Current treatment of dysfunctional uterine bleeding

Bongers, Marlies Y.; Mol, Ben Willem J.; Brölmann, Hans A.M.

doi:10.1016/j.maturitas.2003.08.002

Cited by 40 publications

(26 citation statements)

References 129 publications

(174 reference statements)

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“…Abnormal bleeding can also result from contraceptive methods. Many articles have reviewed the management of abnormal uterine bleeding, 3,6,7,15,16,18,21 and they often include management algorithms. Although clinical algorithms have potential shortcomings, 22,25 there are data to support their benefit to both physicians and patients.…”

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confidence: 99%

Abnormal Uterine Bleeding: A Management Algorithm

Ely

Kennedy

Clark

et al. 2006

The Journal of the American Board of Family Medicine

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Abnormal uterine bleeding is a common problem, and its management can be complex. Because of this complexity, concise guidelines have been difficult to develop. We constructed a concise but comprehensive algorithm for the management of abnormal uterine bleeding between menarche and menopause that was based on a systematic review of the literature as well as the actual management of patients seen in a gynecology clinic. We started by drafting an algorithm that was based on a MEDLINE search for relevant reviews and original research. We compared this algorithm to the actual care provided to a random sample of 100 women with abnormal bleeding who were seen in a university gynecology clinic. Discrepancies between the algorithm and actual care were discussed during audiotaped meetings among the 4 investigators (2 family physicians and 2 gynecologists). The audiotapes were used to revise the algorithm. After 3 iterations of this process (total of 300 patients), we agreed on a final algorithm that generally followed the practices we observed, while maintaining consistency with the evidence. In clinic, the gynecologists categorized the patient's bleeding pattern into 1 of 4 types: irregular bleeding, heavy but regular bleeding (menorrhagia), severe acute bleeding, and abnormal bleeding associated with a contraceptive method. Subsequent management involved both diagnostic and treatment interventions, which often occurred simultaneously. The algorithm in this article is designed to help primary care physicians manage abnormal uterine bleeding using strategies that are consistent with the evidence as well as the actual practice of gynecologists. Abnormal uterine bleeding is a common problem, 1 and its management can be complex.2,3 Physicians are often unable to identify the cause of abnormal bleeding after a thorough history and physical examination. 4,5 The management of abnormal bleeding can involve many decisions about diagnosis and treatment, 3,6,7 which often occur simultaneously and without the benefit of comprehensive, evidence-based guidelines. The available evidence tends to focus on narrow treatment questions rather than the broad clinical approach to management. 8,17 It is not difficult to find long lists of potential causes of abnormal bleeding, but primary care physicians need practical advice about how to approach this common problem. Abnormal uterine bleeding includes both dysfunctional uterine bleeding and bleeding from structural causes. Dysfunctional bleeding can be anovulatory, which is characterized by irregular unpredictable bleeding, or ovulatory, which is characterized by heavy but regular periods (ie, menorrhagia).2 Structural causes include fibroids, polyps, endometrial carcinoma, and pregnancy complications. Abnormal bleeding can also result from contraceptive methods. Many articles have reviewed the management of abnormal uterine bleeding, 3,6,7,15,16,18,21 and they often include management algorithms. Although clinical algorithms have potential shortcomings, 22,25 there are data to support their...

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confidence: 99%

Abnormal Uterine Bleeding: A Management Algorithm

Ely

Kennedy

Clark

et al. 2006

The Journal of the American Board of Family Medicine

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“…Evde tedavi edilecek olgulara 30-35 mcg etinil östradiol içerecek flekilde birkaç gün oral kontraseptif tedavi bafllan›r (1, [19][20][21][22][23]. fiiddetli anemisi olan ve klini¤i fliddetli olgular yat›r›larak tedavi edilmelidir.…”

Section: Tedaviunclassified

“…Sadece östrojen tedavisi verilmiflse kanama durdurulduktan sonra tedaviye progesteron preparatlar› eklenmeli ya da kombine oral kontraseptifler ile tedaviye devam edilmelidir. GnRH analoglar› da tedavide kullan›labilir (19)(20)(21)(22)(23). Uzam›fl oligomenoreli olgulara ise 6-8 haftada bir 5-10 mg/gün 10 gün medroksiprogesteron tedavisi verilebilir (20)(21).…”

Section: Tedaviunclassified

Disfonksiyonel kanama yönetimi

Dündar¹

2011

tpa

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D Di is sf fo on nk ks si iy yo on ne el l k ka an na am ma a y yö ön ne et ti im mi i M Ma an na ag ge em me en nt t o of f d di is sf fu un nc ct ti io on na al l u ut te er ri in ne e b bl le ee ed di in ng g 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 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. 2011; 46 Suppl: 103-6) (Turk Arch Ped

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“…Para establecer su origen es necesario en primera instancia excluir causas relacionadas con embarazo y neoplasias, para luego tratar de identificar patología orgánica que pueda beneficiarse de tratamientos conservadores. Cuando esto no es posible hablamos de metrorragia disfuncional e iniciamos tratamiento médico con alguna de las alternativas actualmente válidas: ácido tranexámi-co, antiinflamatorios no esferoidales (AINE), anticonceptivos orales (ACO), ó progestágenos cícli-cos o de depósito (1).…”

Section: Introductionunclassified

Uso Del Diu Con Levonorgestrel Como Alternativa a La Histerectomía en Pacientes Con Alto Riesgo Quirúrgico

et al. 2007

Rev. chil. obstet. ginecol.

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RESUMENPresentamos nuestra experiencia de 6 pacientes con metrorragia a repetición, portadoras de patologías médicas que representaban un riesgo desde el punto de vista anestésico y quirúrgico, en las cuales se insertó DIU-LNG como alternativa a la histerectomía. Todas evolucionan satisfactoriamente y sin complicaciones, con disminución significativa de las pérdidas hemáticas desde el tercer mes de uso, objetivadas por pictogramas. Se concluye que el DIU-LNG es un excelente método para el control de metrorragias en pacientes con patologías médicas relevantes. PALABRAS CLAVES: DIU-LNG, alto riesgo quirúrgico, menorragia SUMMARYWe present our experience with 6 patients with menorrhagia and medical conditions considered high risk patients for anaesthesia and surgical procedures. We inserted LNG-IUD as alternative to hysterectomy. Three months later, all of them reduced menstrual blood loss as it was shown by pictorial charts, without complications. LNG-IUD is an excellent alternative to hysterectomy in this group of patients.

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Current treatment of dysfunctional uterine bleeding

Cited by 40 publications

References 129 publications

Abnormal Uterine Bleeding: A Management Algorithm

Abnormal Uterine Bleeding: A Management Algorithm

Disfonksiyonel kanama yönetimi

Uso Del Diu Con Levonorgestrel Como Alternativa a La Histerectomía en Pacientes Con Alto Riesgo Quirúrgico

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