Abnormal Uterine Bleeding
Özet
Abnormal Uterine Bleeding (AUB) refers to deviations in menstrual bleeding across quantity, frequency, and pattern, significantly impacting women's physical, psychological, and emotional quality of life. To streamline clinical terminology, the International Federation of Gynecology and Obstetrics (FIGO) established the PALM-COEIN classification system, which categorizes the etiologies of AUB in non-pregnant women of reproductive age into structural and non-structural causes. Structural causes include Polyps, Adenomyosis, Leiomyoma (myoma uteri), and Malignancy/hyperplasia, whereas non-structural causes comprise Coagulopathy, Ovulatory dysfunction, Endometrial causes, Iatrogenic factors, and those Not otherwise classified. While classical terms like menorrhagia and metrorrhagia were historically utilized, contemporary terminology prefers "severe menstrual bleeding" and "intermenstrual bleeding," removing the ambiguous diagnosis of dysfunctional uterine bleeding (DUB). Diagnostic evaluation encompasses a thorough clinical history, physical exams, and lab tests such as beta-hCG, CBC, and TSH. Imaging techniques like transvaginal ultrasonography (TVUSG) serve as initial non-invasive tools, supplemented by advanced methods like Saline Infusion Sonography (SIS), MRI, or hysteroscopy for focal intra-cavitary lesions. Management relies heavily on patient age, fertility desires, and bleeding severity, offering medical interventions (hormonal and non-hormonal agents like combined oral contraceptives or tranexamic acid) as primary treatments, while reserving surgical choices (endometrial ablation, myomectomy, or hysterectomy) for treatment-resistant cases.
Referanslar
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