Characteristics and Outcome in Non-Puerperal Uterine Inversion.

Chronic non-puerperal uterine inversion is rare and usually associated with uterine pathology with a diagnosis that is challenging. We present the case of a 47-year-old para 4 Caucasian woman with a history of polyfibromatous uterus who was admitted for severe vaginal bleeding for the past 48 hours associated with hemodynamical instability and was refusing any surgery. Pelvic MRI showed the uterus presenting an unusual appearance with a highly vascularized intracavitary leiomyoma protruding through the cervix. Upon deterioration of her status despite an optimal blood transfusion, resuscitation and anti-fibrinolytic treatment, she accepted total abdominal hysterectomy. The diagnosis of uterine inversion was made intraoperatively and confirmed on histopathologic examination. It revealed two side-by-side benign fundal leiomyomas which had collapsed the fundus and protruded partly from the cervix. Non-puerperal chronic inversion of the uterus is rare, and its diagnosis should be based on ultrasound, pelvic MRI and a high index of suspicion, allowing rapid diagnosis and treatment and thus decreasing patient morbidity and mortality.

Custo-efetividade e limiar de custo para o uso do sistema intrauterino liberador de levonorgestrel para o tratamento do sangramento uterino anormal sob a perspectiva do Sistema de Saúde Suplementar no Brasil / Cost-effectiveness and cost threshold for the use of levonorgestrel-releasing intrauterine system for treatment of heavy menstrual bleeding from the Supplementary Health System perspective in Brazil

Objetivo: Definir um limiar de custo para o sistema intrauterino liberador de levonorgestrel 52 mg (SIU-LNG 52 mg) para o tratamento do sangramento uterino anormal (SUA) sob a perspectiva do Sistema de Saúde Suplementar brasileiro. Métodos: Foi elaborado um modelo de custo-efetividade para definir o limiar de custo de inserção de SIU-LNG 52 mg em mulheres com SUA em comparação à histerectomia. Um modelo de Markov foi estruturado com ciclos anuais para reproduzir o tratamento do SUA em um e cinco anos, considerando custos médicos diretos e o percentual de histerectomias evitadas como desfecho. O custo da histerectomia foi variado até o valor de 10.000 reais brasileiros (BRL) com incrementos de 500 BRL a cada nova simulação para avaliar o limiar de custo do SIU-LNG 52 mg para igualar o custo total de tratamento de ambas as estratégias analisadas. Resultados: O SIU-LNG 52 mg demonstrou ser uma opção de tratamento dominante quando comparada à histerectomia, levando à redução da frequência de realização do procedimento cirúrgico em 59,62% das mulheres e redução de 2.557,91 BRL no custo total de tratamento em cinco anos. Ao considerar a histerectomia a 6.000 BRL, o custo do procedimento com SIU-LNG 52 mg poderia ser de até 6.150,35 BRL e 3.994,60 BRL para igualar o custo total de tratamento, em horizontes temporais de um e cinco anos, respectivamente. Conclusão: SIU-LNG 52 mg demonstrou ser uma opção dominante para o manejo do SUA, sendo capaz de atrelar economia para o sistema de saúde a benefícios para a mulher perante a cirurgia.

Objective: To define a cost threshold for the use of levonorgestrel-releasing intrauterine system 52 mg (LNG-IUS 52 mg) for the treatment of heavy menstrual bleeding (HMB) in the Brazilian Supplementary Health System perspective. Methods: A cost-effectiveness model was built to define the cost threshold for insertion of LNG-IUS 52 mg considering women with diagnosis of HMB as the target population and hysterectomy as the comparator. A Markov model was structured with annual cycles to reproduce HMB treatment in 1 and 5 years, considering direct medical costs and the percentage of avoided hysterectomies as the outcome. Hysterectomy cost was varied up to 10,000 Brazilian real (BRL) with increments of 500 BRL at each new simulation to define LNG-IUS 52 mg cost threshold, to provide equal total treatment costs for both strategies. Results: LNG-IUS 52 mg proved to be a cost-saving option when compared to hysterectomy, leading to a reduction in the frequency of the surgical procedure by 59.62% and a total treatment cost reduction of 2,557.91 BRL in 5 years. When considering hysterectomy at 6,000 BRL, the cost of the procedure with LNG-IUS 52 mg could be up to 6,150.35 BRL and 3,994.60 BRL to provide equal total treatment cost in 1 and 5 years time horizon, respectively. Conclusion: LNG-IUS 52 mg has proven to be a cost-saving option for the health system in the management of HMB, in addition to the known benefits for women against surgery.

[Safety and acceptability of the 52 mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding in an ambulatory care center in Bogotá, Colombia, 2012-2016].

OBJECTIVE: To describe safety and acceptability with the use of the 52-mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding. METHODS: Retrospective cohort of women 18 years of age and older diagnosed with abnormal uterine bleeding, ultrasound-reported uterine length between 6 and 10 cm and uniform endometrial cavity in its entire length, regardless of structural abnormality, who received treatment with 52-mg levonorgestrel-releasing intrauterine system between 2012 and 2016. Non-probabilistic convenience sampling was carried out. Sociodemographic and clinical baseline variables were measured, as well as patient perception of bleeding and the frequency of failure, amenorrhea, need for hysterectomy and adverse events, over a 12-month follow-up period. Descriptive statistics were applied. RESULTS: Overall, 200 patients were assessed. A subjective perception of improvement in terms of bleeding volume and frequency of leave of absence or visits to the emergency department was found; 90 % of the patients had amenorrhea, and 6 % experienced adverse events. CONCLUSIONS: The 52-mg levonorgestrel-releasing intrauterine system is a safe option for the management of abnormal uterine bleeding in women with normal uterine size and no submucosal endometrial abnormalities. Local randomized studies are required to assess effectiveness and efficiency in comparison with other management options.

TITULO: SEGURIDAD Y ACEPTABILIDAD DEL SISTEMA INTRAUTERINO LIBERADOR DE LEVONORGESTREL 52 MG EN MUJERES CON HEMORRAGIA UTERINA ANORMAL EN UN CENTRO DE ATENCIÓN AMBULATORIA EN BOGOTÁ, COLOMBIA, 2012-2016. OBJETIVO: Describir la seguridad y aceptabilidad del uso del sistema intrauterino liberador de levonorgestrel de 52 mg en mujeres con hemorragia uterina anormal. METODOS: Cohorte retrospectiva en la que se incluyeron mujeres de 18 años o más con diagnóstico de hemorragia uterina anormal, reporte por ultrasonido de tamaño uterino entre 6 y 10 cm de longitud y cavidad endometrial uniforme en toda su longitud, independiente de alteración estructural, a quienes se les colocó para tratamiento el sistema intrauterino liberador de levonorgestrel de 52 mg, en el periodo de 2012 hasta 2016 Se realizó un muestreo por conveniencia. Se midieron variables sociodemográficas y clínicas basales, así como la percepción de la hemorragia por parte de la paciente y la frecuencia de falla, amenorrea, necesidad de histerectomía y eventos adversos, con seguimiento a 12 meses. Se aplicó estadística descriptiva. RESULTADOS: Se evaluaron 200 pacientes, hubo una percepción de mejoría subjetiva del volumen de sangrado y de la frecuencia de incapacidad laboral o asistencia a urgencias. El 90 % de las pacientes registró amenorrea y el 6 % eventos adversos. CONCLUSIONES: El sistema intrauterino liberador de levonorgestrel de 52 mg es una alternativa segura para el manejo de la hemorragia uterina anormal en mujeres con úteros de tamaño normal y sin al- teraciones submucosas del endometrio. Se requieren estudios aleatorizados en el medio local para evaluar su efectividad y eficiencia respecto a otras alternativas de manejo.

Safety and acceptability of the 52 mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding in an ambulatory care center in Bogotá, Colombia, 2012-2016 / Seguridad y aceptabilidad del sistema intrauterino liberador de levonorgestrel 52 mg en mujeres con hemorragia uterina anormal en un centro de atención ambulatoria en bogotá, colombia, 2012-2016

RESUMEN Objetivo: describir la seguridad y aceptabilidad del uso del sistema intrauterino liberador de levonorgestrel de 52 mg en mujeres con hemorragia uterina anormal. Materiales y métodos: cohorte retrospectiva en la que se incluyeron mujeres de 18 años o más con diagnóstico de hemorragia uterina anormal, reporte por ultrasonido de tamaño uterino entre 6 y 10 cm de longitud y cavidad endometrial uniforme en toda su longitud, independiente de alteración estructural, a quienes se les colocó para tratamiento el sistema intrauterino liberador de levonorgestrel de 52 mg, en el periodo de 2012 hasta 2016 Se realizó un muestreo por conveniencia. Se midieron variables sociodemográficas y clínicas basales, así como la percepción de la hemorragia por parte de la paciente y la frecuencia de falla, amenorrea, necesidad de histerectomía y eventos adversos, con seguimiento a 12 meses. Se aplicó estadística descriptiva. Resultados: se evaluaron 200 pacientes, hubo una percepción de mejoría subjetiva del volumen de sangrado y de la frecuencia de incapacidad laboral o asistencia a urgencias. El 90 % de las pacientes registró amenorrea y el 6 % eventos adversos. Conclusiones: el sistema intrauterino liberador de levonorgestrel de 52 mg es una alternativa segura para el manejo de la hemorragia uterina anormal en mujeres con úteros de tamaño normal y sin alteraciones submucosas del endometrio. Se requieren estudios aleatorizados en el medio local para evaluar su efectividad y eficiencia respecto a otras alternativas de manejo.

ABSTRACT Objective: To describe safety and acceptability with the use of the 52-mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding. Materials and methods: Retrospective cohort of women 18 years of age and older diagnosed with abnormal uterine bleeding, ultrasound-reported uterine length between 6 and 10 cm and uniform endometrial cavity in its entire length, regardless of structural abnormality, who received treatment with 52-mg levonorgestrel-releasing intrauterine system between 2012 and 2016. Non-probabilistic convenience sampling was carried out. Sociodemographic and clinical baseline variables were measured, as well as patient perception of bleeding and the frequency of failure, amenorrhea, need for hysterectomy and adverse events, over a 12-month follow-up period. Descriptive statistics were applied. Results: Overall, 200 patients were assessed. A subjective perception of improvement in terms of bleeding volume and frequency of leave of absence or visits to the emergency department was found; 90 % of the patients had amenorrhea, and 6 % experienced adverse events. Conclusions: The 52-mg levonorgestrel-releasing intrauterine system is a safe option for the management of abnormal uterine bleeding in women with normal uterine size and no submucosal endometrial abnormalities. Local randomized studies are required to assess effectiveness and efficiency in comparison with other management options.

Hemorragia uterina anormal / Uterine abnormal hemorrhage

La hemorragia uterina anormal (HUA) es un signo y síntoma clínico frecuente en el consultorio de ginecología, manifestándose en cualquier etapa de la vida de la mujer. Se presenta en el 25% de adolescentes y en el 50% en mayores de 40 años; además represen-ta un 25% de las cirugías ginecológicas. Tiene como factores predisponente la raza, gemelar, agregación familiar, asociación a enfermedades geneticas. La cantidad y duración de las menstruaciones es muy subjetiva, por lo que hay problemas para valorar las pérdidas sanguíneas de las pacientes. El diagnóstico de hemorragia uterina disfuncional es por exclusión, primero se debe descartar las causas orgánicas. Por ello la HUA es un problema frecuente que se puede presentar a cualquier edad repercutiendo en varios aspectos como el sanitario y social, su tratamiento debe ser multidisciplinario, ya que no debemos olvidar que es una de las principales causas de anemia en la mujer y también de histerectomías. (AU)

The HUA is a common clinical signs and symptoms in gynecology clinic, being a disorder in the female genital tract, can occur at any age of life of women. It comes in a 25% in adolescents and 50% older than 40 years and 25% of gynecological surgeries. It has an ethnic predisposition, twins, familial aggregation, association with genetic diseases. The amount and duration of menses is very subjective, so there are problems in assessing blood loss of patients. The diagnosis of dysfunctional uterine bleeding is by exclusion, you must first rule out organic causes. Thus the HUA is a common problem that can occur at any age impacting several aspects such as health and social, treatment should be multidis-ciplinary, and we must not forget that it is a major cause of anemia in women and hysterectomy. (AU)

Abnormal Uterine Bleeding / Sangramento uterino anormal

Abstract Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. The objective of this chapter is to describe the main evidence on the treatment of women with abnormaluterinebleeding, both acuteand chronic.Didactically,thetreatmentoptions were based on the current International Federation of Gynecology and Obstetrics (FIGO) classification system (PALM-COEIN). The etiologies of PALM-COEIN are: uterine Polyp (P), Adenomyosis (A), Leiomyoma (L), precursor and Malignant lesions of the uterine body (M), Coagulopathies (C), Ovulatory dysfunction (O), Endometrial dysfunction (E), Iatrogenic (I), and Not yet classified (N). The articles were selected according to the recommendation grades of the PubMed, Cochrane and Embase databases, and those in which the main objective was the reduction of uterine menstrual bleeding were included. Only studies written in English were included. All editorial or complete papers that were not consistent with abnormal uterine bleeding, or studies in animal models, were excluded. The main objective of the treatment is the reduction of menstrual flow and morbidity and the improvement of quality of life. It is important to emphasize that the treatment in the acute phase aims to hemodynamically stabilize the patient and stop excessive bleeding, while the treatment in the chronic phase is based on correcting menstrual dysfunction according to its etiology and clinical manifestations. The treatment may be surgical or pharmacological, and thelatterisbasedmainlyonhormonaltherapy,anti-inflammatorydrugsandantifibrinolytics.

Resumo O sangramento uterino anormal é uma afecção frequente que pode afetar negativamente aspectos físicos, emocionais, sexuais e profissionais, piorando a qualidade de vida das mulheres. Nos casos de sangramento intenso e agudo, as mulheres podem necessitar de tratamento de urgência, com reposição volumétrica e substâncias hemostáticas. Há situações que necessitam de tratamento prolongado, e ainda situações em que o tratamento cirúrgico pode ser necessário. O objetivo deste estudo é descrever as principais evidências sobre o tratamento das mulheres com sangramento uterino anormal, tanto na fase aguda quanto na crônica. A apresentação do tratamento foi baseada no sistema de classificação (PALM-COEIN, na sigla em inglês) da Federação Internacional de Ginecologia e Obstetrícia (FIGO). As etiologias do PALMCOEIN são: Pólipo uterino (P), Adenomiose (A), Leiomiomia (L), lesões precursoras e Malignas do corpo uterino (M), Coagulopatias (C), distúrbios da Ovulação (O), disfunção Endometrial (E), Iatrogênicas (I), e não classificadas nos itens anteriores (N). Os artigos foram selecionados conforme os graus de recomendação das bases de dados PubMed, Cochrane e Embase que tivessem como objetivo o tratamento do sangramento uterino anormal em mulheres. Somente artigos escritos em inglês foram incluídos. Todos os editoriais ou papers completos que não tratassem de sangramento uterino anormal, ou estudos baseados em modelos animais, foram excluídos. O tratamento tem como objetivo a redução do fluxo menstrual, reduzindo morbidade e melhorando a qualidade de vida. O tratamento na fase aguda visa estabilizar hemodinamicamente a paciente e estancar o sangramento excessivo, enquanto a terapia da fase crônica é baseada na correção da disfunção menstrual, conforme sua etiologia ou conforme a manifestação clínica. O tratamento pode ser cirúrgico ou medicamentoso, sendo o segundo baseado principalmente em fármacos hormonais, anti-inflamatórios ou antifibrinolíticos.

Embolización de arterias uterinas para manejo de miomatosis: experiencia con 200 pacientes / Uterine arteries embolization for the treatment of leiomyomatosis: experience with 200 patients

Objetivos: Evaluar la eficacia y seguridad de la embolización de arterias uterinas en la reducción del volumen uterino, tamaño de miomas, signos y síntomas relacionados a la enfermedad y la satisfacción del paciente. Diseño: Estudio clínico, retrospectivo y longitudinal. Locación: Instituto de Radiología Intervencionista Brazzini. Participantes: Doscientos pacientes sometidos a EAU bilateral. Intervención: Embolización de arterias uterinas realizado con partículas de polyvinyl alcohol de 355 a 500 μm y micro esferas embolizantes de 500 a 900 micras. El seguimiento fue de tres, seis, doce y hasta setenta y dos meses, que incluyeron ecografías uterinas pre y post embolización, reporte de mejoría sintomatológica por pacientes (EAV 0 a 10), satisfacción postratamiento, complicaciones y datos epidemiológicos relevantes. Resultados: De los 200 pacientes estudiados, los síntomas que impulsaron la consulta fueron, en primer lugar y con 42%, los trastornos menstruales, y en segundo lugar con 17%, la anemia. El tipo de mioma más frecuente fue, con 54%, el mioma intramural. La reducción media en el tamaño uterino y del mioma dominante fue 43,4% y 59%, respectivamente. De las pacientes, 56,5% tenía indicación de histerectomía al llegar a la consulta (N° 113), y de estos, luego del tratamiento, dos pacientes fueron sometidas a este procedimiento (1,02%). Las mujeres refirieron mejoría de sus síntomas en la escala análoga visual (0 a 10) de 6,7 puntos (Pre: 9 puntos, Post: 2,3 puntos). La mayoría (95%) refirió estar satisfecha con el procedimiento realizado. Conclusiones: La EAU redujo el tamaño de los miomas, el tamaño total de útero y como resultado del tratamiento se evidenció una disminución significativa de los síntomas. Las pacientes intervenidas refirieron estar satisfechas con el procedimiento, tenían una mejor calidad de vida y estaban contentas de haber evitado someterse a un procedimiento quirúrgico mayor.

Objectives: To determine safety and efficacy of uterine artery embolization (UAE) for uterine volume reduction, leiomyoma size, symptoms relief and patient satisfaction. Design: Clinical retrospective and longitudinal study. Setting: Brazzini Interventional Radiology Institute. Participants: Two hundred patients who underwent a UAE. Interventions: Bilateral UAE with hydrogel microspheres and polyvinyl alcohol particles sized 500-900 microns were applied to 200 women. Follow-up was from three, six, twelve and up to 72 months, and included pre and post embolization uterine ultrasound, complications, and relevant epidemiological data. Results: The most common symptoms were menstrual abnormalities (42%) and anemia (17%), among others. Most common type of leiomyoma was intramural (54%). Median uterine and dominant fibroid volume reductions were 43.4% and 59%, respectively. Out of the 200 women, 113 had previous indication of hysterectomy, and 2 patients were treated surgically (1.02%). Visual analog scale assessment showed improvements of 6.7 points (0 to 10). 95% of the studied and treated population reported satisfaction with the treatment. Conclusions: UAE reduced uterine total volume and fibroids size, resulting in significant symptom relief. Treated patients reported improvements in quality of life and treatment satisfaction.

Ação da acupuntura no tratamento de disfunções ginecológicas: relato de experiência / Action of acupuncture in the treatment of gynecological dysfunctions: experience report / Acción de la acupuntura en el tratamiento de disfunciones ginecológicas: relato de experiencia

Objetivo: relatar a experiência de uma enfermeira com especialidade em acupuntura acerca de uma paciente com disfunção ginecológica. Método: estudodescritivo, tipo relato de experiência, resultado da prática de uma enfermeira especialista no tocante ao tratamento de acupuntura. A coleta ocorreu por meio de anamnese realizada em ambiente terapêutico. Escolheu-se acupontos específicos relacionados ao caso. Resultados: os encontros eram realizados semanalmente, os quais perfizeram um total de 14 sessões, em que foi possível eliminar a menorragia associada à dismenorreia, queixas anteriormente apresentadas. Conclusão: constatou-se que a acupuntura corroborou no impacto positivo de qualidade de vida da paciente, tendo em vista os indicadores analisados na evolução, as verbalizações e a sensação de bem-estar evidenciando a resolutividade do tratamento.(AU)

Objective:to report the experience of a nurse specializing in acupuncture on a patient with gynecological dysfunction. Method:descriptive study of the type experience report, resulting from the practice of a specialist nurse regarding the acupuncture treatment. The collection was done by anamnesis realized in a therapeutic environment. Specific acupoints related to the case were chosen. Results:meetings were conducted weekly, and amounted to a total of 14, in which it was possible to eliminate menorrhagia associated with dysmenorrhea, earlier complaints. Conclusion:it was found that acupuncture corroborated the positive impact in the quality of life of the patient, considering the indicators analyzed in evolution, the utterances and the sense of well-being demonstrating the resoluteness of treatment.(AU)

Objetivo: relatar la experiencia de una enfermera con especialidad en acupuntura acerca de una paciente con disfunción ginecológica. Método: estudio descriptivo, tipo relato de experiencia, resultado de la práctica de una enfermera especialista referente al tratamiento de acupuntura. La recolección de datos se dio por medio de anamnesis realizada en ambiente terapéutico. Se eligió acupuntos específicos relacionados al caso. Resultados: los encuentros eran realizados semanalmente, los cuales fueron un total de 14 sesiones, en que fue posible eliminar la menorragia asociada a la dismenorrea, quejas anteriormente presentadas. Conclusión: se constató que la acupuntura corroboró en el impacto positivo de calidad de vida de la paciente, teniendo en cuenta los indicadores analizados en la evolución, las verbalizaciones y la sensación de bien estar evidenciando la resolución del tratamiento.(AU)

Prevalencia de Ferropenia por Menorragia en una institución educativa del área de la salud en Colombia / Prevalence of iron deficiency due to menorrhagia in medical students in Colombia

La menorragia es la causa más frecuente de ferropenia en mujeres en edad reproductiva. Objetivo: describir la prevalencia de ferropenia en estudiantes del área de la salud mayores de 18 años y que no había sido detectada. Materiales y métodos: a 154 estudiantes de medicina (rango de edad: 18 a 36 años) se les aplicó el cuestionario PBAC (siglas en inglés de la tabla pictórica para la estimación del sangrado menstrual). Se describe la presencia de anemia ferropénica y los niveles de ferritina con frecuencias absolutas y relativas. Resultados: se detectó ferropenia en 15% (nivel sérico <15 ug/L), menorragia 3.25% (pérdida menstrual >80 ml por ciclo) y anemia en 2%, (hemoglobina <12 g/dL). Conclusión: se observó alta prevalencia de ferropenia. Es necesario estudiar las causas con programas que incluyan promoción y evaluación de hábitos alimenticios en la población estudiantil. En nuestro estudio la herramienta no fue útil...

Menorrhagia is the most common cause of iron deficiency in women of reproductive age. Objective: to describe the prevalence of iron deficiency, which had not been detected before, in older than 18 years old medical students. Materials and Methods: the PBAC (pictorial menstrual blood loss assessment chart) was applied to 154 medical students (aged: 18 to 36 years). The presence of iron-deficiency anemia and ferritin levels were described using absolute and relative frequencies. Results: iron deficiency was detected in 15% (serum level <15 ug/L), menorrhagia 3.25% (menstrual blood loss >80 ml per cycle) and anemia in 2%, (hemoglobin <12 g/dL). Conclusion: a high prevalence of iron deficiency was observed. A study on the causes by means of promotion programs and assessment of nutritional habits in the student population is needed. The tool used in our study was not useful...

[Evaluation of endometrectomy by radiofrequency for premenopausal women: a retrospective study]. / Évaluation de l'endométrectomie par radiofréquence chez les femmes préménopausiques : étude rétrospective sur 90 cas.

OBJECTIVE: In present study, we are assessing the efficiency of endometrial ablation by radiofrequency (Novasure(®)) for the treatment of abnormal uterine bleeding. MATERIAL AND METHODS: A total of 90 patients underwent an endometrial ablation by radiofrequency for uterine bleeding between 2009 and 2012. For the postoperative follow-up, symptoms amelioration and eventual adverse-events were evaluated by a self-administered questionnaire given to all patients after the surgery. RESULT: Sixty-five patients (74%) responded to the questionnaire with an average of 17.5 months. Among them, endometrial bleeding decreased in 92% of the cases (IC 95%; 86-99). The amenorrhea rate was 55% (IC 95%; 43-67) and 36% of the patients presented a diminution of menstrual bleeding after treatment. Thirty-two patients (36%) presented dysmenorrhea before the radiofrequency and 78% of them experienced an amelioration of the symptoms after treatment (IC 95%; 64-93). In 19 patients (21%), the cause of uterine bleeding was adenomyosis, among them, bleeding decreased in 84% of the cases (IC 95%; 71-98) and dysmenorrhea in 70%. (IC 95%; 41-97). Finally, 84% of the patients were satisfied with the result of the treatment. CONCLUSION: Our findings suggest that endometrial radiofrequency is effective for the treatment of menometrorrhagia, dysmenorrhea and also adenomyosis.

Sangramento uterino anormal / Abnormal uterine bleeding

O sangramento uterino anormal é um distúrbio frequente que pode ocorrer em qualquer idade entre a menarca e a menopausa, mas concentra-se principalmente em seus extremos, logo após a menarca e no período perimenopausa, quando ocorrem alterações no eixo hipotálamo-hipófise-ovário, que levam com muita frequência à anovulação. O sangramento uterino disfuncional, considerado diagnóstico de exclusão, pode ser ovulatório ou anovulatório. O manejo do quadro pressupõe que o sangramento agudo seja coibido e que se evite a recidiva; para tanto, é fundamental que se estabeleça o diagnóstico etiológico. Os autores fazem uma revisão objetiva sobre o assunto, dando ênfase ao diagnóstico e tratamento da doença.

Abnormal uterine bleeding is a clinical problem wich may occur at any time during the reproductive years; however, it is most prevalent during perimenarche and perimenopause, when women tend to have anovularoty cycles. Disfunctional uterine bleeding is a prevalent disease that affects women from adolescence to menopause. The treatment should control the acute bleeding and avoid the recidive. The etiological diagnosis is fundamental for this purpose. The authors make an objective review about dysfunctional uterine bleeding herein, focusing on the diagnosis and treatment of the disease.

Alteraciones hemostáticas en pacientes con sangrado uterino anormal / Hemostatic alterations in patients with abnormal uterine bleeding

Conocer la frecuencia de defectos hemostáticos en mujeres con sangrado uterino anormal. Se estudiaron 55 mujeres de edades comprendidas entre 17 y 55 años, que presentaban sangrado uterino anormal. En cada paciente se realizó un estudio que comprendió: Historia clínica, examen físico (incluido examen ginecológico), biopsia endometrial, ultrasonograma transvaginal y pélvico y estudio hemostático a través de la determinación de los tiempos de protrombina y de tromboplastina parcial, concentraciones de factor VIII (FVIII), factor von Willebrand (FvW) y IX y agregación plaquetaria con epinefrina, ADP, colágeno y ristocetina. Hospital Nuestra Señora de Chiquinquirá, e Instituto de Investigaciones Clínicas “Dr. Américo Negrette”, Facultad de Medicina. Universidad del Zulia, Maracaibo, Venezuela. En todas las mujeres se halló una alteración orgánica, funcional o mixta en el área genital. Los tiempos de coagulación y las concentraciones de los factores estudiados fueron normales con excepción de una paciente cuya concentración de FVIII fue de 0,47U/μL. La agregación plaquetaria mostró alteraciones en el 51,1 por ciento de los casos. La frecuencia de alteraciones de la coagulación en mujeres con sangrado uterino anormal, fue similar a la de la población general, por esta razón no se justifica que todas las pacientes con sangrado uterino anormal, se sometan a un estudio de coagulación; sin embargo, la alta frecuencia de agregación plaquetaria anormal, se debe tomar en cuenta antes de decidir una conducta quirúrgica.