ABSTRACT
Objective:To explore the distribution characteristics of traditional Chinese medicine （TCM） syndromes of abnormal uterine bleeding associated with ovulatory dysfunction （AUB-O）. Method:A clinical and epidemiological investigation was conducted in 6 688 patients with AUB-O from the provincial， municipal， and county/district hospitals in 29 provinces， autonomous regions， and municipalities across China to identify the distribution characteristics of their TCM syndromes. Result:The AUB-O patients nationwide were mainly differentiated into the kidney Qi deficiency syndrome （17.34%）， the spleen Qi deficiency syndrome （13.25%）， the Qi and blood deficiency syndrome （12.62%）， the Qi deficiency and blood stasis syndrome （8.45%）， and the kidney Yin deficiency syndrome （6.88%）. AUB-O resulted from Qi deficiency， Yin deficiency， and blood deficiency， often involving the kidney， spleen and liver. The analysis of the regional distribution of TCM syndromes in AUB-O patients revealed that kidney Qi deficiency， spleen Qi deficiency， and Qi and blood deficiency were the shared syndromes. However， due to regional discrepancy， the TCM syndrome varied widely from one geographic region to another. The kidney Qi deficiency syndrome was more frequently seen in North China， Northwest China， Southwest China， and East China， but less frequently in central China， Northeast China， and South China. The spleen Qi deficiency syndrome occurred most frequently in central China， while the East China had the highest frequency of Qi and blood deficiency syndrome. The spleen and kidney deficiency syndrome was mostly present in central China， North China， and Southwest China， the Qi deficiency （kidney deficiency） and blood stasis syndrome in Northwest China， South China， and North China， the kidney Yin deficiency syndrome in East China， Northwest China， and Northeast China， the deficiency-heat syndrome in Southwest China and East China， the kidney Yang deficiency syndrome in South China， the liver depression and blood heat syndrome in Northeast China， and the liver depression and spleen deficiency syndrome in central China. The diagnostic criteria for the kidney Qi deficiency， spleen Qi deficiency， Qi and blood deficiency， Qi deficiency and blood stasis， and kidney Yin deficiency syndromes were not significantly different from the previous ones. The distinctive symptoms for the kidney Qi deficiency syndrome were irregular vaginal bleeding， heavy menstrual flow， or shortened menstrual cycle， back soreness and pain， and forgetfulness， while those for the spleen Qi deficiency syndrome mainly included the shortened menstrual cycle， mental fatigue， lack of strength， poor appetite， loose stool， and white tongue coating. The Qi and blood deficiency syndrome were mainly manifested as the shortness of breath， laziness to speak， pale complexion， dizziness， and palpitation. The Qi deficiency and blood stasis syndrome were mainly judged by the scanty menstrual flow frequently or occasionally accompanied by blood clots， mental fatigue， lack of strength， and dark purple tongue. The ovulatory bleeding， dizziness， tinnitus， vexing heat in chest， palms and soles， and night sweat were the characteristic signs for the kidney Yin deficiency syndrome. Conclusion:There exist certain rules in the geographical distribution of TCM syndromes of AUB-O patients， which has provided a reference for the clinical treatment of AUB-O in accordance with the local conditions.
ABSTRACT
Background: Abnormal uterine bleeding is a common problem of the women in the reproductive age group and leads to the frequent visits of women in hospitals to health care providers. In an effort to create a universally accepted system of nomenclature to describe uterine bleeding abnormalities in reproductive-aged women, an alternative classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN developed.Methods: It is a retrospective study on 200 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patient grouped under these categories after detailed history, examination, investigations and histopathological reports.Results: Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=60, 30%). It was followed by leiomyoma (n=48, 24%) and endometrial causes (n=38, 19%) and were the top three etiologies for AUB respectively. Adenomyosis (n=26, 13%), not classified (n=12, 6%), iatrogenic (n=8, 4%), polyp (n=4, 2%) and malignancy and coagulopathy each (n=2, 1%) contributing least to the PALM-COEIN classification as an etiology for AUB.Conclusions: PALM-COEIN classification is a universally accepted and consistent method of knowing exact etiology following investigations, so the proper treatment can be done for AUB.
ABSTRACT
OBJECTIVE: To observe the clinical efficacy of motherwort injection in the treatment of abnormal uterine bleeding-ovulatory dysfunction(AUB-O),and provide data support for broadening the clinical application range of motherwort injection.METHODS: A multicenter,randomized,prospective study was used.The patients who were diagnosed with AUB-O in Hospital of Chengdu University of Traditional Chinese Medicine in 2018 were randomly divided into the control group and the experimental group according to random numbers.There were 75 cases in the experimental group,7 cases were lost,and 68 cases were the final cases;another 75 cases were in the control group,4 cases were lost,and there were 71 cases in the end.In the control group,only the tranexamic acid was given.On the basis of this,the experimental group was given intramuscular injection of motherwort injection 2 mL/time,b.i.d.,for 3 consecutive days.The clinical TCM symptom scores,blood loss,blood routine,coagulation function,endometrial thickness and effective rate were compared between the two groups.All data were statistically analyzed using IBM SPSS 21.0.RESULTS: After treatment,the total effective rate of the experimental group was 97.06%,which was significantly better than that(84.51%)of the control group(P0.05),but on the 2nd day and the 3rd day after treatment,the difference was statistically different(P<0.05),and the cumulative amount of bleeding after 3 days of treatment was statistically different(P<0.05).The endometrial thickness of the experimental group was lower than that of the control group(P<0.01).CONCLUSION: Motherwort injection combined with basic therapy is effective in the treatment of AUB-O.
ABSTRACT
Introducción: Aproximadamente, el 15 por ciento de todos los matrimonios no tienen hijos. Según estudios realizados en Cuba, la prevalencia de infertilidad oscila entre 12 y 14 por ciento, destacándose dentro de sus causas los factores pélvicos que afectan las trompas o el endometrio con 30-50 por ciento, seguido de la disfunción ovulatoria con el 10 a 25 por ciento y solo 10 por ciento son de causa desconocida. Objetivo: Caracterizar a las parejas infértiles según variables clínico epidemiológicas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo, transversal a 224 parejas infértiles, en la provincia Santiago de Cuba. Cuba, en el periodo 2015-2016. Resultados: El 40,3 por ciento de las parejas estudiados presentaron infecciones de transmisión sexual de diferentes etiologías y el 45,6 por ciento se diagnosticaron con infertilidad secundaria. Conclusiones: La edad de la mujer por encima de los 35 años, los antecedentes patológicos personales, la ingestión de medicamentos, la presencia previa de infección de trasmisión sexual así como el antecedente de varios episodios de enfermedad pélvica inflamatoria, están relacionadas con la etiología infecciosa de la infertilidad y pudieran constituir las principales causas de este trastorno en nuestro país(AU)
Introduction: Approximately 15 percent of all marriages do not have any children. According to studies carried out in Cuba, the prevalence of infertility ranges from 12 to 14 percent, among whose highlighted causes are pelvic factors that affect the tubes or the endometrium, accounting for 30-50 percent, followed by ovulatory dysfunction, accounting for 10-25 percent, while only 10 percent are of unknown cause. Objective: To characterize infertile couples based in the selected clinical-epidemiological variables. Methods: An observational, descriptive, cross-sectional study was carried out with 224 infertile couples in Santiago de Cuba Province, Cuba, in the period from 2015 to 2016. Results: 40.3 percent of the studied couples had sexually transmitted infections of different etiologies, while 45.6 percent were diagnosed with secondary infertility. Conclusions: The age of the woman over 35 years, personal pathological antecedents, ingestion of medications, the previous presence of sexually transmitted infections, as well as the history of several episodes of pelvic inflammatory disease, are related to the infectious etiology of infertility and could be the main causes of this disorder in our country(AU)
Subject(s)
Humans , Female , Pelvic Inflammatory Disease/epidemiology , Reproductive Techniques, Assisted , Infertility/epidemiology , Ovarian Function Tests/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Observational StudyABSTRACT
Objective To observe the therapeutic effect of Lai's acupuncture therapy combined with Chinese herbal decoction for the treatment of infertility with ovulatory dysfunction, and to summarize the experience of Professor Lai Xin-Sheng in treating infertility. Methods Ninety-six infertility patients with ovulatory dysfunction were randomized into treatment group and control group, 48 cases in each group. The treatment group was treated with Lai's Tongyuan acupuncture therapy for regulating Governor Vessel to tranquilize mind, inducing meridian Qi to original Qi, and was also given oral use of Chinese herbal decoction of Lai's Yiyun Recipe for promoting gestation. The control group was treated with Chinese herbal decoction alone. The treatment began exactly after the completion of menstruation period and lasted 15 days for one treatment course, covering 3 courses. And then the patients of the two groups were followed-up for 3 months. Therapeutic effect and pregnancy rate were evaluated after treatment, serum levels of estradiol and progesterone were examined, and abdominal ultrasonography was used for monitoring the maximum diameter of the dominant follicles and endometrial thickness before and after treatment. Results (1) Three cases from the treatment group and 5 cases from the control group were dropped out, and the final case number in the treatment group and control group was 45, 43 respectively. (2) The total efficiency of the treatment group was 88.9％, and that of the control group was 81.4％. The effect of the treatment group was better than that of the control group (P < 0.05). (3) The pregnancy rate of the treatment group was 73.3％, higher than that of the control group (51.2％), the difference being significant (P < 0.05). (4) After treatment, the maximum diameter of the dominant follicles and endometrial thickness in the two groups were obviously improved(P < 0.05 compared with those before treatment), and the improvement in the treatment group was superior to that in the control group (P < 0.05). (5) After treatment, the serum levels of estradiol and progesterone in the two groups were obviously improved(P < 0.05 compared with those before treatment) , and the improvement in the treatment group was superior to that in the control group(P < 0.05). Conclusion The therapeutic effect of Lai's acupuncture therapy combined with Chinese herbal decoction is superior to that of Chinese herbal decoction alone, showing an obvious synergistic effect by shortening the course of treatment and enhancing pregnancy rate.
ABSTRACT
Objective:To observe the effect of Yulin mixture on ovarian function in rats with kidney-yang deficiency ovulatory dysfunction.Methods:The hydrocortisone-induced ovulation disorder rat models were established,and the rats were divided into the model control group,Yulin mixture group and positive control group (clomiphene citrate group),and the normal control group was set up,and 10 rats were in each group.The general situation of the rats was observed.The wet weight indices of uterus and ovary were measured by an electronic analytical balance.Serum estradiol (E2),progesterone (P),follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured by radioimmunoassay.Ovarian morphology was observed after HE staining.Results:Yulin mixture could improve the general status of ovulation disorder rats,increase the wet weight indices of uterus and ovary (P<0.05) and the levels of serum E2,P,LH and FSH (P<0.01),and improve the pathological state of ovarian morphology.Conclusion:Yulin mixture can improve the levels of serum E2,P,LH and FSH resulting in promoting ovarian development.
ABSTRACT
Abnormal uterine bleeding (AUB) is a very common gynecological condition, which may have several causes. A new classification system was recently proposed to standardize the terminology used to describe Abnormal Uterine Bleeding. The International Federation of Gynecology and Obstetrics (FIGO) published guidelines in 2011 to develop universally accepted nomenclature and a classification system. The FIGO classification system (PALM-COEIN) was published to standardize the terminology used in the diagnosis and in investigations into the causes of abnormal uterine bleeding. According to the new FIGO classification, in the absence of structural etiology, the former term "dysfunctional uterine bleeding" should be avoided and clinicians should specify whether AUB is caused by coagulation disorders (AUB-C), ovulation disorder (AUB-O), or endometrial primary dysfunction (AUB-E). This system is based on the pattern and etiology of bleeding and has been adopted by other organizations. Additionally, the American College of Obstetrics and Gynecology (ACOG) has recently updated the recommendations on evaluation of abnormal uterine bleeding and the indications for endometrial biopsies. In short, AUB is a common complaint that can vary from mild to life-threatening if not recognized and treated promptly. In this review, we describe the main causes of abnormal uterine bleeding and summarize the most relevant new guidelines for the diagnosis and management of non-organic abnormal uterine bleeding that comprises AUB-C, AUB-O, AUB-E, AUB-I and AUB-N due to other non-classifiable causes
La hemorragia uterina anormal (HUA) es un trastorno ginecológico muy común, que puede deberse a varias causas. La Federación Internacional de Ginecología y Obstetricia (FIGO) publicó unas directrices en 2011 para establecer una nomenclatura que fuera universalmente aceptada y un sistema de clasificación. El sistema de clasificación de la FIGO (PALM-COEIN) se publicó para intentar estandarizar la terminología que se empleaba en el diagnóstico y en la investigación de las causas de sangrado uterino anormal. Según la nueva clasificación de la FIGO, en ausencia de una patología estructural, debe evitarse el empleo de la antes denominada "hemorragia uterina disfuncional" y los médicos deben indicar si la HUA está ocasionada por trastornos de la coagulación (HUA-C), trastorno de la ovulación (HUA-O), yatrogenia (HUA-I), disfunción primaria del endometrio (AUB-E) o causas no clasificables (HAU-N). Este sistema se basa en el patrón y la etiología de la hemorragia y ha sido adoptado por otras organizaciones. Además, el Colegio Americano de Obstetricia y Ginecología (ACOG) han actualizado recientemente las recomendaciones sobre la evaluación de sangrado uterino anormal, así como las indicaciones para la práctica de biopsias endometriales. En resumen, la HUA es una queja común que puede variar de leve a potencialmente mortal si no se reconoce y trata a tiempo. En esta revisión se describen las principales causas de sangrado uterino anormal y resumimos las nuevas directrices más relevantes para el diagnóstico y el tratamiento del sangrado uterino anormal no orgánico que comprende HUA-C, HUA-O, HUA-E, HUA-I y HUA-N
Subject(s)
Humans , Female , Uterine Hemorrhage , Blood Coagulation Disorders , Endometrium , Gynecology , Hysterectomy , Iatrogenic Disease , ObstetricsABSTRACT
The polycystic ovary syndrome (PCOS) is a heterogeneous disorder that is characterized principally by oligomenorrhea or amenorrhea with clinical or laboratory evidence of hyperandrogenemia. Furthermore, it is now recognized that a significant proportion of overweight women with PCOS have hyperinsulinemia. Three features are generally recognized to compose this syndrome, including androgen excess, ovulatory dysfunction, and polycystic ovaries. Because its etiology and natural history are poorly understood, there is controversy about the diagnostic criteria and clinical evaluation of the syndrome. But the diagnosis of PCOS entails two principal steps: (a) to determine whether features suggestive of PCOS are present and (b) to exclude related androgen excess or ovulatory disorders. The PCOS results in a number of immediate and long-term morbidities that are associated with a significant impact on quality of life and on economic costs. Immediate morbidities include menstrual dysfunction and abnormal uterine bleeding, subfertility and infertility, and androgen excess-related dermatologic abnormalities including hirsutism, acne, and androgenic alopecia, and an increased risk of obstetrical complications such as pregnancy-induced hypertension and gestational diabetes. However, PCOS is also associated with an increased risk of various other long-term complications or morbidities including cancer, type 2 diabetes mellitus, the metabolic syndrome, and possibly cardiovascular disease. For the management of PCOS, we should consider not only immediate but also the long-term morbidities.