性激素在围绝经期异常子宫出血中的作用机制

Mechanism of action of sex hormones in perimenopausal abnormal uterine bleeding

围绝经期异常子宫出血(abnormal uterine bleeding,AUB)病因众多,主要包括子宫与宫腔局部因素,全身出凝血功能的异常与生殖内分泌轴的功能异常。性激素在三大因素中分别起到不同作用,涉及到的疾病包括功能性AUB、子宫内膜增生引起的AUB、应用性激素类药物引起的AUB等,上述疾病与性激素的量、时间、比例有关,根据性激素的作用机制可大致分为雌激素撤退性出血、雌激素突破性出血、孕激素突破性出血三类。

Abnormal uterine bleeding in perimenopa- usal women is mainly associated with uterine and u- terine cavity abnormalities, impaired coagulation function and disturbances of the hypothalamus-pitui- tary-ovary axis. Sex hormones play different roles in all causes. Disturbances of their level, action dura- tion, and proportion may lead to functional AUB, AUB caused by endometrial hyperplasia, AUB caused by sex hormone drugs. The bleeding patterns mainly include estrogen withdrawal bleeding, estro- gen breakthrough bleeding, and progesterone break- through bleeding.