绝经后出血的病因机制及临床诊疗进展

doi:10.12280/gjfckx.20260228

摘要/Abstract

摘要：

绝经后出血（postmenopausal bleeding，PMB）是绝经后女性常见的妇科症状，其背后潜藏着良性病变与恶性病变的双重风险，是绝经后女性健康管理的重要关注点。绝经后女性卵巢功能衰竭导致雌激素缺乏，进而引发生殖系统一系列退行性改变。结合女性绝经后这一特殊时期的病理生理特点，PMB的病因主要分为生殖系统炎症、良性病变、肿瘤、卵巢内分泌功能波动、药物和保健品、损伤和异物以及全身性疾病等。在临床实践中，PMB的诊断需结合详细的病史采集、全面的体格检查以及针对性的辅助检查，优先排除恶性病变，同时鉴别良性病因，以确保诊断的准确性。PMB的治疗需依托明确的病因诊断，综合考量患者的个体情况、临床特征及治疗意愿，针对不同病因实施规范化、个体化治疗，包括药物治疗、手术治疗、放射治疗、中医辅助治疗及生活方式调整等。

关键词: 绝经后期, 子宫不规则出血, 诊断, 治疗, 病理生理变化, 病因机制

Abstract:

Postmenopausal bleeding (PMB) is a common gynecological symptom in postmenopausal women, harboring dual risks of benign and malignant lesions, making it a critical focus in the health management of postmenopausal females. Ovarian failure in postmenopausal women leads to estrogen deficiency, subsequently triggering a series of degenerative changes in the reproductive system. Considering the pathophysiological characteristics unique to the postmenopausal period, the etiologies of PMB can be primarily categorized as reproductive system inflammation, benign lesions, neoplasms, ovarian endocrine dysfunction, drugs and supplements, trauma and foreign bodies, and systemic diseases. In clinical practice, the diagnosis of PMB requires combining a detailed medical history, comprehensive physical examination, and targeted ancillary investigations, prioritizing the exclusion of malignant lesions while differentiating benign causes to ensure diagnostic accuracy. The management of PMB relies on a definitive etiological diagnosis, comprehensively considering the patient's individual circumstances, clinical characteristics, and treatment preferences. Standardized and individualized treatments are implemented according to different etiologies, including pharmacotherapy, surgical intervention, radiotherapy, Traditional Chinese medicine adjuvant therapy, and lifestyle modifications.

Key words: Postmenopause, Metrorrhagia, Diagnosis, Therapy, Pathophysiological changes, Etiology and pathogenesis

范佳萱, 李晓钰, 代聪伟, 杨艳艳. 绝经后出血的病因机制及临床诊疗进展[J]. 国际妇产科学杂志, 2026, 53(4): 424-429.

FAN Jia-xuan, LI Xiao-yu, DAI Cong-wei, YANG Yan-yan. Pathogenesis and Clinical Progress in Diagnosis and Treatment of Postmenopausal Bleeding[J]. Journal of International Obstetrics and Gynecology, 2026, 53(4): 424-429.

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