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Stelian Hodorogea
Caracteristicele unui ciclu menstrual normal
Dereglarile ciclului menstrual
Ovarian changes
Endometrial changes
Caracteristicele unui ciclu menstrual normal
Durata medie 28 zile (variind de la 21 la 35 sile)
Regulat (nu-s diferente de durata mai mari de 8
zile)
Durata medie a sangerarii menstruale - 4 zile
(variatii 3-8 zile).
Pierderea medie de sange 35-40 mL. Se
considera patologica - daca e peste 80 mL.
De asemenea:
Este ovulator
Nu este foarte dureros .
Dereglarile ciclului menstrual
De regularitate
De frecventa
De durata a sangerarii
De volum a sangelui pierdut
Anovulatia
Dysmenorea
Dereglarile regularitatii
Amenorrhea absenta menstruatiilor.
Mensruatii neregulate variatii de durata a
ciclului menstrual mai mari de 8 zile.
Dereglarile frecventei
Postmenopauza
Pre-menarhe (9 ani)
Cauzele hemoragiilor uterine
patologice
Pregnancy-related Systemic
Miscarriage Thyroid disease
Ectopic pregnancy Liver disease
Gestational trophoblastic disease Coagulation disorders
Infection Sepsis
Cervicitis Iatrogenic
Endometritis Oral contraceptives
Neoplasm Progestin-only contraceptives
Cervical dysplasia/carcinoma Intrauterine devices
Endometrial hyperplasia/carcinoma Hormone replacement therapy
Submucous leiomyomas Steroids
Endometriosis Anticoagulants
Estrogen-producing ovarian tumors
Hemoragii uterine disfuncionale
AUB-A
Structural causes: leiomyoma
Most relevant: sub-mucous leiomyoma
Diagnosis:
Bimanual exam
Ultrasound
Other radiological
AUB Lsm
AUB Lother
Structural causes:
Malignancy and hyperplasia
Factoi de risc
Varsta
Obezitatea
Anovulatia cronica .
Diagnostic histologia
Non-structural causes: coagulopathy
Initial screening for an underlining disorder of hemostasis in patients
with AUB should be by a structured history:
1. HMB since menarche
2. One of the following:
Post-partum hemorrhage
Surgical related bleeding
Bleeding associated with dental work
3. Two or more of the following symptoms:
Bruising 1-2 times/months
Epistaxis 1-2 times/months
Frequent gum bleeding
Family symptoms of bleeding symptoms
Non-structural causes: Iatrogenic
AUB-I comprises the spectrum of uterine bleeding problems
related to intrauterine contraceptive systems, exogenous
sex-steroid administration or agents such as gonadotrophin
releasing hormone agonists that directly affect sex steroid
production.
AUB-O
Hemoragii ovulatorii vs Anovulatorii
Ovulatorii de regula regulate si asociate cu
symptome premenstruale and dysmenorrhee.
Etapele tratamentului
Stoparea hemoragiei acute, abundente
Prevenirea recurentei
Tratamentul cauzei
1. Stoparea hemoragiei in
hemoragia uterin abundent
1. Intravenous estrogen at 25mg every 4 hours for
12 hours is said to be the treatment of choice
OR
2. Intravenous conjugated equine estrogen
(Premarin) at 1.25mg every 4 hours is a good
alternative
THEN
Estrogen at 1.25mg per day of conjugated estrogen
can be administered for 7 to 10 days, PLUS a
progestational agent such as MPA 10 mg/day
1. Stoparea hemoragiei uterine
moderate
1. Monophasic oral contraceptives (MOC) to be
taken 3 to 4 times per day for a week, then start
a new pack of pills one pill a day after this week
OR
MOC 5 times per day first day, 4 times
second, 3 times third, 2 times fourth and 1
pill per day till full 21 days course
OR
2. MPA10 mg daily for 10 days
2. Prevenire recurentei:
hemoragii moderate si recurente
1. COC - cel putin 6 luni
ORI
2. MPA 10 mg zilnic cate 10 zile fiecare ciclu nu este effectiv
- Trebuie adminstrate de la a 5 pana la a 28 zi a ciclului menstrual
ORI
3. Depo Provera intramuscular150mg fiecare 3 luni
ORI
4. DIU cu progestin (Mirena)
ORI
5. Antiinflamatoare nesteroidiene (Acid Mefenamic cel mai eficient)
ORI
6. Antifibrinolitice: acid tranexamic (Etamsilat s-a docvedit ca este
ineficient)
Tratement chirurgical
Vacuum aspiratie
D&C
Endometrial ablation
Uterine artery embolization
Polypectomy or miomectomy
Hysterectomy