妇科疾病

妇科疾病

妇女更年期是中年向老年的过渡期,主要是妇女卵巢功能逐渐减退至完全消失的过程。

此期前後的妇女由於性激素减少,生理功能衰退,容易发生下列妇科疾病:

子宫脱垂:

随年龄增长,性激素分泌渐渐减少,生殖器官将发生一系列退行性变,在子宫退化的同时,子宫阴道支援组织也变得松弛,子宫难以维持其正常位置而脱入阴道甚至脱出阴道口外方,患者感腰骶部酸痛和下坠,阴道口有脱出的子宫颈甚至于宫体,因摩擦可使脱出部组织黏膜糜烂、溃疡。

阴道炎:

停经後卵巢功能衰退,雌激素下降,阴道黏膜失去雌激素的支援与保护作用逐渐萎缩,上皮细胞内糖原减少,致使乳酸杆菌糖原酵解产生乳酸的能力下降,阴道内PH值由酸性转为硷性。这种环境有利於阴道内致病菌群生长繁殖,从而导致阴道感染。患者最常见的症状是白带增多,似米汤样,严重时可以是血性,脓性白带。自觉外阴痒,灼痛感。如果病变波及到泌尿系统,还可出现尿急、尿频、尿痛等泌尿系感染症状。

外阴瘙痒: 

外阴瘙痒在更年期妇女中常见,它的发病原因有:

全身性因素:

如糖尿病患者尿糖对外阴皮肤的刺激,外阴瘙痒特别严重;患有黄疸,贫血、维生素缺乏疾病的患者也可引起瘙痒;另有一些原因不明的瘙痒可能与精神或心理方面的因素有关。

局部因素: 

一些特别感染如霉菌性阴道炎和滴虫性阴道炎是引起瘙痒的最常见原因:肥皂、避孕套或某些清洗剂等可因直接刺激或过敏而引起接触性或过敏性皮炎出现外阴瘙痒;不注意外阴清洁,外阴皮肤的肿瘤,湿疹、疣等均可引起外阴剌痒。

更年期功能失调性子宫出血: 

妇女在停经前5—7年开始进入更年期,表现为月经从规律变为不规律,周期缩短或延长,最後月经停止,称为停经。部分妇女经量增多或经期延长,在除外全身及生殖系统器质性病变後一般称为更年期功能失调性子宫出血简称为功血,它的出血特点是周期不规则,经量多少不一,经期延长,少数患者因出血过多,过频而重度贫血。

子宫颈癌: 

子宫颈癌的发病率在40岁後显著上升,50—65岁是发病高峰年龄。多年的调查资料显示,早婚、早育、多产,性行为紊乱以及反覆发生阴道、子宫颈病毒感染的妇女子宫颈癌发病率高。本病的主要症状有接触性出血(如性交、妇科检查後),血性白带,停经後出血;阴道分泌物增多,早期多为稀薄的水样白带,晚期可有腰、腹痛,便血、里急後重,尿频、尿痛等表现。

子宫内膜癌:

子宫内膜癌发病的高峰年龄为55—59岁。此病的发生与雌激素的长期剌激同时缺乏孕激素的对抗和调节有关,因此久治不愈的更年期功能性子宫出血或停经延迟到52岁以後者应警惕子宫内膜癌;一生不孕或未产妇女因其子宫内膜缺乏孕激素的调节也易患此病;另外口服雌激素治疗更年期综合症者随著用药时间的延长,子宫内膜癌发生的危险增加,因此雌激素用量应尽可能小,还应合并用孕激素。子宫内膜癌的常见表现为不规则阴道出血,尤其是停经1年後出现的阴道出血更应引起重视;白带异常可以是水样、血性甚至是哝性白带;疾病晚期可有腰部或腰背部疼痛。

卵巢肿瘤: 

卵巢肿瘤中,良性肿瘤约占75%,多发生於生育年龄层妇女;恶性肿瘤占25%,多发生於中老年。卵巢恶性肿瘤患者早期症状不明显,待临床出现典型表现时往往已是晚期,失去了最佳治疗期,因此应注重普查,以便早期发现,早期治疗卵巢肿瘤。

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