Management of disfunctional uterine bleeding

Abstract

Dysfunctional uterine bleeding DUB is defined as abnormal uterine bleeding in the absence of demonstrable structural or organic pathology Bleeding occurs frequently or irregularly lasts longer or is heavier DUB is the most common cause of abnormal vaginal bleeding during a woman 39;s reproductive years and occurs most commonly at the beginning of the reproductive years in adolescent girls The frequency is 20 in adolescent girls DUB is diagnosed when all other possible causes of vaginal bleeding have been excluded such as bleeding disorders pregnancy medications iatrogenic causes genital tract pathology malignancy and systemic disease by appropriate investigations Approximately 90 of DUB cases result from hypothalamic anovulation in adolescents during early puberty The goal of therapy should be to arrest bleeding replace lost iron to avoid anemia and prevent future bleeding Conjugated estrogen Premarin 25 mg IV can be given every 4 6 hours until the bleeding stops for very heavy bleeding After bleeding stops low doses of the oral contraceptive may then be prescribed for at least 3 months to prevent the bleeding from recurring Combination oral contraceptive pills with 35 mcg of ethinyl estradiol may be used or nbsp; progesterone alone can be used to stabilize an immature endometrium until the bleeding stops for up to 7 days in patients with moderate bleeding Gonadotropin releasing hormone agonists may be helpful for short term use when oral contraceptive pills are contradicated Turk Arch Ped nbsp; 2011; 46 Suppl: 103 6

Keywords

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Disfonksiyonel kanama yönetimi

Öz

Disfonksiyonel uterus kanaması DUK organik ya da yapısal anormallik olmadan anormal uterus kanaması olması şeklinde tanımlanmaktadır Kanama sık ya da düzensiz uzun süreli ya da ağır şekilde olabilir DUK üreme çağındaki kadınlarda en sık anormal vajinal kanama nedenidir ve ergen nbsp; kızlarda özellikle üreme çağının ilk yıllarında sıkça görülür Ergen kızlarda 20 sıklıkla görülmektedir DUK tanısı; kanama bozuklukları nbsp; gebelik ilaç kullanımı iatrojenik nedenler genital yoldaki patolojiler malignensi ve sistemik hastalıklar yapılacak ileri incelemelerle dışlandıktan sonra konulur Pubertenin erken dönemindeki ergenlerde 90 neden hipotalamik anovülasyondur Tedavinin hedefleri kanamayı durdurmak anemiyi önlemek için demir desteği vermek ve ileride olabilecek kanamaları önlemektir Çok ağır kanaması olan olgularda konjuge östrojen Premarin 25 mg damardan 4 6 saatte bir kanama durana kadar verilebilir Kanama durduktan sonra düşük doz doğum kontrol hapları ile nbsp; en az 3 ay daha ilerideki kanamaları önlemek amacıyla tedaviye devam edilir Orta derecedeki olgularda 35 mg etinil östrojen içeren doğum kontrol hapları ya da endometrium stabilizasyonunu sağlamak amacıyla tek başına progesteron preparatlerı kanama durana kadar ya da bir hafta süreyle verilebilir Doğum kontrol hapı kullanımı sakıncalı olgularda gonadotropin salgılatıcı hormon agonistlerinin kısa süreli kullanımı yarar sağlayabilir Türk Ped Arş 2011; 46 Özel Sayı: 103 6

Anahtar Kelimeler

• Disfonksiyonel uterus kanaması, yönetim, ergen

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