Kadın Genital Sisteminde Anormal Kanamalar
Özet
Kadın genital sistemindeki anormal kanamalar yaş gruplarına göre prepubertal, adölesan, reprodüktif ve postmenapozal dönem olmak üzere dört ana başlıkta incelenmektedir. Prepubertal dönemdeki kanamalar menarş öncesi gerçekleştiklerinden her zaman anormal kabul edilir; en sık künt travmalar, yabancı cisimler ve enfeksiyonlar gibi benign nedenlerden kaynaklansa da malignite riski ve cinsel istismar şüphesi mutlaka dışlanmalıdır. Adölesan dönemdeki anormal kanamaların birincil nedeni hipotalamo-hipofizer-ovaryan aksın immatüritesine bağlı gelişen anovülasyondur; ayrıca hematolojik bozukluklar ve kontraseptif kullanımları da bu grupta etkili faktörler arasındadır. Reprodüktif dönem kanamaları ise PALM-COEIN sınıflama sistemine göre yapısal (polip, adenomyozis, leiomyom, malignite) ve yapısal olmayan (koagülopati, ovülatuar disfonksiyon, endometriyal, iyatrojenik) nedenler olarak dokuz kategoride değerlendirilir. Postmenapozal dönemde görülen her türlü kanama ise doğrudan anormal kabul edilir; çoğunlukla polipler ve endometriyal atrofi gibi benign durumlardan kaynaklansa da bu yaş grubunda yaşla birlikte riski artan endometriyal karsinomun ana belirtisi olduğundan jinekolojik onkoloji açısından ileri tetkik ve dışlama gerektirir. Tüm dönemlerde yönetim hastanın hemodinamik stabilitesine ve altta yatan etiyolojiye göre şekillenir.
Abnormal bleeding in the female genital system is examined across four main age groups: prepubertal, adolescent, reproductive, and postmenopausal periods. Bleeding in the prepubertal period is always considered abnormal as it occurs before menarche; although mostly caused by benign reasons such as blunt trauma, foreign bodies, and infections, malignancy risks and suspicion of sexual abuse must absolutely be ruled out. The primary cause of abnormal bleeding in the adolescent period is anovulation due to the immaturity of the hypothalamo-pituitary-ovarian axis, while hematological disorders and contraceptive use are also influential factors. Reproductive period bleeding is evaluated under nine categories according to the PALM-COEIN classification system as structural (polyp, adenomyosis, leiomyoma, malignancy) and non-structural (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic) causes. Any bleeding observed in the postmenopausal period is directly deemed abnormal; though it mostly stems from benign conditions like polyps and endometrial atrophy, it requires further investigation and exclusion in terms of gynecological oncology since it is the primary symptom of endometrial carcinoma, the risk of which increases with age. Across all periods, management is shaped according to the hemodynamic stability of the patient and the underlying etiology.
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