ABSTRACT
ABSTRACT BACKGROUND: Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES: To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING: Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS: MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life - abbreviated version (WHOQOL-BREF) were applied. RESULTS: Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION: The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.
ABSTRACT
Background: Abnormal uterine bleeding (AUB) or menstrual bleeding of abnormal amount, duration, or schedule is a common gynecological condition occurring in up to 50% of women of all age groups. Chronic, heavy, prolonged, or irregular uterine bleeding can lead to anemia, and raise a concern about severe underlying malignancy. Therefore, histopathological examination of the endometrium is critical in evaluating the cause of AUB. Aims and Objectives: The aims of this study were to study the various histomorphological patterns in endometrial biopsies in cases of AUB. Materials and Methods: This is a retrospective study done on 212 endometrial tissues in women presenting with AUB. The study is aimed at analyzing the histopathological changes occurring in the endometrium by identifying the cause of bleeding and recording the incidence of various histopathological findings in different age groups. Results: Proliferative endometrium, the most common histopathological finding, accounted for 51.9% of cases, followed by secretory endometrium (24.5%). Eight cases of disordered proliferative endometrium were found in the present study. Eight cases, accounting for 3.8% of endometrial hyperplasia, were associated with AUB, out of which two cases were found to be complex hyperplasia with atypia. Endometrial carcinoma was seen in two cases associated with AUB. Pregnancy-related changes were found in 7 (3.3%) cases, retained product of conception was the leading cause of bleeding (3 cases). Conclusion: Histopathological evaluation of endometrium in women presenting with AUB is of paramount importance not only to diagnose various benign conditions but also to detect some highly malignant lesions and precancerous conditions so that early interventions can be started.
ABSTRACT
Background: Menstrual disorders are a common clinical problem due to multiple causes. Hyperprolactinemia, is disorders of hypothalamic-pituitary axis in young women, is usually associated with amenorrhea, oligomenorrhea, anovulation, and ovulatory cycles with short or inadequate luteal phase, and galactorrhoea. Menstrual disorder affects physical and mental health of every woman. Aims and Objectives: The aim of the study was to know hyperprolactinemia among the patients of menstrual disorders in a tertiary care hospital. Materials and Methods: Women with menstrual irregularities attending Gynae outpatient department and admitted initially checked clinically and their serum prolactin level were measured. Women in reproductive age group (15–45 years) with complain of abnormal uterine bleeding were included in the study. Menopausal women, women with organic diseases in uterus and cervix, and pregnant women were excluded from the study. Results: Prolactin level is statistically significant with age (P = 0.011). The patients from age group of 20 to 35 years had high proportion (14.4%) of hyperprolactinemia followed by age group <20 years. (12.9%) and >35 years (12.9%). The women presenting with menstrual disorders enlisted in the study were evaluated on the basis of their sociodemographic parameters. About (15.5%) were below 20 years. About (27%) were above 35 years and majority of the women (57.5%) enrolled in the study were from age group of 2035 years of age. Serum prolactin level was observed in 15.4% in patients with frequent menses, 9.1% in patients with metrorrhagia and 7.7% in patients with heavy menstrual bleeding. That result was statistically significant with P = 0.039. Conclusion: Serum prolactin level should be evaluated in every patient of menstrual disorders.
ABSTRACT
Resumen ANTECEDENTES: Los leiomiomas son neoplasias benignas comunes durante la edad reproductiva. Su aparición en adolescentes es excepcional y un reto diagnóstico en menores de 18 años de edad. El caso aquí reportado se integra a los 26 casos asentados en la bibliografía y se trata del tumor más grande en la paciente más joven hasta ahora comunicado. CASO CLÍNICO: Paciente de 14 años, con inicio de sangrado uterino anormal, aumento del perímetro abdominal y tres semanas con hipermenorrea. El reporte inicial de la química sanguínea informó: anemia severa y el ultrasonido pélvico: un gran tumor anexial sólido. Luego de mejorar las condiciones hemodinámicas de la paciente por medio de transfusiones de concentrados eritrocitarios se practicó una laparotomía exploradora y se extirpó un leiomioma gigante, dependiente del útero. El informe histopatológico fue de: leiomioma de 16 cm de diámetro, con degeneración roja. La paciente cursó sin complicaciones posquirúrgicas y hasta la actualidad no ha experimentado datos de recurrencia ni sangrado uterino anormal. CONCLUSIÓN: La fisiopatología de la miomatosis uterina sigue aún sin comprenderse del todo. El tratamiento quirúrgico a una edad temprana debe tomar en consideración el deseo de embarazo y llevar a cabo un seguimiento estrecho para valorar: la fertilidad, recurrencia, atipia celular y trastornos menstruales.
Abstract BACKGROUND: Leiomyomas are common benign neoplasms during reproductive age. Its appearance in adolescents is exceptional and a diagnostic challenge in children under 18 years of age. The case reported here is one of the 26 cases reported in the bibliography and it is the largest tumor reported in the youngest patient to date. CLINICAL CASE: A 14-year-old patient with onset of abnormal uterine bleeding, increased abdominal circumference and three weeks with hypermenorrhea. Initial blood chemistry report: severe anemia and pelvic ultrasound: a large solid adnexal tumor. After improving the patient's hemodynamic conditions through transfusions of erythrocyte concentrates, an exploratory laparotomy was performed and a giant leiomyoma, dependent on the uterus, was removed. The histopathological report was: leiomyoma of 16 cm in diameter, with red degeneration. The patient had no postoperative complications and to date she has not experienced recurrence or abnormal uterine bleeding. CONCLUSION: The pathophysiology of uterine fibroids remains poorly understood. Surgical treatment at an early age should take into account the desire for pregnancy and carry out a close follow-up to assess: fertility, recurrence, cellular atypia and menstrual disorders.
ABSTRACT
ObjectiveTo perform a predictive analysis of the quality marker（Q-Marker） for the anticoagulant activity of Kunning granules. MethodThe chemical components of Kunning granules were analyzed by ultra high performance liquid chromatography-quadrupole-time of flight tandem mass spectrometry（UHPLC-Q-TOF-MS/MS） on a Waters ACQUITY UPLC HSS T3 column（2.1 mm×100 mm， 1.8 μm） with the mobile phase of acetonitrile（A）-25 mmol∙L-1 ammonium acetate aqueous solution（B） for gradient elution （0-5 min， 5%-22%A； 5-10 min， 22%-30%A； 10-15 min， 30%-95%A； 15-20 min， 95%-5%A； 20-30 min， 5%A）， flow rate of 0.2 mL∙min-1， column temperature at 30 ℃， injection volume of 1 μL， electrospray ionization（ESI）， positive and negative ion detection modes. Interaction analysis between the targets of chemical components and the targets of abnormal uterine bleeding（AUB） was performed by network pharmacology， and the key components were screened through network topology analysis. The fingerprints of 10 batches of Kunning granules were established by high performance liquid chromatography（HPLC）， the anticoagulant activity of the granules was determined by blood coagulation method and fibrinogen plate method， and the spectrum-effective relationship was established. The components co-occurring in the topological analysis and spectrum-effective relationship were selected as Q-Markers， and their anticoagulant activities were verified and confirmed. ResultA total of 475 chemical components were identified from Kunning Granule， of which 22 key components such as salvianolic acid B， paeoniflorin， naringin and neohesperidin， were the potential material basis for the treatment of AUB. The spectrum-effective analysis showed that peaks 7（paeoniflorin）， 9（naringin）， 10（neohesperidin） and 11（salvianolic acid B） were the optimal principal components， and in vitro activity test showed that these four components could better characterize their anticoagulant activity. ConclusionSalvianolic acid B， paeoniflorin， neohesperidin and naringin may be Q-Markers for the anticoagulant activity of Kunning granules.
ABSTRACT
Objective@#To determine the prevalence of the causes of abnormal uterine bleeding based on the FIGO (PALM-COEIN) Classification, among patients admitted at a tertiary hospital in Las Pinas City@*Methods@#A cross sectional (retrospective) study was done. Patients aged 15-50 years old who were admitted due to abnormal uterine bleeding from January 2017 to December 2019 were included. Patients with AUB due to pregnancy, vaginitis, bleeding before menarche, and bleeding after menopause were excluded from the study. Patient’s data as to age, obstetrical score, co-morbidity, bleeding patterns were tabulated.@*Results@#A total of 455 subjects were included in the study. Results showed that the most common causes of abnormal uterine bleeding among admitted patients in Perpetual Help Medical Center Las Piñas from January 2017 – December 2019 were due to structural causes (91%). Most prevalent was bleeding due to polyps (50.5%), followed by adenomyosis (18.8%), leiomyoma (16.04%), and malignancy (6.2%). Prevalence of non-structural causes of bleeding was 0.4% for coagulopathy, 3.3% due to ovulatory dysfunction, 4.6% due to endometrial dysfunction, and 0.2% for AUB-N.@*Conclusion@#Based on this 3-year retrospective study, structural causes are the most common causes of AUB, comprising about 91% of all patients admitted for AUB. The most common structural causes are AUB-P (50.5%), followed by AUB-A, AUB-L and AUB-M. Prompt recognition of the causes of AUB is very important, to prevent complications such as severe anemia and shock. Proper treatment, be it surgical or medical, also depends on the exact cause of AUB.
Subject(s)
Polyps , AdenomyosisABSTRACT
Objectives@#To determine the efficacy of micronized oral progesterone (OMP) versus Medroxyprogesterone Acetate (MPA) in the control and regulation of mild to moderate abnormal uterine bleeding in adolescents with ovulatory dysfunction.@*Materials and Methods@#This is an open labelled Randomized Controlled Trial. Fifty patients with mild to moderate abnormal uterine bleeding were randomized to treatment with Medroxyprogesterone Acetate or Oral Micronized Progesterone.
Subject(s)
Medroxyprogesterone AcetateABSTRACT
Background@#The International Endometrial Tumor Analysis (IETA) group developed a catalog of standardized terms to describe findings that may be associated with uterine pathology. However, there is a lack of reliability studies for these descriptors in the literature.@*Objective@#The objective of this study was to estimate interobserver and intraobserver reliability with regard to the IETA group descriptors for endometrial vascular characteristics in women with abnormal uterine bleeding.@*Materials and Methods@#Five nonexpert and five expert raters assessed stored still images of transvaginal ultrasound examinations obtained from 68 women with abnormal uterine bleeding and endometrial thickening. Endometrial vascularity was evaluated using the IETA group descriptors for color flow and vascular pattern. Interobserver agreement was estimated by comparing the assessments of the nonexpert and expert raters. Intraobserver agreement was estimated by repeating the raters’ assessment after 4 weeks. Interrater agreement to the subjective assessment of an expert investigator was also computed.@*Results and Conclusion@#The reproducibility of assigning IETA color score is good regardless of the degree of expertise of the rater, although the experts displayed better interobserver reliability (κ = 0.74 vs. 0.57) and intraobserver reliability (κ = 0.84 vs. 0.63). However, the reproducibility of describing IETA vascular patterns is significantly worse for both expert and nonexpert raters in both interobserver reliability (experts κ = 0.49 vs. 0.34) and intraobserver reliability (experts κ = 0.65 vs. 0.42). Both expert and nonexpert raters exhibited acceptable agreement with the reference standard, with experts performing better for both color score (κ = 0.79 vs. 0.70) and vascular pattern (κ = 0.63 vs. 0.44).
Subject(s)
EndometriumABSTRACT
Background: Abnormal uterine bleeding (AUB) is one of the most common problems encountered in gynecological practice. Various benign and malignant disorders of the endometrial tissue show vascular changes such as congestion, dilatation, and vessel wall irregularities. Aim: To evaluate the vascular morphometry of the endometrial tissue in AUB. Materials and Methods: A descriptive cross-sectional study of the endometrial tissue in patients presented with AUB was undertaken for vascular morphometric analysis. Histopathological processing of the endometrial tissue samples was done as per the standard format, and the slides were evaluated for vascular morphometry. Results: Out of 150 cases of endometrial tissue in patients presented with AUB, 80 cases were reported as proliferative phase, 41 as secretory phase, 15 as disordered proliferative endometrium, 6 as atrophic phase endometrium, and 4 each of endometrial hyperplasia without atypia and endometrial carcinoma. An average number of endometrial blood vessels and large-sized blood vessels were more in endometrial carcinoma and endometrial hyperplasia without atypia as compared to proliferative phase, secretory phase, atrophic endometrium, and disordered proliferative endometrium. Vessel shape irregularities and vascular congestion were observed in all the cases of atrophic endometrium, endometrial carcinoma, and endometrial hyperplasia without atypia. Endometrial carcinoma showed severe dilatation of the endometrial blood vessels. Conclusion: Vascular morphometry changes were noted in endometrial hyperplasia, endometrial carcinoma, disordered proliferative endometrium, and atrophic phase endometrium. These findings suggest that studies or trials related to anti-angiogenic therapy may help to plan anti-angiogenic therapy in patients with AUB.
ABSTRACT
Background: Abnormal uterine bleeding (AUB) is a common gynecological disorder among women of reproductive age, interfering with their day-to-day activity. A better understanding of commonly used drugs in the medical management reduces the need of unnecessary surgical procedures and benefits both the patient and health-care providers. Aims and Objectives: This study aims to study the patient characteristics and prescription pattern in the medical management of AUB and to assess the menstrual blood loss by pictorial blood loss assessment chart (PBAC) and the association between different treatment groups with PBAC score. Materials and Methods: A cross-sectional study was conducted at gynecology OPD, Vanivilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, from January 2019 to January 2020 with approval from the Institutional Ethics Committee, BMCRI, Bengaluru. A total of 200 AUB patients on medical treatment were included for the study, demographic data and relevant data on drug prescription were recorded in the case record form. Menstrual blood loss was assessed using PBAC. Association between PBAC score and different medical treatment groups was determined. Results: AUB was observed mostly in the age group of 21–30 years (35.5%), multiparous women (69.5%) were at higher risk of developing AUB, ovulatory dysfunction (44.5%) was the common cause of AUB in reproductive age group. Medical management included hormonal (36.3%), non-hormonal (21%), combined (9.3%), and concomitant medications (33.4%). Median of PBAC score was 75. There was no significant association among different treatment groups and PBAC score. Conclusion: Majority of AUB patients received hormonal treatment had functional causes with normal PBAC score. This study gives an overview of medical management of AUB in a tertiary care hospital.
ABSTRACT
Describir los hallazgos ecográficos de las pacientes que acudieron por sangrado uterino anormal al servicio de Ginecología y Obstetricia del Hospital Dr. Domingo Luciani durante el período enero 2021 a enero 2022. Métodos: Estudio observacional-descriptivo, de tipo retrospectivo. Muestra no probabilística e intencional, integrada por 99 pacientes. Variables involucradas: edad, raza, paridad, antecedentes personales, ciclo menstrual, duración del período menstrual, fecha última de menstruación, uso de algún medicamento, método anticonceptivo y hallazgos ecográficos. Resultados: Los hallazgos ecográficos evidenciaron diferentes causas que explican el sangrado uterino anormal de las pacientes que integraron la muestra de estudio; las tres más frecuentes fueron: miomatosis uterina, sangrado uterino anormal por leiomioma o por endometrio, sangrado uterino anormal tipo L y tipo E(AU)
Objective: To describe the ultrasound findings ofpatients who came for abnormal uterine bleeding to theGynecology and Obstetrics service of the Dr. Domingo LucianiHospital during the period January 2021 to January 2022.Methods: This was an observational-descriptive, retrospectivestudy. The sample was non-probabilistic and intentional,consisting of 99 patients. The data were collected in an Excelsheet for analysis to determine their percentage frequencyaccording to the variables involved: age, ethnicity, parity,personal history, menstrual cycle, duration of menstrual period,last date of menstruation, use of some medication, contraceptivemethod and ultrasound findings. Results: The ultrasoundfindings showed different causes to explain the abnormal uterinebleeding of the patients who made up the study sample; however,the three most frequent were: uterine myomatosis, sangradouterino anormal tipo L y tipo E(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Uterine Hemorrhage , Ultrasonography , Contraceptive Agents , Gynecology , Hemorrhage , Myoma , ObstetricsABSTRACT
Asrigdar has been characterised by excessive bleeding per vaginum. Acharya Charaka described Asrigdar as a separate disease along with its treatment in Yoni Vyapada Chikitsha Adhyaya. Acharya Charaka also described it as a Raktaja Vikara. Acharya Sushruta described Asrigdar due to Pitta Samyukt Apana Vayu. It can be correlated with Abnormal Uterine bleeding in modern. Any uterine bleeding other than normal duration, frequency and volume is considered as abnormal uterine bleeding. It affects about 30% of women in reproductive period. It is often associated with backache, pain in lower abdomen and weakness. A 23 years old female patient presented with complaints of Irregular menses with excessive bleeding per vaginum associated with pain lower abdomen. On further enquiry it was found that she had irregular menses since menarche. She took modern treatment but didn’t get significant relief. Due to excessive bleeding she had Anaemia also. Keeping all the aspects in mind a treatment has been planned. Doshas involved in Asrigdar are mainly Pitta and Vata, That is why, for Samprapti vighatan basic treatment divided into three parts i.e. Shaman chikitsha along with Sthanik chkitsha over abdomen with Krishna Mritika and Basti chikitsha. Shaman chikitsha which includes Pitta and Vata shamak, Raktastambhaka and Balya Aushadh. In Bhavprakash Nighantu Krishna Mritika has been kept in Ashtama Dhatwadi Varga and mentioned in Rakta Pradra or Rakt Vikara. The treatment protocol was followed for three cycles with positive outcome as better cycle control and symptomatic improvement in this patient.
ABSTRACT
One of the commonest reasons for women seeking gynecological advice is Abnormal uterine bleeding (AUB). Most common anatomical causes of abnormal uterine bleeding in women are endometrial polyps, sub mucosal fibroids and endometrial hyperplasia. Hysteroscopy is an effective procedure but is more expensive than Saline Infusion Sonography (SIS). Direct visualization of uterine cavity is possible by hysteroscopy, but it does not give any information about myometrium and adnexa. Saline infusion sonography is effortlessly accepted by most patients as it can be an outpatient procedure. This article present summary of salient features of the procedure which will help the practitioner to take informed decision.
ABSTRACT
Background: Abnormal Uterine Bleeding (AUB) is a very frequent cause of gynecological visits in women of all age groups. Ultrasound pelvis with or without endometrial sampling have been conventionally used to make diagnosis. Power Doppler is a comparatively recent modality which can be used to screen patients who will need endometrial biopsy/ curretage. We hereby conducted a study to compare the diagnostic accuracy of power Doppler sonography and hysteroscopy with histopathology associated with abnormal uterine bleeding. We also calculated the incidence of uterine pathology in AUB by power Doppler ultrasound and hysteroscopy and compared it with histopathology. Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University. After excluding 42 women, a total of 100 women fulfilling the inclusion criteria contributed to our study. Selected women underwent power Doppler ultrasound and hysteroscopy with guided biopsy. Results were compared with histopathology as per the gold standard. Evaluation of sensitivity, specificity, positive and negative predictive values were performed for each modality. All statistical analyses were performed using the SPSS 11.0 statistical package. P value ?0.05 was considered statistically significant for all tests used. Results: Sensitivity and specificity of power Doppler are 75% and 100% for carcinoma endometrium, 72.72% and 98.9% for endometrial hyperplasia, and 81.81% and 100% for endometrial polyp, respectively. Conclusion: Power Doppler sonography can be used to screen outpatients who do not need an endometrial biopsy for abnormal uterine bleeding. This will avoid unnecessary hysteroscopy in definitive benign cases, and watchful hysteroscopy in suspected premalignant and malignant cases. Irregular branching vessels and color splashes were found to be the best parameters for diagnosing endometrial carcinoma. Power Doppler should be done along with transvaginal sonography in all cases of abnormal uterine bleeding
ABSTRACT
Objectives:To assess the feasibility of diagnos?c hysteroscopy in the diagnosis of abnormal structure and pathological lesions in the uterine cavi?es of women presen?ng abnormal bleeding of the uterus. Methods: This is a Prospec?ve Cross-sec?onal study conducted in the Department of Gynaecology at Prathima Ins?tute Of Medical Sciences, Karimnagar: one hundred women presen?ng with Abnormal Uterine Bleeding, over a period of one year from December 2020 to November 2021, were subjected to the procedure. Results: The results of our study show that hysteroscopy has high accuracy for detec?ng the pathology in women with abnormal uterine bleeding, especially in benign lesions such as endometrial polyp and submucosal fibroid and it can be used as the first line diagnos?c method for these abnormali?es. Conclusion:Hysteroscopy provides a more accurate diagnosis than dilata?on and cure?age or ultrasonography alone to diagnose pathology in women with abnormal bleeding of the uterus. It is very sensi?ve for diagnosing intracavitary lesions like submucous myoma and endometrial polyp
ABSTRACT
Objective@#To determine the prevalence of premalignant and malignant changes in hysteroscopically removed endometrial polyps in reproductive aged women, and to determine clinical, ultrasonographic and hysteroscopic characteristics of such women. @*Methods@#This is a cross-sectional study of patients diagnosed with endometrial polyp, and underwent hysteroscopy from 2015-2019. A review of the medical records (ultrasound results, intraoperative findings and histopathology results) was done.@*Results@#A total of 117 patient records were included in the analysis. The median age of all patients who underwent hysteroscopy was 38 years old (age range: 19-44 years). The prevalence of endometrial hyperplasia or carcinoma in the 18-44 year old age group was 8.5% (n=10/117). Among patients with endometrial hyperplasia or carcinoma, 70% were nulligravid, 40% had anovulation disorder, and 40% had infertility. Most of the patients were overweight or obese (70%). Co-morbidities were present in only 3 cases, and diabetes mellitus (30%) was the predominant illness seen in these patients. @*Conclusion@#Our findings showed a higher prevalence (8.5%) of endometrial hyperplasia or carcinoma in endometrial polyps among Filipino reproductive-aged women, compared to reports in published literature. Among the different clinical characteristics, ultrasound and hysteroscopic findings, no particular factor had a significant association with endometrial hyperplasia or malignancy.
Subject(s)
Hysteroscopy , Endometrial Neoplasms , Endometrial HyperplasiaABSTRACT
Abstract Introduction Abnormal uterine bleeding is more frequent in adolescence. Although, most commonly, it has a non-structural etiology, it may be due to any cause described. Clinical case A 12-year-old adolescent, with no relevant personal history, menarche 1 month before, was observed in the emergency department for severemenstrual bleeding with progressive worsening, and hemodynamic repercussion in need of transfusion support. Physiological ovulatory dysfunction associated with possible previously unknown coagulopathy was considered to be the most likely diagnosis and medical treatment was initiated. Without response, the patient was submitted to sedated observation and uterine aspiration, which ultimately led to the diagnosis of a Burkitt Lymphoma. Discussion Although structural causes, and particularly malignancy, whether gynecological or not, are a rare cause of abnormal uterine bleeding in this age group, they must be considered, thus enhancing the fastest and most appropriate treatment.
Resumo Introdução A hemorragia uterina anormal é mais frequente na adolescência. Apesar de maioritariamente de etiologia não estrutural, pode dever-se a qualquer causa descrita. Caso clínico Adolescente de 12 anos, sem antecedentes pessoais relevantes, com menarca há 1 mês, observada no serviço de urgência por hemorragia menstrual grave com agravamento progressivo e repercussão hemodinâmica com necessidade de suporte transfusional. Foi colocada a hipótese de disfunção ovulatória fisiológica associada a eventual coagulopatia desconhecida previamente e foi instituído tratamento médico. Por ausência de resposta a tratamento médico, foi submetida a observação sob sedação e aspiração uterina que evidenciou tratar-se de um Linfoma de Burkitt. Discussão Apesar de as causas estruturais, e particularmente as neoplasias, do foro ginecológico ou não, serem uma causa rara de hemorragia uterina anormal nesta faixa etária, elas devem ser levadas em consideração potenciando assim um tratamento mais célere e adequado.
Subject(s)
Humans , Female , Child , Adolescent , Uterine Hemorrhage , Gynecology , MenarcheABSTRACT
Objective:To explore the distribution characteristics of traditional Chinese medicine （TCM） syndromes of abnormal uterine bleeding associated with ovulatory dysfunction （AUB-O）. Method:A clinical and epidemiological investigation was conducted in 6 688 patients with AUB-O from the provincial， municipal， and county/district hospitals in 29 provinces， autonomous regions， and municipalities across China to identify the distribution characteristics of their TCM syndromes. Result:The AUB-O patients nationwide were mainly differentiated into the kidney Qi deficiency syndrome （17.34%）， the spleen Qi deficiency syndrome （13.25%）， the Qi and blood deficiency syndrome （12.62%）， the Qi deficiency and blood stasis syndrome （8.45%）， and the kidney Yin deficiency syndrome （6.88%）. AUB-O resulted from Qi deficiency， Yin deficiency， and blood deficiency， often involving the kidney， spleen and liver. The analysis of the regional distribution of TCM syndromes in AUB-O patients revealed that kidney Qi deficiency， spleen Qi deficiency， and Qi and blood deficiency were the shared syndromes. However， due to regional discrepancy， the TCM syndrome varied widely from one geographic region to another. The kidney Qi deficiency syndrome was more frequently seen in North China， Northwest China， Southwest China， and East China， but less frequently in central China， Northeast China， and South China. The spleen Qi deficiency syndrome occurred most frequently in central China， while the East China had the highest frequency of Qi and blood deficiency syndrome. The spleen and kidney deficiency syndrome was mostly present in central China， North China， and Southwest China， the Qi deficiency （kidney deficiency） and blood stasis syndrome in Northwest China， South China， and North China， the kidney Yin deficiency syndrome in East China， Northwest China， and Northeast China， the deficiency-heat syndrome in Southwest China and East China， the kidney Yang deficiency syndrome in South China， the liver depression and blood heat syndrome in Northeast China， and the liver depression and spleen deficiency syndrome in central China. The diagnostic criteria for the kidney Qi deficiency， spleen Qi deficiency， Qi and blood deficiency， Qi deficiency and blood stasis， and kidney Yin deficiency syndromes were not significantly different from the previous ones. The distinctive symptoms for the kidney Qi deficiency syndrome were irregular vaginal bleeding， heavy menstrual flow， or shortened menstrual cycle， back soreness and pain， and forgetfulness， while those for the spleen Qi deficiency syndrome mainly included the shortened menstrual cycle， mental fatigue， lack of strength， poor appetite， loose stool， and white tongue coating. The Qi and blood deficiency syndrome were mainly manifested as the shortness of breath， laziness to speak， pale complexion， dizziness， and palpitation. The Qi deficiency and blood stasis syndrome were mainly judged by the scanty menstrual flow frequently or occasionally accompanied by blood clots， mental fatigue， lack of strength， and dark purple tongue. The ovulatory bleeding， dizziness， tinnitus， vexing heat in chest， palms and soles， and night sweat were the characteristic signs for the kidney Yin deficiency syndrome. Conclusion:There exist certain rules in the geographical distribution of TCM syndromes of AUB-O patients， which has provided a reference for the clinical treatment of AUB-O in accordance with the local conditions.
ABSTRACT
Perimenopausal anovulatory dysfunctional uterine bleeding （ADUB） is a severe acute disease that is difficult to be dealt with in gynecology， accounting for about 70% of abnormal uterine bleeding. The significant differences in bleeding patterns make it particularly challenging to treat. The main manifestations of perimenopausal ADUB are prolonged menstrual period， inexhaustible menstrual bleeding， or heavy inter-menstrual vaginal bleeding， which allow it to be classified into the category of metrorrhagia and metrostaxis in traditional Chinese medicine （TCM）. After conducting in-depth research on this disease， physicians of the past dynasties have figured out its etiology and pathogenesis and accumulated rich experience in its differentiation and treatment， thus forming a relatively systematic theoretical system. The existing literature mainly focuses on four types of its pathogenesis， namely blood heat， blood stasis， spleen deficiency， and kidney deficiency， and there are few discussions on liver. However， patients with metrorrhagia and metrostaxis due to liver dysfunction are commonly seen in clinical practice. The theory of liver being innate basis of women explores the special physiological and pathological characteristics of women and emphasizes the important role of liver in the treatment of this disease based on its characteristic functions and meridian circulation. Considering the close relationship of liver Qi and blood with spleen， kidney， and thoroughfare and conception vessels， this paper discussed the TCM treatment of perimenopausal ADUB from the following four aspects： soothing liver Qi and nourishing liver blood， liver and kidney sharing the same source， simultaneous regulation of liver and spleen， and liver meridian circulation， so as to broaden the clinical treatment options. Perimenopause is a unique physiological period when women tend to suffer from Qi stagnation and blood deficiency. Liver， characterized by Yin in property and Yang in function， governs the free flow of Qi， induces ovulation， stores blood， and regulates blood volume. Therefore， the liver should be emphasized in the treatment of perimenopausal ADUB， which contributes to correcting the hormone disorder caused by abnormal ovulation， stopping bleeding， and alleviating perimenopausal symptoms. This paper has provided a new direction for the clinical treatment of perimenopausal ADUB .
ABSTRACT
OBJECTIVE: To evaluate the association of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVUS) findings with adenomyosis symptoms. METHODS: This prospective study conducted between January and December 2018 enrolled 78 women aged 18 to 40 years with abnormal uterine bleeding (AUB), infertility, and/or pelvic pain. All patients underwent 2D and 3D TVUS. Signs of adenomyosis on TVUS were identified according to the consensus of the Morphological Uterus Sonographic Assessment group. RESULTS: The prevalence of adenomyosis on TVUS was 55.12%. Patients with adenomyosis were older (p=0.002) and had more dysmenorrhea, AUB, and endometriosis than those without adenomyosis. When comparing the presence of symptoms with each adenomyosis feature, on 2D TVUS, severe dyspareunia was significantly associated with the presence of a poorly defined junctional zone (JZ) (p=0.023) and on 3D TVUS, patients with AUB had a more irregular (p=0.003), poorly defined (p=0.028), and interrupted JZ (p=0.011). After logistic regression analysis, signs of adenomyosis on TVUS remained significantly associated only with age over 30 years (OR: 1.2; 95% CI: 1.0-1.2) and AUB (OR: 7.65; 95% CI: 2-29). Patients with diffuse adenomyosis were older and presented with more infertility and AUB than patients with focal or no adenomyosis. CONCLUSION: The findings of adenomyosis by 2D and 3D TVUS showed association with age and AUB. 3D TVUS alterations in the JZ were associated with AUB and dyspareunia. Diffuse adenomyosis was associated with older age, a greater prevalence of infertility, and AUB.