selected for biopsy under direct vision of the hysteroscope. This has 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 fibroids, and endometrial cancer.

3. Basal body temperature measurement: It is a simple and feasible method to measure ovulation. A monophasic basal body temperature indicates no ovulation.

4. Other examinations: cervical mucus crystal examination; vaginal exfoliated cell smear examination, the smear generally shows moderate to high estrogen influence; hormone measurement, to determine whether ovulation occurs, serum progesterone or urine pregnanediol can be measured.