A 41-Year-Old Woman With Menorrhagia, Anemia, and Fibroids

Voorhis, Bradley J. Van

doi:10.1001/jama.2008.791

Cited by 40 publications

(27 citation statements)

References 98 publications

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“…Obesity is a risk factor, while increased parity and cigarette smoking are protective [28]. Compared with normal myometrium, leiomyomas have a higher concentration of ER, PR and aromatase [32] and they grow in response to estrogen and progesterone.…”

Section: Myometrial Dysfunctions (Adenomyosis and Leiomyoma) Leiomyomasmentioning

confidence: 99%

Pathophysiology of Heavy Menstrual Bleeding

Hapangama

Bulmer

2016

Womens Health (Lond Engl)

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Heavy menstrual bleeding (HMB) is a common gynecological complaint with multiple etiologies and diverse pathophysiological origins. This review discusses HMB with reference to the recently proposed PALM-COEIN classification system for abnormal uterine bleeding, initially describing the endometrial events in normal menstruation followed by discussion of the perturbations of normal endometrial shedding that can result in HMB. Our present understanding of the mechanisms of menstrual bleeding as well as many of the pathological aberrations of HMB is incomplete. Further research into the pathophysiology of HMB is urgently needed, as clear knowledge of the mechanisms of this disorder will provide new therapeutic targets to formulate more effective treatments. Keywords: endometrial cancer • endometrial hyperplasia • heavy menstrual bleeding • leiomyoma/fibroid • polycystic ovarian syndromeIn the developed world an average woman undergoes ∼400 repetitive cycles of monthly menstrual bleeding with shedding of her superficial endometrial functional layer. In as many as 20-30% of women, this bleeding is excessive and is termed heavy menstrual bleeding (HMB) [1]. Apart from the physical symptoms of anemia (fatigue, lethargy and exertional dyspnea), HMB can interfere with normal daily life and may affect the social and emotional well being of women, reducing their productivity in society. HMB commonly presents to primary and secondary healthcare providers, with over 1.5 million women suffering from this problem in England and Wales alone [1]. It is the fourth most common reason for secondary gynecological referrals and each year over 30,000 women in England and Wales undergo surgical treatment for HMB [1]. The annual cost to the National Health Service in 2000 was estimated to be over GB£65 million [2] and with the spiraling cost of healthcare provision, it is clear that the current cost of HMB to women, society and the National Health Service is huge.In this review HMB will be discussed with reference to the recently proposed polyps; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic and not yet classified (PALM-COEIN) classification system for abnormal uterine bleeding (AUB), approved by the International Federation of Gynecology and Obstetrics [3]. HMB can present as a chronic disorder of over 12 months duration or as an acute increase in bleeding over a short time period. The age at presentation can range from adolescence to the perimenopausal phase and HMB may occur in the context of either ovulatory or anovulatory cycles. This review will briefly describe the endometrial events in normal menstruation followed by discussion of the perturbations of normal endometrial shedding that can result in HMB. Normal menstruationThe purpose of menstruation is unknown but it is a phenomenon confined mainly to the upper order primates and humans [4], suggesting an associated evolutionary advan- tage. The morphology of human endometrium, relatively greater quantity of menstr...

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Section: Myometrial Dysfunctions (Adenomyosis and Leiomyoma) Leiomyomasmentioning

confidence: 99%

Pathophysiology of Heavy Menstrual Bleeding

Hapangama

Bulmer

2016

Womens Health (Lond Engl)

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“…Hysteroscopic myomectomy is the standard minimally invasive surgical procedure for treating submucous fibroids in women with symptoms who desire to retain fertility (10)(11)(12). Despite the lack of randomized controlled trials, the current evidence shows a significant improvement in selected patients as regards both the reproductive outcome and menorrhagia (7,13,14).…”

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confidence: 99%

Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question

Casadio¹,

Youssef²,

Spagnolo³

et al. 2011

Fertility and Sterility

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“…Abnormal uterine bleeding and pelvic pressure are the two most common symptoms leading women 7 . Frequently, these symptoms can lead to the development of iron-deficiency anemia 40 . Symptoms may be related to pressure exerted by the tumor on adjacent organs, such as the bladder, the ureters, or the bowel.…”

Section: Signs and Symptomsmentioning

confidence: 99%