【正文】 Genitals damage, extraneous material and exogenous hormone ? Genitals damage: vulovaginal straddle injury (外陰陰道騎跨傷 ) ? Sexual intercause cause hymen and vaginal injury and bleeding. ? IUD: hard and large area IUD oppress cause local endometrium necrosis and ulcer ? E2 /P misapply. 6. Bleeding due to systemic diseases ? Purpura haemorragica (血小板減少性紫癜 ) ? Aplastic anemia(再生障礙性貧血 ) ? Leukemia (白血病 ) ? Hepatic function damage disturbances of blood coagulation(凝血機制障礙 ) thrombocytopenia (血小板減少 ) increased capillary permeability (毛細血管通透性增加 ) some liver disorder hormone change. 7. Others ? Pelvic inflammation： congestion (充血 ), vessel wall brittleness (脆性 ) increased ? Endometrial polyps ? EMs： steroid hormone disorder Part II Patterns of Abnormal Uterine Bleeding(陰道流血特點與相關疾病的聯(lián)系 ) ? Age factors ? Regulation of period or not ? Pregnancy or not 1. menorragia/ hypermenorrhea (經(jīng)量增多 ) Heavy (80ml) or prolonged （ 7d） menstrual flow. ? Submucous myomas (子宮粘膜下肌瘤 ) ? Complications of pregnancy ? Endometrial hyperplasias ? Malignant tumors ? Endometrial polyps (子宮內(nèi)膜息肉 ) ? Adenomyosis (子宮腺肌病 ) ? Dysfunctional bleeding (排卵性月經(jīng)失調(diào) ) ? IUDs (放置宮內(nèi)節(jié)育器 ) Myomas Symptoms： 1. Abnormal uterine bleeding： 30%, prolonged and heavy menses， irregular uterine bleeding often in submucous myomas 2. Abdominal mass (腹塊 ) 3. Leucorrhea (白帶 ) increased 4. Pain or sore waist (腰酸 ) 5. Pressure effects 6. Infertility, spontaneous abortion, malposition (胎位不正等 ) 7. Secondary anemia (繼發(fā)貧血 ) 8. B type ultrasound, CT, MRI help to diagnosis Endometrial polyps ? Spotting or irregular uterine bleeding ? Ultrasound help to diagnosis ? Diagnosis curettage(診斷性刮宮 ), hysteroscope (宮腔鏡檢查 ) and pathology examination help final diagnosis Adenomyosis ? Menstruation change: 50% hypermenorrhea ? Menalgia (痛經(jīng) )， increasingly severe ? Enlarged uterus, hard ? Ultrasound, MRI help to diagnosis Ovulatory menstrual dysfunction ? Luteal phase defect (LPD) (黃體功能不全 ) （ 1） shorten cycle,luteal phase 11d,frequently cycle （ 2） infertility （ 3） repeating spontaneous abortion （ 4） D amp。G, cervix mucus score help to diagnosis 2. Menometrorrhagia (周期不規(guī)則的陰道流血 ) ? Bleeding occurs at irregular intervals. ? Amount and duration of bleeding also vary. ? Anovulatory dysfunctional uterine bleeding ? Exclude early endometrial cancer ? Complications of pregnancy Anovulatory dysfunctional uterine bleeding ? Irregular uterus bleeding ? Characteristic of bleeding: （ 1） irregular cycle and duration （ 2） not stop by oneself （ 3） irregular amount （ 4） no menalgia (痛經(jīng) ) （ 5） anaemia Endometrial cancer 1. Irregular bleeding： Postmenopause bleeding: middle or less amount, durative(持續(xù)性 ) or intermittence(間歇性 )； Childbearing age women: prolonged and heavy menses or intermenstrual bleeding 2. Vaginal apocenosis (排液 ) 3. pain 4. General symptom 5. Enlarged uterus, tender, tissue emersion in advanced stage( 組織物脫出