[Management of abnormal uterine bleeding].

R Gaetje, A Scharl, M Kaufmann, A Ahr
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Abstract

Bleeding disorders are one of the most frequent gynecological problems. The causes of bleeding disorders, and their frequency in particular, vary depending on the age of the woman affected. In premenopause and perimenopause, the most frequent causes are hormonal, in up to 90 % of cases, as well as organic changes in the uterus such as myomas, adenomyosis uteri, or endometrial polyps, in up to 70 % of cases. Coagulation defects cause increased bleeding, particularly in girls and young women, with no other recognizable cause. The treatment of bleeding disorders is causally based, although if the woman does not wish to have children, the therapeutic algorithm in many cases leads to similar symptomatic measures. The following therapeutic approaches, listed in order of increasing efficacy, are mainly used in the treatment of increased bleeding: gestagen, estrogen-gestagen combination, levonorgestrel (Mirena) and endometrial ablation or myoma enucleation, with comparable success rates, and finally hysterectomy. Embolization of the uterine artery in myomas or adenomyosis uteri, nonsteroidal anti-inflammatory drugs, and antifibrinolytic agents represent alternatives that may be useful in individual cases. The paper provides an overview of the various causes, useful diagnostic measures, and treatment options in uterine bleeding disorders.

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子宫异常出血的处理。
出血性疾病是最常见的妇科问题之一。出血性疾病的原因,特别是其频率,因受影响妇女的年龄而异。在绝经前和围绝经期,最常见的原因是激素,高达90%的病例,以及子宫的器质性变化,如肌瘤、子宫腺肌病或子宫内膜息肉,高达70%的病例。凝血缺陷导致出血增加,特别是在女孩和年轻妇女中,没有其他可识别的原因。出血性疾病的治疗是基于因果关系的,尽管如果妇女不想生孩子,治疗算法在许多情况下会导致类似的症状措施。以下治疗方法主要用于治疗出血增多:孕激素、雌激素-孕激素联合、左炔诺孕酮(mrena)联合子宫内膜消融或肌瘤去核,成功率相当,最后是子宫切除术。子宫肌瘤或子宫腺肌病的子宫动脉栓塞、非甾体类抗炎药和抗纤溶药物可能是个别病例中有用的替代方案。本文提供了一个概述的各种原因,有用的诊断措施,并在子宫出血障碍的治疗方案。
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