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月经失调AbnormalMenstrualCycleDysfunctionaluterinebleeding(DUB)功能失调性子宫出血Amenorrhea闭经PCOS多囊卵巢综合征Dysmennorrhea痛经Premenstrualsyndrome(PMS)经前期综合征Perimenopausalperiodsyndrome围绝经期综合征Dysfunctionaluterinebleeding(DUB)Anovulatorydysfunctionalbleeding无排卵性功能失调性子宫出血Ovulatorymenstrualdysfunction排卵性月经失调normalnormalDysfunctionaluterinebleeding(DUB)AnovulatorydysfunctionalbleedingCauses:localorsystemic,includingpsychogenicPathologicphysiologywithdrawalbleedingorbreakthroughbleeding撤退出血或突破出血1.adolescence2.postmenopausalvaginalbleedingDysfunctionaluterinebleeding(DUB)AnovulatorydysfunctionalbleedingEndometrialchanges1.endometrialhyperplasia子宫内膜增生症（1）simplehyperplasia单纯型增生（2）complexhyperplasia复杂型增生（3）atypicalhyperplasia不典型增生2.proliferativephaseendometrium增生期子宫内膜3.atrophicendometrium萎缩型子宫内膜Dysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingClinicmanifestationirregularvaginalbleeding1.menorrhagia月经过多2.hypermenorrhea经量过多3.menometrorrhagia子宫不规则过多出血4.metrorrhagia子宫不规则出血Dysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingDiagnosisaccordingto1.historyofpresentillness现病史2.menstrualhistory月经史3.physicalexamination体格检查4.otheradjuvantexaminations辅助检查Dysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingDiagnosis4.otheradjuvantexaminationsincludingD&C诊刮,Bultrasonography超声,uterusmicroscopy宫腔镜,measurementofBBTandhormone,etc.基础体温及激素水平测定等Dysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingDysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingDysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingBBTofAnovulatoryfunctionalbleedingDysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingDifferentialdiagnosis鉴别诊断abnormalpregnancyandpregnancycomplications异常妊娠或异位妊娠并发症tumorofreproductivetract生殖道肿瘤infectionofreproductivetract生殖道感染unsuitableuseofhormoneandIUD激素使用不当或宫内节育器所致出血systemicdisease全身性疾病Dysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingDysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingTreatment1.generaltherapy一般治疗(1)enoughnutritionandrest营养和休息(2)antibioticsfortheoneoflongtimebleeding流血时间长者给予抗生素Dysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingDrugs:first-linetherapy一线治疗1.hemostasia止血combinativeuseofsexhormone性激素联合用药estrogen雌激素progestin孕激素andrin雄激素otherhemostaticdrugs其他Dysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingDrugs2.adjustmentofmenstruation调整月经周期estrogen-progestinsequentialtherapy雌、孕激素序贯法estrogen-progestincombinativetherapy雌、孕激素联合法useofprogestininlatterperiodofthecycle后半周期疗法Dysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingDrugs3.levonorg-estrel-releasingIUD宫内孕激素释放系统4.inducedovulation促排卵Dysfunctionaluterinebleeding(DUB)AnovulatoryfunctionalbleedingSurgicaltherapyuteruscurettage刮宫术endometrialablation子宫内膜切除术uterotomy子宫切除术Dysfunctionaluterinebleeding(DUB)OvulatorymenstrualdysfunctionLutealphasedefect(LPD)黄体功能不足Irregularsheddingofendometrium子宫内膜不规则脱落Dysfunctionaluterinebleeding(DUB)OvulatorymenstrualdysfunctionLPDPathogenesisPathologyClinicalmanifestationpolymenorrhea,infertility,earlyabortion月经频发，周期缩短，不孕，早期流产DiagnosisTreatmentDysfunctionaluterinebleeding(DUB)OvulatorymenstrualdysfunctionLUPDysfunctionaluterinebleeding(DUB)OvulatorymenstrualdysfunctionIrregularsheddingofendometriumPathogenesisPathologyClinicalmanifestationnormalmenstrualcycle,月经周期正常elongateddurationofepisode,经期延长excessiveinamount出血量多DiagnosisTreatmentDysfunctionaluterinebleeding(DUB)OvulatorymenstrualdysfunctionIrregularsheddingofendometrium