Management of disfunctional uterine bleeding

Year 2011, , 3 - 6, 01.03.2011

Bumin Dündar

https://doi.org/10.4274/tpa.46.46

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

-

Disfonksiyonel kanama yönetimi

Abstract

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

Keywords

Disfonksiyonel uterus kanaması, yönetim, ergen

References

• Fleisch A, Gordon C. Adolescent menstrual abnormalities. In: Lifshitz F ed. Pediatric Endocrinology. New York: İnforma Healthcare USA Inc, 2007: 349-63.
• Adams Hillard PJ. Menstruation in young girls: a clinical perspective. Obstet Gynecol. 2002; 99: 655-62. (Abstract)
• World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. I. A multicenter cross-sectional study of menarche. World Health Organization Task Force on Adolescent Reproductive Health. J Adolesc Health Care. 1986; 7: 229-35. (Abstract)
• yaklaşım algoritması
• Yapısal puberte gecikmesi, yeme bozuklukları, aşırı egzersiz
• Meme gelişimi yok Beslenme durumu,
• egzersiz, stres Progesteron yükleme testi Kanama var Androj. ↑ PKOS
• yanıt, hipofiz MRI normal
• American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care, Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics 2006; 118: 2245-50. (Abstract) / (Full Text) / (PDF)
• Vihko R, Apter D. Endocrine characteristics of adolescent menstrual cycles: impact of early menarche. J Steroid Biochem. 1984; 20: 231-6. (Abstract)
• Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol 2004; 190: 1216-23. (Abstract) / (Full Text) / (PDF)
• Rosenfield RL, Barnes RB. Menstrual disorders in adolescence. Endocrinol Metab Clin North Am 1993; 22: 491-505. (Abstract) / (Full Text) / (PDF)
• Ellis MH, Beyth Y. Abnormal vaginal bleeding in adolescence as the presenting symptom of a bleeding diathesis. J Pediatr Adolesc Gynecol. 1999; 12: 127-31. (Abstract) / (PDF)
• Frick KD, Clark MA, Steinwachs DM, et al. Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment. Womens Health Issues. 2009; 19: 70-8. (Abstract) / (Full Text) / (PDF)
• Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG. Abnormal uterine bleeding. In: Schorge JO (ed) s. Williams Gynecology. New York: McGraw-Hill, 2008; 8.
• Tibbles CD. Selected gynecologic disorders. In: Marx JA ed (s). Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 1. 7th ed. Mosby Elsevier; 2009; 98.
• Pitkin J. Dysfunctional uterine bleeding. BMJ 2007; 334: 1110-1. (Abstract) / (Full Text) / (PDF)
• Speroff L, Glass R, Kase N. Dysfunctional uterine bleeding. In: Seifer DB, Speroff L (ed)s. Clinical Gynecologic Endocrinology & Infertility 1999: 575-91.
• Falcone T, Desjardins C, Bourque J, Granger L, Hemmings R, Quiros E. Dysfunctional uterine bleeding in adolescents. J Reprod Med 1994; 39: 761-4. (Abstract)
• LaCour DE, Long DN, Perlman SE. Dysfunctional uterine bleeding in adolescent females associated with endocrine causes and medical conditions. J Pediatr Adolesc Gynecol 2010; 23: 62-70. (Abstract) / (Full Text) / (PDF)
• Claessens EA, Cowell CA. Dysfunctional uterine bleeding in the adolescent. Pediatr Clin North Am 1981; 28: 369-78. (Abstract)
• Crosignani PG, Rubin B. Dysfunctional uterine bleeding. Hum Reprod 1990; 5: 637-8.
• Bayer SR, DeCherney AH. Clinical manifestations and treatment of dysfunctional uterine bleeding. JAMA 1993; 269: 1823-8. (Abstract) / (PDF)
• Munro MG. Dysfunctional uterine bleeding: advances in diagnosis and treatment. Curr Opin Obstet Gynecol 2001; 13: 475-89. (Abstract)
• Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am 2008; 35: 219-34.
• Strickland JL. Management of abnormal bleeding in adolescents. Mo Med 2004; 101: 38-41.
• Bongers MY, Mol BW, Brolmann HA. Current treatment of dysfunctional uterine bleeding. Maturitas 2004; 47: 159-74.
• Ely JW, Kennedy CM, Clark EC, et al. Abnormal uterine bleeding: a management algorithm. J Am Board Fam Med. Nov-Dec 2006; 19: 590-602. (Abstract) / (Full Text) / (PDF)