Anormal Uterin Kanama ve Yönetimi
Özet
Anormal uterin kanama (AUK), kadınların yaşam kalitesini düşüren aşırı kan kaybı olup sıklığı, süresi ve miktarı yönünden menstrüel düzensizlikleri ifade eder. Reprodüktif çağdaki kadınların %30'unu etkileyen bu durum, FIGO tarafından PALM-COEIN akronimi ile yapısal (polip, adenomyozis, leiyomiyom, malignite) ve yapısal olmayan (koagülopati, ovulatuar disfonksiyon, endometrial, iatrojenik) nedenler olarak sınıflandırılmıştır. Tanıda tam kan sayımı, koagülasyon testleri, ultrasonografi ve salin infüzyon sonografisi gibi yöntemler kullanılırken, şüpheli durumlarda altın standart histeroskopidir. Tedavi yaklaşımı hastanın yaşına, doğurganlık beklentisine ve kanamanın akut veya kronik olmasına göre değişir. Akut ve kronik kanamalarda antifibrinolitikler (traneksamik asit), nonsteroid antiinflamatuar ilaçlar, kombine oral kontraseptifler ve progestinler gibi medikal ajanlar önceliklidir. Özellikle levonorgesterelli rahim içi araçlar kanama miktarını azaltmada yüksek etkinlik gösterir. Medikal tedaviye yanıt vermeyen, malignite şüphesi olan veya fertilite arzusu bulunmayan hastalarda ise endometrial ablasyon, uterin arter embolizasyonu, polip/miyom eksizyonu ve histerektomi gibi cerrahi prosedürler uygulanmaktadır. Prepubertal dönemden postmenopozal döneme kadar tüm yaş gruplarında jinekolojik başvuruların önemli bir kısmını oluşturan AUK yönetiminde, özellikle postmenopozal kanamalarda endometrial kalınlık takibi ve karsinom riskinin ekarte edilmesi kritik önem taşımaktadır.
Abnormal uterine bleeding (AUB) is an excessive blood loss that diminishes women's quality of life, characterized by menstrual irregularities in frequency, duration, and volume. Affecting 30% of reproductive-aged women, it is classified by FIGO under the PALM-COEIN acronym into structural (polyps, adenomyosis, leiomyoma, malignancy) and non-structural (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic) causes. Diagnosis involves complete blood count, coagulation tests, ultrasonography, and saline infusion sonography, while hysteroscopy remains the gold standard for suspected cases. Treatment approaches vary based on the patient's age, fertility desires, and whether the bleeding is acute or chronic. Medical agents such as antifibrinolytics (tranexamic acid), nonsteroidal anti-inflammatory drugs, combined oral contraceptives, and progestins are prioritized for managing acute and chronic bleeding. In particular, levonorgestrel-releasing intrauterine systems demonstrate high efficacy in reducing blood loss. Surgical procedures, including endometrial ablation, uterine artery embolization, polyp/myoma excision, and hysterectomy, are performed on patients who fail to respond to medical therapy, present malignancy suspicion, or have no desire for fertility. Comprising a significant portion of gynecological visits across all age groups from prepubertal to postmenopausal periods, the management of AUB requires careful monitoring of endometrial thickness and ruling out carcinoma risk, especially in postmenopausal bleeding.
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