When a patient asked, "I shouldn't be getting face slimming shots anymore?" I said, "If it worked for you, you can

since a V-line face is also something important!" (opening song)
English subtitles written by Woori subtitles
*woori.subtitles.eng@gmail.com

Dr. Hong: You are going to talk from there, Dr. Choo?
Dr. Kwon: Cheer up!

Dr. Kwon: We can do this! Dr. Kwon: Let's do this!

OBGYNs that you, me, and people of all genders and ages should know (low tension)
Our neighborhood's OBGYN!
Wooridongsan

Hooray! What time is it now? What time is it now! Do you know what time it is now?

(Answer: 11 PM)
Dr. Choo: We just started a 10-minute live (which ended up being a 150-minute live)

(Dr. Hong eager to go home)
Dr. Choo: but we did it for 100 minutes)

We are going to talk about what many people are curious about, which is very awkward that we haven't filmed about this until now.

The two main reasons that make people visit an obgyn are (1) I am not having periods

(1) I am not having periods
and
(2) I have bleeding not during periods

We haven't filmed about amenorrhea and metrorrhagia. So today, we would like to talk about metrorrhagia.

First, what is the definition of metrorrhagia? Definition is the most important in medicine.

It's the first sentence of every chapter. Q. What is metrorrhagia? Opposite from women's regular uterine bleeding,

irregular bleeding from the uterus is called metrorrhagia. In Korean, the word's pronunciation is the same as "bad," so some people think it's bad bleeding.

Dr. Kwon: Ah, so some may think there is good bleeding and bad bleeding. If there's bleeding other than menstruation, that is "metrorrhagia."

Medical terms are abnormal uterine bleeding (AUB) and abnormal vaginal bleeding. Although normal menstrual bleeding differs between individuals,

is there a range that can be considered "normal"? In terms of period, if there's menstruation every 24–38 days,

we can consider it a "normal period". If the period is shorter than 24 days or longer than 38 days,

we can consider the period outside the normal range. Some people may experience a delay in menstruation,

but depending on age, if the delay is within a week, it can be considered "normal".

For example, if your menstrual period was 24 days last month and is now 31 days,

if the interval between the last menstruation and this one is 31 days, it is normal.

Menstrual bleeding at the beginning and end of the month is also normal. Since it's called a "period", 28 days (4 weeks) is emphasized.

However, only 15% of people have a 28-day period. Others (85%) have periods within 24–38 days.

Dr. Hong: I am amazed to see people who say that their menstruation is on the same date every month.

Dr. Kwon: The interesting part is that there are 31-day and 30-day months.

Dr. Hong: I thought the same! Dr. Choo: Maybe it's false recognition due to a lack of period tracking.

Dr. Kwon: Those people are remembering by dates. Within the first 2–5 years or before the age of 20, metrorrhagia is quite common.

Don't worry too much and visit a doctor for a consultation. People in the very early stages of menstruation

Metrorrhagia doesn't necessarily mean huge problems unless they are pregnant. However, people with an imperforate hymen

or an imperfectly formed hymen, may mistake bleeding for menstrual bleeding. Therefore, if teenagers are experiencing abnormal bleeding, it's better to visit a doctor

to check that there's no anatomical problem. Q. What are the causes of metrorrhagia?

Anatomical issues that cause metrorrhagia are: polyp, adenomyosis, uterine fibroids, endometrial cancer, cervical cancer, and endometrial hyperplasia.

Another cause is hormonal imbalance. Among the anatomical issues, a polyp can be located at the cervix and endometrium

that can easily cause metrorrhagia. In the case of an endometrial polyp, its removal is not complicated.

For young people who have a symptomless endometrial polyp, it can be left untreated, but if there's related metrorrhagia every few months,

you can simply have it removed with hysteroscopy, just like a gastroscopy. So, don't worry too much. It's better to get it treated.

It's too simple to be called a "surgery". Removal of a cervical polyp is much simpler.

Neither hurts, so you should get the polyps removed when there's accompanying metrorrhagia.

If the beginning and end of menstruation is unclear, we can suspect that a polyp is the cause,

although that's not always the case. If you have such a symptom with an actual polyp, we can try removing it.

Dr. Kwon: However, they may recur.
Dr. Hong: Yes. Bleeding from a cervical polyp

mostly occurs after sexual intercourse. So if you have bleeding after sex, it may be due to a cervical polyp or cervical cancer,

which YOU MUST GET EXAMINED for. Regarding hormonal imbalance, the most common cause is thyroid issues.

You may find it odd to hear that the thyroid is related. The thyroid hormone and the hormone that controls ovulation (LH)

partly share the same molecular structure. Thus, when there are fluctuations in TSH (Thyroid-Stimulating Hormone),

periods become irregular. Common causes of metrorrhagia are hypothyroidism and hyperthyroidism.

Also, hormone imbalances can stem from prolactin. Women who have delivered a baby will know that during breastfeeding, there is no menstruation.

So, if there's a prolactin hormone imbalance, there may be either no period or metrorrhagia.

When you've visited an OBGYN for metrorrhagia, you might have wondered, "Why are they examining my thyroid hormone and prolactin?"

It's because those two (TSH and prolactin) are the basic factors to check.

Along with estrogen, we check your thyroid function and prolactin.  The moment I feel pity during outpatient appointments is when

they ask about their one-month-old bleeding. Dr. Kwon: After the bleeding stopped
Dr. Hong: Yes. There are many moments like that.

Then, I ask, "Why didn't you come earlier?" and they say, "I felt sorry to show you my blood,"

or "How can I come when I'm bleeding?" BUT! You should come when you are bleeding.

You should see a doctor when there's bleeding. Secondly, in the case of a polyp, it's difficult to see during bleeding

because of the polyp's adhesion to the blood clot. In such cases, most OBGYNs will suggest you

come back right after your next menstruation. Dr. Kwon: When I ask them to come after their next menstruation,

many of them come later than I expected. It's best to come when the bleeding changes to brown.

so that the doctors can examine more precisely. Some may ask how transvaginal ultrasound is possible during bleeding, but it doesn't matter.

We can perform ultrasound during bleeding. In fact, it's more important to capture the moment.

It's good to visit 5–7 days after menstruation. Small bleeding doesn't matter, so please visit a gynecologist at the right time.

Especially, days 5–7 are best to examine the endometrial polyp.

Q. What are other possible causes of metrorrhagia? One of the most common causes of bleeding is anovulatory dysfunctional uterine bleeding or anovulatory amenorrhea (absence of a period).

Regardless of anovulation, the hormone system is running, which leads to an incomplete menstrual cycle and hormonal imbalance.

That's most common. Many polycystic ovary syndrome (PCOS) patients not only have amenorrhea

but also metrorrhagia. Estrogen stimulation weakens the endometrium.

I had bad ovulation bleeding. Ovulation bleeding is a common cause of metrorrhagia.

So, many people worry about potential infertility. However, ovulation bleeding does not directly imply infertility.

You can consider ovulation bleeding as one of several symptoms. It's important to confirm that it is truly ovulation bleeding

and not to leave it to personal guesswork. Your guess of "Hmm, this seems to be ovulation bleeding"

may not be accurate unless examined. The best solution is to check your period history. Many people who have bleeding right after a period

are experiencing ovulation bleeding. Some people have a similar amount of bleeding during abnormal bleeding and menstruation.

I tell my patients how to distinguish the two.  Not only the type of bleeding, but also the characteristic symptoms during menstruation

Symptoms like irritation, intense cravings for sweets, headaches, menstrual pain, and depression should be checked.

Bleeding accompanied by these characteristic symptoms is menstruation.  If not, it's highly likely metrorrhagia.

We often ask patients to keep a menstrual diary. If you have metrorrhagia, you must

Dr. Hong: Recently, smartphones are so convenient.
Dr. Kwon: Yes, with nice applications.

record it regularly. A menstrual diary is convenient for doctors, too. Observing the data from the app almost gives us all the answers.

Moreover, if you've taken medications like aspirin or steroids prescribed by an orthopedist,

Dr. Choo: metrorrhagia happens often.
Dr. Hong:  And face slimming injections.

If you've had any injections recently or eaten special foods before menopause, like:

pomegranate, herbal extracts, or herbal medicine, it disrupts hormone balance. Around menopause, hormones are already unbalanced,

but these foods make things worse, leading to metrorrhagia. If you are taking anything other than vitamins, you should tell us.

Many brides-to-be get slimming injections and then come to me with metrorrhagia.

Such metrorrhagia doesn't last forever. Metrorrhagia caused by things like steroids is not permanent.

When patients ask if they should avoid slimming injections, I tell them to get them if they were successful.

I say, "Good shape is more important, right?"  The effects of the injections aren't permanent, though...so they need to get them constantly.

Drastic weight loss.  Many young people are dieting these days. It's important to maintain a weight that supports regular periods.

If you've gained or lost too much weight, you might notice a change in your menstrual cycle.

If you have a history of regular periods, it's best to return to a healthy weight. Sudden weight changes

can cause metrorrhagia or amenorrhea.  It's better to adjust your weight gradually.

I feel bad for flight attendants because of constant jet lag.
Dr. Kwon: Also people who work shifts.

If someone works night shifts, their hormone balance can be disrupted, leading to metrorrhagia or

amenorrhea.  Students preparing for exams and resident doctors are extreme examples.

Dr. Kwon: We rarely menstruate during residency. Dr. Hong: I had constant metrorrhagia.
Dr. Kwon: And I had no menstruation.

If you have a very stressful job, metrorrhagia is more likely to occur.

As our subscribers tell us, it's like a sunfish (*)
(*Do you know the Survive! Mola Mola! game?)

that they often skip periods. Women after menopause may experience abnormal bleeding during hormone therapy, or the menopause itself can cause bleeding.

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