DOCSLIB.ORG

Nelson: Abnormal Uterine Bleeding: from Terminology to Treatment

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Nelson: Abnormal Uterine Bleeding: from Terminology to Treatment Nelson: Abnormal Uterine Bleeding: From Terminology to Treatment Abnormal Uterine Bleeding: Conflict of Interest Disclosure From Terminology to Treatment Anita L. Nelson, MD Grants/ Bayer, Merck, Pfizer, Teva Research Anita L. Nelson, MD Honoraria/ Harbor-UCLA Medical Center Bayer, Merck, Teva Speakers Bureau Consultant/ Agile, Bayer, Advisory Board Merck, Teva, Watson Contraceptive Technology Washington DC – April 17-20, 2013 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 2 Learning Objectives Normal Menstrual Cycle At the end of this presentation, the participants Interval: 24-38 days will be able to Duration: 4.5-8 days State the terminology used to describe abnormal uterine bleeding. Blood loss: 5-80 cc Describe the evaluation needed for women with chronic excessive bleeding. Develop a treatment plan for acute heavy bleeding and for chronic menstrual blood loss which reflects their individual desire for fertility. Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 3 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 4 New Terminology and Menstrual Bleeding Terminology Classification System for Clinical Dimensions Descriptive Normal Limits Abnormal Uterine Bleeding Terms (5th to 95th percentiles) New terms to replace older, imprecise terms Frequency of menses Frequent <24 Bleeding described in 4 dimensions: Normal 24-38 Infrequent >38 Frequency, duration, volume and variability Absent -- English words (heavy, prolonged, infrequent) Regularity of menses, Regular Variation ± 2-20 replace Greek and Latin terms (menorrhagia) cycle-to-cycle days variation over Irregular Variation > 20 Fraser IS, et al. Curr Opin Obstet Gynecol. 2007;19:591-5. 12 months days Woolcock JG, et al. Fertil Steril. 2008;90;2269-80. Fraser IS, et al. Semin Reprod Med. 2011;29:383-90. Fraser IS, et al. Fertil Steril. 2007;87(3):466-76. Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 5 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 6 1 Nelson: Abnormal Uterine Bleeding: From Terminology to Treatment Menstrual Bleeding Terminology PALM-COEIN Classification Clinical Dimensions Descriptive Normal Limits Terms (5th to 95th percentiles) Duration of flow Prolonged >8.0 Normal 4.5-8.0 Shortened <4.5 Volume of monthly Heavy >80 blood loss Normal 5-80 Light <5 Fraser IS, et al. Fertil Steril. 2007;87(3):466-76. Adapted from the Munro. Fertil Steril. 2011;95:2204. Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 7 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 8 PALM-COEIN PALM-COEIN Cases AUB-P Polyps AUB-A Adenomyosis AUB P0 A1 L1→sm M0 C0 O0 E0 I0 N0 AUB-L Leiomyoma SM/O (location) AUB P1 A0 L0 M0 C0 O0 E0 I1 N0 WHO/FIGO subclassification AUB-M Malignancy AUB P0 A0 L1→0 M1 C0 O1 E0 I0 N0 AUB-C Coagulopathy AUB P0 A1 L1→sm M0 C1 O0 E0 I0 N0 AUB-O Ovulatory dysfunction AUB-E Endometrial causes AUB-I Iatrogenic AUB-N Not yet classified Garza-Cavazos A, et al. Female Patient. 2012;37(8):27-36. Garza-Cavazos A, et al. Female Patient. 2012;37(8):27-36. Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 9 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 10 Coding for AUB Coding for AUB 626 Disorders of menstruation and other 626.4 Irregular menstrual cycle, irregular abnormal bleeding from female bleeding, irregular menstruation, genital tract irregular periods 626.0 Amenorrhea (primary)(secondary) 626.5 Ovulation bleeding, regular 626.1 Scanty of infrequent menstruation, intermenstrual bleeding hypomenorrhea, oligomenorrhea 626.6 Metrorrhagia, bleeding unrelated to 626.2 Excessive or frequent menstruation, menstrual cycle, irregular heavy periods, menorrhagia, intermenstrual bleeding menometrorrhagia, polymenorrhea 626.8 Dysfunctional or functional uterine hemorrhage Graza-Cavazos A, et al. Female Patient. 2012;37:27-36. Graza-Cavazos A, et al. Female Patient. 2012;37:27-36. Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 11 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 12 2 Nelson: Abnormal Uterine Bleeding: From Terminology to Treatment Secondary Amenorrhea Secondary Amenorrhea Special Issues Amenorrhea in a reproductive woman Estrogen status determines concerns ≥ 3-6 months in a previously normally Estrogen deficiency osteoporosis, menstruating woman menopausal issues OR Estrogen unopposed endometrial < 9 months or 2 times usual interval carcinoma ASRM. Fertil Steril. 2006;86(5 Suppl):S148-55 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 13 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 14 Common Causes of Chronic Diseases Secondary Amenorrhea Causing Amenorrhea Category Frequency Low or normal FSH: weight loss/anorexia; 66% Uncontrolled Hepatic failure non-specific hypothalamic; chronic anovulation juvenile diabetes Adrenal insufficiency including PCOS; hypothyroidism; Cushing’s syndrome; pituitary tumor, empty sella, End-stage renal Cushing’s syndrome Sheehan syndrome disease Gonadal failure: high FSH 12% Sarcoidosis AIDS 46 XX; abnormal karyotype Acromegaly High prolactin 23% Malabsorption Anatomic: Asherman syndrome 7% Craniopharyngiomas Malignancy Hyperandrogenic states: 2% Thyroid dysfunction ovarian tumor; non-classic CAH; undiagnosed Androgen excess Obesity ASRM. Fertil Steril. 2006;86(5 Suppl):S148-55 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 15 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 16 Medications Causing Amenorrhea Secondary Amenorrhea Differential Diagnosis DMPA, LNG IUS, extended-cycle OCs Pregnancy Chemotherapeutic agents Anesthetics, including cocaine Endocrine disorder Psychoactive drugs: phenothiazines, tricyclic Thyroid dysfunction: TRH increases PRO antidepressants, opiates, chlordiazepoxide, amphetamines, diazepams, haloperidol, fluphenazine, Diabetes mellitus: slowed clearance of chlorpromazine, SSRIs estrogen Antihypertensives: α-methyldopa, reserpine, verapamil Androgen excess: adrenal or ovarian origin Dopamine receptor agonists: metoclopramide Obesity: excess estrogen Antiemetics: sulpiride, promazine, perphenazine Others: cimetidine, cyproheptadine, protease inhibitors Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 17 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 18 3 Nelson: Abnormal Uterine Bleeding: From Terminology to Treatment Menstrual Cycle Workup of Secondary Amenorrhea History: recent surgical procedures, weight changes, medications, other health problems, radiation therapy, chemotherapy Family history: autosomal disorders associated with ovarian failure, endocrinopathy Physical exam: galactorrhea, obstruction, hirsutism, virilization, acromegaly Lab tests: pregnancy test, FSH, TSH, prolactin Other tests if indicated: androgens ASRM. Fertil Steril. 2006;86(5 Suppl):S148-55 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 19 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 20 A Treatment Course of Progestin Progestin Challenge Test Limitations High false positive rate: no withdrawal bleed Up to 20% of women with estrogen have no withdrawal bleeding Androgen excess states common High false negative rate: withdrawal bleeding Up to 40% of women with amenorrhea from Stress, weight loss, exercise or hyperprolactinemia Up to 50% of women with amenorrhea from ovarian failure ASRM. Fertil Steril. 2006;86(5 Suppl):S148-55 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 21 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 22 Ovary Evaluation Work-up of Secondary Amenorrhea Ovary Evaluation High FSH = If FSH and LH elevated and E2 low, consider probable ovarian ovarian failure or (rarely) insensitive ovary failure syndrome Low FSH = pituitary Repeat tests to confirm if early menopause is or hypothalamic suspected etiology Perform karyotype if patient < 30 Rule out autoimmune disease if patient < 35 Common sites affected include thyroid, adrenal, parathyroid, pancreas Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 23 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 24 4 Nelson: Abnormal Uterine Bleeding: From Terminology to Treatment Work-up of Secondary Amenorrhea High Prolactin If gonadotrophins level or low (FSH and LH <5 IU/L) and no response to progestin Persistent hyperprolactinemia without challenge, evaluate pituitary and hypothalamus primary hypothyroidism or medication, evaluate with MRI of pituitary If androgen elevated or high normal If levels in tumor range, order radiographic Pituitary tumor found in 50-60% studies to localize tumor Other CNS lesions High normal testosterone consistent with PCOS or medications Congenital aqueductal stenosis Elevated DHEAS, consider adrenal Adenomas- ACTH, GH hyperfunction Empty sella syndrome Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 25 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 26 CAT Scan or MRI Hypothalamic Amenorrhea Hypothalamic amenorrhea is a diagnosis of Tumor involving exclusion with the pituitary Low-normal gonadotrophins gland Normal PRO Normal imaging of pituitary No withdrawal bleeding Most common cause of amenorrhea, often associated with stress, eating disorders, weight loss?, diabetes?? 72% of women had spontaneous return of menses within 6 years Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 27 Anita L. Nelson, MD HMB 2013- 04-17 CT WDC 28 Secondary Amenorrhea Secondary Amenorrhea Athletic Triad Treatments: Target the Cause Long-Term Consequences Correct thyroid or prolactin dysfunctions Reduced bone mass: particularly harmful in Provide progestin protection for endometrium young adolescents, who should be until normalizes accumulating bone mineralization Estrogen deficient conditions Lipid changes: amenorrheic athletes Provide estrogen and progestin demonstrate increased potential for lipid Unopposed estrogen conditions peroxidation after exercise Provide progestin
Load more

Recommended publications
  • Prevalence of Menstrual Irregularities in Correlation with Body Fat Among Students of Selected Colleges in a District of Tamil Nadu, India
    National Journal of Physiology, Pharmacy and Pharmacology RESEARCH ARTICLE Prevalence of menstrual irregularities in correlation with body fat among students of selected colleges in a district of Tamil Nadu, India Sherly Deborah G1, Siva Priya D V2, Rama Swamy C2 1Department of Physiology, Faculty of Medicine, AIMST University, Bedong, Kedah, Malaysia, 2Department of Physiology, Saveetha Medical College, Chennai, Tamil Nadu, India Correspondence to: Sherly Deborah G, E-mail: [email protected] Received: March 05, 2017; Accepted: March 22, 2017 ABSTRACT Background: Menstrual irregularities are usually due to imbalance of hormones. Although menstrual irregularities may be normal during the early postmenarchal years, pathological conditions require proper and prompt management. Obesity associated with many health consequences including hormonal imbalance has a direct effect on menstrual cycle. Hence, attention to obesity is obligatory for the inclusion of diagnosis and treatment of menstrual complaints which has become a leading issue in women’s life. Aims and Objectives: The aims and objectives of the study are to assess the menstrual irregularities and to find the association between menstrual irregularities and body fat among students. Materials and Methods: A cross-sectional study was conducted in three selected colleges in a district of Tamil Nadu in India. A total of 399 samples were included in the study. A 10-item questionnaire was administered to assess the menstrual irregularity in each student. The demographic variables along with anthropometric measurements were collected. Anthropometric measurements were taken to calculate the body fat percentage using modified YMCA formula. Results: The prevalence of menstrual irregularities was high in obesity compared with those with normal body fat and particularly oligomenorrhea, amenorrhea, and hypomenorrhea had statistically significant increase in obese students.
    [Show full text]
  • (IJCRI) Abdominal Menstruation
    www.edoriumjournals.com CASE SERIES PEER REVIEWED | OPEN ACCESS Abdominal menstruation: A dilemma for the gynecologist Seema Singhal, Sunesh Kumar, Yamini Kansal, Deepika Gupta, Mohit Joshi ABSTRACT Introduction: Menstrual fistulae are rare. They have been reported after pelvic inflammatory disease, pelvic radiation therapy, trauma, pelvic surgery, endometriosis, tuberculosis, gossypiboma, Crohn’s disease, sepsis, migration of intrauterine contraceptive device and other pelvic pathologies. We report two rare cases of menstrual fistula. Case Series: Case 1: A 27- year-old nulliparous female presented with complaint of cyclical bleeding from the abdomen since three years. There was previous history of hypomenorrhea and cyclical abdominal pain since menarche. There is history of laparotomy five years back and laparoscopy four years back in view of pelvic mass. Soon after she began to have blood mixed discharge from scar site which coincided with her menstruation. She was diagnosed to have a vertical fusion defect with communicating left hypoplastic horn and non-communicating right horn on imaging. Laparotomy with excision of fistula and removal of right hematosalpinx was done. Case 2: 25-year-old female presented with history of lower segment caesarean section (LSCS) and burst abdomen, underwent laparotomy and loop ileostomy. Thereafter patient developed cyclical bleeding from scar site. Laparotomy with excision of fistulous tract and closure of uterine rent was done. Conclusion: Clinical suspicion and imaging help to clinch the diagnosis. There is no recommended treatment modality. Surgery is the mainstay of management. Complete excision of fistulous tract is mandatory for good long-term outcomes. International Journal of Case Reports and Images (IJCRI) International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.
    [Show full text]
  • Exploring Typical Menstruation, Menstrual Pain
    Thesis submitted for a Master of Nursing (Research) The University of Canberra December, 2006 The MDOT Study: Prevalence of Menstrual Disorder of Teenagers; exploring typical menstruation, menstrual pain (dysmenorrhoea), symptoms, PMS and endometriosis Melissa A Parker Supervisors: Dr Anne Sneddon Dr Jan Taylor Chair of Supervisory Panel: Adjunct Professor Paul Arbon Abstract There are few data available about the menstrual patterns of Australian teenagers and the prevalence of menstrual disorder in this age group. Aims To establish the typical experience of menstruation in a sample of 16-18 year old women attending ACT Secondary Colleges of Education. To determine the number of teenagers experiencing menstrual disorder that could require further investigation and management. Method The MDOT questionnaire was used to survey participants about their usual pattern of menstruation, signs and symptoms experienced with menses and how menstruation affected various aspects of their lives including school attendance, completion of school work, relationships, social, sexual and physical activity. Data analysis included exploration of aggregated data, as well as individual scrutiny of each questionnaire to determine menstrual disturbance requiring follow up. Those participants whose questionnaire indicated a requirement for further investigation, and who consented to being contacted, were followed up through an MDOT Clinic. Results One thousand and fifty one (1,05 1) completed questionnaires - 98% response rate. The typical experience of menstruation in the MDOT sample includes: bleeding patterns within normal parameters for this age group; menstrual pain, 94%; cramping pain, 71 %; symptoms associated with menstruation, 98.4%; PMS symptoms, 96%; mood disturbance before or during periods, 73%; school absence related to menstruation, 26%; high menstrual interference on one or more life activity, 55.8%; asymptomatic menstruation, 1%; True response to 'My periods seem pretty normal' 7 1.4%.
    [Show full text]
  • Vaginitis and Abnormal Vaginal Bleeding
    UCSF Family Medicine Board Review 2013 Vaginitis and Abnormal • There are no relevant financial relationships with any commercial Vaginal Bleeding interests to disclose Michael Policar, MD, MPH Professor of Ob, Gyn, and Repro Sciences UCSF School of Medicine [email protected] Vulvovaginal Symptoms: CDC 2010: Trichomoniasis Differential Diagnosis Screening and Testing Category Condition • Screening indications – Infections Vaginal trichomoniasis (VT) HIV positive women: annually – Bacterial vaginosis (BV) Consider if “at risk”: new/multiple sex partners, history of STI, inconsistent condom use, sex work, IDU Vulvovaginal candidiasis (VVC) • Newer assays Skin Conditions Fungal vulvitis (candida, tinea) – Rapid antigen test: sensitivity, specificity vs. wet mount Contact dermatitis (irritant, allergic) – Aptima TMA T. vaginalis Analyte Specific Reagent (ASR) Vulvar dermatoses (LS, LP, LSC) • Other testing situations – Vulvar intraepithelial neoplasia (VIN) Suspect trich but NaCl slide neg culture or newer assays – Psychogenic Physiologic, psychogenic Pap with trich confirm if low risk • Consider retesting 3 months after treatment Trichomoniasis: Laboratory Tests CDC 2010: Vaginal Trichomoniasis Treatment Test Sensitivity Specificity Cost Comment Aptima TMA +4 (98%) +3 (98%) $$$ NAAT (like GC/Ct) • Recommended regimen Culture +3 (83%) +4 (100%) $$$ Not in most labs – Metronidazole 2 grams PO single dose Point of care – Tinidazole 2 grams PO single dose •Affirm VP III +3 +4 $$$ DNA probe • Alternative regimen (preferred for HIV infected
    [Show full text]
  • Quality Standards
    Quality Standards Indicator Technical Specifications for the Quality Standard Heavy Menstrual Bleeding: Care for Adults and Adolescents of Reproductive Age Technical Appendix July 25, 2017 Table of Contents OUTCOME INDICATORS FOR MEASURING SUCCESS ............................................................................ 3 Outcome Indicators........................................................................................................................................ 4 Table 1: Percentage of patients with heavy menstrual bleeding who reported that they are satisfied with symptom control ........................................................................................................................................ 4 Table 2: Percentage of patients with heavy menstrual bleeding who reported involvement in their care and treatment ............................................................................................................................................ 6 Table 3: Rate of unplanned visits to emergency department for heavy menstrual bleeding ...................... 8 Table 4: Rate of regional variation in hysterectomies among patients with heavy menstrual bleeding ... 10 Quality Standards Heavy Menstrual Bleeding: Care for Adults and Adolescents of Reproductive Age—Technical Appendix 2 This technical appendix is intended to accompany Health Quality Ontario’s Quality Standard Heavy Menstrual Bleeding. Early in development of each quality standard, a few health outcomes are chosen as the most important measures
    [Show full text]
  • Association Between Menstrual Disorders and Obesity
    ArchiveInt J School of Health SID. 2018 April; 5(2):e65716. doi: 10.5812/intjsh.65716. Published online 2018 April 17. Research Article Association Between Menstrual Disorders and Obesity-Related Anthropometric Indices in Female High School Students: A Cross-Sectional Study Mostafa Rad,1 Marzieh Torkmannejad Sabzevary,2 and Zahra Mohebbi Dehnavi3,* 1Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, IR Iran 2Mobini Hospital, Sabzevar University of Medical Sciences, Sabzevar, IR Iran 3Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran *Corresponding author: Zahra Mohebbi Dehnavi, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-9139752086, E-mail: [email protected] Received 2018 January 02; Revised 2018 April 11; Accepted 2018 April 13. Abstract Background: The menstrual cycle determines the health of women. Menstrual disorders are a major Geneologic problem among women, especially adolescents, which is a major source of anxiety for them and their families. Factors such as BMI, exercise, and stress can be related to menstrual disorders. As a result, this study was conducted to determine the association between menstrual disorders and anthropometric indices in Female High School Students. Methods: This descriptive cross-sectional study was conducted in Sabzevar on 200 high school female students in 2017. The partici- pants first completed the personal, midwifery,
    [Show full text]
  • Impact of Anemia on Menstruation and Academic Performance of Adolescent Girls Attending Secondary Schools of Rural Wardha District 1Rufina Binoy,2 Neema Acharya
    WJOA Impact of Anemia on Menstruation and Academic10.5005/jp-journals-10065-0001 Performance of Adolescent Girls ORIGINAL ARTICLE Impact of Anemia on Menstruation and Academic Performance of Adolescent Girls attending Secondary Schools of Rural Wardha District 1Rufina Binoy,2 Neema Acharya 3 ABSTRACT adolescents, and women of childbearing age group. Anemia is a common nutritional problem in adolescents.4 In this research, we hope to understand the Introduction: Very few studies focus on adolescent girls’ health, in view effect of anemia on the various menstrual parameters and disorders and on the academic performance of adolescent of that the present study was taken up to throw light on girls attending secondary schools of rural Wardha. the prevalence of anemia in the rural district of Wardha Materials and methods: Questionnaires were prepared and and to assess the effect of the same on their menstrual distributed to the female students who came to attend the health and academic performance. adolescent clinic in Acharya Vinoba Bhave Rural Hospital, Sawangi, India, for health checkup. Their hemoglobin was estimated and recorded in their respective questionnaires. MATERIALS AND METHODS Questionnaires were designed to understand in the best way possible the effects of anemia on the menstrual health and • Site: The research was conducted in Acharya Vinoba academic life of the adolescent girls. Bhave Rural Hospital (AVBRH), Sawangi, Wardha, Results: The results revealed a remarkable correlation India. between the grades of anemia and poor menstrual health; a • Type of study: Questionnaire-based study similar result was seen in case of academic performance as • Duration: 6 months well.
    [Show full text]
  • Menstrual Disorders Among Nursing Students at Al Neelain University
    Sudan Journal of Medical Sciences Volume 15, Issue no. 2, DOI 10.18502/sjms.v15i2.7067 Production and Hosting by Knowledge E Research Article Menstrual Disorders Among Nursing Students at Al Neelain University, Khartoum State Aisha Mohammed Adam1, Hammad Ali Fadlalmola2, and Huda Khalafala Mosaad3 1Department of Obstetrics and Gynecological Nursing, Faculty of Nursing Sciences, Al Neelain University, Sudan 2Department of Community Health Nursing, Nursing College, Taibah University, Saudi Arabia 3Faculty of Applied Medical Sciences, Department Nursing, Hafar Albatin University, Saudi Arabia Abstract Background: Menstrual disorders can severely affect the daily life of young females, particularly the student population, which generates a massive tension that extends to families, but they seldom affect the quality and standard of life. Corresponding Author: Objectives: The aim of this study was to determine the morbidity nature of menstrual Dr. Hammad Ali Fadlelmola; disorders among nursing students and their effect on students’ life activities. Nursing College, Taibah Methods: This study was a descriptive cross-sectional institutional-based study University, Saudi Arabia conducted at the Al Neelain University, Faculty of Nursing. Of the 200 students email: [email protected] recruited, 149 completed the questionnaire with the responding rate of (74.5%). Data were collected using a self-administered structured questionnaire. Received 12 March 2020 Results: Of the 149 participants, most were young and in the age range of 18–24 years Accepted 7 June 2020 with a mean age of 21 years. Most students (74%) started their menarche at a normal age Published 30 June 2020 range of 12–15 years. A relatively high dysmenorrhea (94.0 %) was observed among Production and Hosting by the participants.
    [Show full text]
  • Epidemiology of Menstrual Disorders in Developing Countries: a Systematic Review
    BJOG: an International Journal of Obstetrics and Gynaecology DOI: 10.1046/j.1471-0528.2003.00012.x January 2004, Vol. 111, pp. 6–16 REVIEW Epidemiology of menstrual disorders in developing countries: a systematic review Introduction Information on the prevalence of menstrual complaints in the past three months was obtained in seven countries In developing countries, priority setting in the health (Table 1). These data permit cross national comparisons sector traditionally focuses on the principal causes of mor- in so far as similar questions with a similar time reference tality. More recently, the Global Burden of Disease approach were asked. However, no definitions were provided and incorporates assessment of morbidity and quality of life in considerable variation in the interpretation of questions identifying priorities. Yet, although investigations in various among individuals and across cultures is likely. developing countries reveal that women are concerned by Approximately a dozen subsequent surveys, including menstrual disorders, little attention is paid to understanding community-based, clinic-based and one national census, or ameliorating women’s menstrual complaints.1 Menstrual include some information on menstrual morbidities6–29 dysfunction, like other aspects of sexual and reproductive (Table 2). A few health surveys of special populations, health, is not included in the Global Burden of Disease such as factory workers in Vietnam17 and medical students estimates2,3 and, even as reproductive health programs in Venezuela,27,28 have also included relevant questions expand their focus to address gynaecologic morbidity, the on menstrual disorders. These surveys vary consider- utility of evaluating and treating menstrual problems is ably in the definition of and reference period for men- not generally considered.
    [Show full text]
  • Changes Before the Change1.06 MB
    Changes before the Change Perimenopausal bleeding Although some women may abruptly stop having periods leading up to the menopause, many will notice changes in patterns and irregular bleeding. Whilst this can be a natural phase in your life, it may be important to see your healthcare professional to rule out other health conditions if other worrying symptoms occur. For further information visit www.imsociety.org International Menopause Society, PO Box 751, Cornwall TR2 4WD Tel: +44 01726 884 221 Email: [email protected] Changes before the Change Perimenopausal bleeding What is menopause? Strictly defined, menopause is the last menstrual period. It defines the end of a woman’s reproductive years as her ovaries run out of eggs. Now the cells in the ovary are producing less and less hormones and menstruation eventually stops. What is perimenopause? On average, the perimenopause can last one to four years. It is the period of time preceding and just after the menopause itself. In industrialized countries, the median age of onset of the perimenopause is 47.5 years. However, this is highly variable. It is important to note that menopause itself occurs on average at age 51 and can occur between ages 45 to 55. Actually the time to one’s last menstrual period is defined as the perimenopausal transition. Often the transition can even last longer, five to seven years. What hormonal changes occur during the perimenopause? When a woman cycles, she produces two major hormones, Estrogen and Progesterone. Both of these hormones come from the cells surrounding the eggs. Estrogen is needed for the uterine lining to grow and Progesterone is produced when the egg is released at ovulation.
    [Show full text]
  • Abnormal Uterine Bleeding: a Management Algorithm
    J Am Board Fam Med: first published as 10.3122/jabfm.19.6.590 on 7 November 2006. Downloaded from EVIDENCED-BASED CLINICAL MEDICINE Abnormal Uterine Bleeding: A Management Algorithm John W. Ely, MD, MSPH, Colleen M. Kennedy, MD, MS, Elizabeth C. Clark, MD, MPH, and Noelle C. Bowdler, MD 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 comprehen- sive 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 rel- evant reviews and original research. We compared this algorithm to the actual care provided to a ran- dom 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 interven- tions, which often occurred simultaneously.
    [Show full text]
  • Dell Childrens Hospital
    DELL CHILDREN’S MEDICAL CENTER EVIDENCE-BASED OUTCOMES CENTER Abnormal Uterine Bleeding Heavy Menstrual Bleeding in Adolescents LEGAL DISCLAIMER: The information provided by Dell Children’s Medical Center of Texas (DCMCT), including but not limited to Clinical Pathways and Guidelines, protocols and outcome data, (collectively the "Information") is presented for the purpose of educating patients and providers on various medical treatment and management. The Information should not be relied upon as complete or accurate; nor should it be relied on to suggest a course of treatment for a particular patient. The Clinical Pathways and Guidelines are intended to assist physicians and other health care providers in clinical decision-making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. These guidelines should not be considered inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment regarding care of a particular patient must be made by the physician in light of the individual circumstances presented by the patient. DCMCT shall not be liable for direct, indirect, special, incidental or consequential damages related to the user's decision to use this information contained herein. Definition: sexually active, including consensual and coerced sex7. An acute episode of heavy menstrual bleeding is one that, in Specific questions should be asked to determine possibility of the opinion of the clinician, is of sufficient quantity to require bleeding/coagulation disorder (see Table 2 in Addendum 1). immediate intervention to prevent future blood loss1.
    [Show full text]