Objective To observe the clinical effect of Guchong Zhixue traditional Chinese medicine combined with mifepristone on dysfunctional uterine bleeding in perimenopausal period. Methods 45 patients were randomly divided into two groups. The control group was treated with oral mifepristone, while the treatment group was treated with TCM syndrome differentiation and hemostasis. The course of treatment was three months and the curative effect was observed. Results The patients in the two groups had a certain effective rate during taking the medicine, and the effective rate in the treatment group was higher, with statistical significance compared with the control group (P < 0.05). Conclusion Traditional Chinese medicine combined with mifepristone is an ideal method to treat dysfunctional uterine bleeding in perimenopausal period.
Keywords mifepristone, traditional Chinese medicine for hemostasis, dysfunctional uterine bleeding in perimenopausal period
Dysfunctional uterine bleeding is a common and frequently-occurring disease in gynecology. It is abnormal uterine bleeding caused by abnormal neuroendocrine mechanism regulating reproduction, but there are no organic diseases in the whole body and internal and external reproductive organs, which can be divided into ovulation and anovulation, and anovulation is common in clinic (about 85% cases) [1]. The treatment principle of dysfunctional uterine bleeding in perimenopausal period is to stop bleeding, regulate menstruation or reduce menstrual flow, induce amenorrhea, improve general condition and prevent endometrial cancer. The author followed the tutor for 20 10 March? From September, 2065438 to September, 2000, the patients with dysfunctional uterine bleeding in perimenopausal period were treated with traditional Chinese medicine and mifepristone, and the effect was good. The report is as follows.
Clinical data and methods of 1
1. 1 subjects: 45 patients with dysfunctional uterine bleeding in perimenopausal period, aged 45-52 years, who came to our hospital from March 20/kloc-0 to September 20/kloc-0, had a course of three months to two years, and their symptoms were irregular vaginal bleeding and menorrhagia in different degrees. All the included cases were examined by B-ultrasound and diagnosed curettage before taking the medicine, so as to exclude the organic uterine diseases such as hysteromyoma and endometrial cancer. Exclude the history of cardiovascular disease, hematological disease and diabetes. I haven't taken hormone drugs for nearly three months. There are no contraindications to taking medicine.
1.2 treatment: All patients were randomly divided into treatment group and control group, with 25 cases in treatment group and 20 cases in control group. Drug treatment: The patients in the two groups took mifepristone tablets 12.5mg before going to bed every day during the bleeding period, and the maintenance dose was changed to 10mg after stopping the bleeding, and the medication was continued for three months. During the treatment, we should closely observe the improvement of patients' vaginal bleeding and regularly check the relevant biochemical indexes. If there is any abnormality, we should take corresponding auxiliary treatment measures. On this basis, the treatment group was given 200ml of Guchong Zhixue concentrated decoction twice a day. The prescription comprises Radix Rehmanniae Preparata 15g, Rhizoma Dioscoreae 15g, Fructus Corni 15g, Semen Cuscutae 12g, Radix Angelicae Sinensis 12g, Fructus Lycii 12g, Os Draconis 10g, and Concha Ostreae. Ginseng 12g, Astragalus 12g, Atractylodes macrocephala12g were added for patients with qi deficiency; Scutellaria baicalensis Georgi 12g, Radix Rehmanniae 12g, and Sanguisorba officinalis12g were added for patients with blood heat; Semen Persicae 12g, Radix Paeoniae Rubra 12g, Cortex Moutan 12g are added for patients with blood stasis. Follow-up for three months, once a week, to understand the therapeutic effect and menstruation.
1.3 Efficacy evaluation: Effective: After one week of treatment, vaginal bleeding was significantly reduced. After three months of treatment, amenorrhea or menstrual cycle is regular, menstrual volume is obviously reduced, menstrual period is shortened or menstruation is scarce, and there is no recurrence after three months of follow-up. Ineffective: there is no obvious change in the amount and time of vaginal bleeding before and after treatment, or it is effective in the short term after treatment, such as the amount of vaginal bleeding is reduced and the cycle is regular, but it recurs during follow-up [2].
1.4 statistical method: average measurement data? Standard deviation (x-? S) T test was used for comparison between the two groups, and X2 test was used for comparison of clinical efficacy, P
Two results
2. 1 clinical efficacy: both groups took it for three months 1 course of treatment, and the effective rate in the treatment group was 88%, while that in the control group was 69%. Statistical analysis showed that there was a significant difference between the two groups (P
2.2 Adverse reactions A small number of patients in the two groups had adverse reactions during the medication, with 4 cases in the treatment group and 5 cases in the control group, mainly manifested as nausea, vomiting and occasional dizziness.
3 discussion
3. 1 Pathophysiology of menopausal dysfunctional uterine bleeding Climacteric dysfunctional uterine bleeding is a common disease in perimenopausal women. If the amount of bleeding is too large and the bleeding time is too long, symptoms such as dizziness, palpitation and anemia will often appear, which will seriously affect the normal life of patients. It is to eliminate abnormal uterine bleeding caused by organic diseases of reproductive organs or systemic diseases. The clinical manifestations are menstrual disorder, menstrual disorder and ovarian dysfunction in perimenopausal women. Generally speaking, it belongs to anovulatory dysfunctional uterine bleeding, which belongs to estrogen withdrawal or breakthrough bleeding. Endometrium is an endometrium that proliferates under the long-term action of estrogen. When the estrogen level drops and the thickened endometrium cannot be maintained, irregular shedding and bleeding may occur on the surface of the endometrium [3].
3.2 Pharmacological Effects of Mifepristone Mifepristone is a synthetic steroid, which is often used to terminate pregnancy and induce labor in clinic. It can act as a progesterone receptor in endometrium and cause uterine contraction. There is no ovulation and luteal phase in menopausal dysfunctional uterine bleeding patients, so there is no obvious menstrual induction. Because of its unique anti-estrogen regulation mechanism on endometrial hyperplasia, this drug has been used in bed to treat dysfunctional uterine bleeding in recent years, especially menopausal dysfunctional uterine bleeding [4].
3.3 TCM etiology and pathogenesis and syndrome differentiation Does dysfunctional uterine bleeding in perimenopausal period belong to the category of TCM? Collapse? Category. The onset of metrorrhagia is a serious imbalance of kidney-Tiangui-Chongren-uterus reproductive axis. The main pathogenesis is unconsolidated chong and ren, uncontrollable menstrual blood and abnormal uterus. The common causes of metrorrhagia are spleen deficiency, kidney deficiency, blood heat and blood stasis. The blood volume of spleen deficiency is out of control, even asthenia, and the chong and ren are not solid, which can not restrict menstrual blood; Kidney deficiency is divided into kidney qi deficiency, kidney yang deficiency and kidney yin deficiency; Blood-heat-heat injury rushes to ren, forcing blood to rush; Blood stasis blocks uterine flow and blood does not return to menstruation. The occurrence and development of metrorrhagia and metrorrhagia often involve both qi and blood and multiple viscera. No matter how dirty the disease is, must the phase shift of the four viscera be attributed to the spleen and kidney? ,? When the five internal organs are injured, poverty will reach the kidney? So that the kidney was injured. Although the etiology and pathogenesis of metrorrhagia are different, the source of the disease is the kidney, the location of the disease is Chongren, and the change is in qi and blood, which shows that the uterus is full of diarrhea [5]. According to our syndrome differentiation and treatment, the application of traditional Chinese medicine combined with oral mifepristone in the treatment of this disease has achieved good clinical results. In the prescription, Radix Rehmanniae Preparata can tonify kidney, nourish yin and replenish essence. Cornus officinalis, Chinese yam and Liuwei Dihuang Pill are used to replenish raw water, and * * * is the monarch drug. Cuscuta is a minister medicine, while Angelica sinensis and Lycium barbarum nourish blood, soften liver and benefit chong ren. Calcined Os Draconis and Calcined Oysters nourish yin and suppress yang, and stop bleeding; Colla Corii Asini enriches blood and stops bleeding, while Folium Artemisiae Argyi warms channels to stop bleeding. Add and subtract this recipe according to the specific symptoms of patients. Ginseng Radix, Radix Astragali and Atractylodis Rhizoma are added to patients with qi deficiency to invigorate qi and spleen, strengthen yang and consolidate the body constitution; Scutellaria baicalensis Georgi, Radix Rehmanniae and Sanguisorba officinalis are added in blood heat to clear away heat, cool blood and stop bleeding. Peach kernel, Radix Paeoniae Rubra and Cortex Moutan are added to patients with blood heat to promote blood circulation, remove blood stasis and stop bleeding.
The combination of traditional Chinese medicine and mifepristone can greatly improve the quality of life of menopausal dysfunctional uterine bleeding patients, effectively improve the symptoms of irregular vaginal bleeding, and induce menopausal women to have sparse menstruation or amenorrhea. It is an ideal treatment in clinic.
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