經血過多：修订间差异
删除的内容 添加的内容
翻譯外文連結 |
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** [[复合口服避孕药]]停藥 |
** [[复合口服避孕药]]停藥 |
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* 全身性原因：甲狀腺疾病、精神壓力 |
* 全身性原因：甲狀腺疾病、精神壓力 |
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== 診斷 == |
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診斷需依據理學檢查、超音波診斷，以及完整藥物史判斷。如果必要可安排實驗室檢查或[[子宮鏡檢查]]。以下列表列出可以協助醫師診斷的方法： |
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* 骨盆腔及肛門檢查：確認出血地點是否位於下生殖道或直腸 |
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* 子宮頸抹片：確認是否為子宮頸癌 |
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* 盆腔超音波：確認是否有生殖道結構異常<ref name="NICE44-2007" /> |
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* 子宮內膜切片：排除癌症或異常增生 |
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* [[子宮鏡檢查]] |
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* 血中TSH及T4濃度：排除甲狀腺機能低下<ref>{{cite journal|title=Menorrhagia and hypothyroidism. Evidence supports association between hypothyroidism and menorrhagia|author=Weeks AD|journal=BMJ|doi=10.1136/bmj.320.7235.649|year=2000|volume=320|pages=649|pmc=1117669|pmid=10698899}}</ref> |
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== 治療 == |
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如能找出原因，治療需針對根本原因下手， |
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Where an underlying cause can be identified, treatment may be directed at this. Clearly heavy periods at [[初潮]] and [[更年期]] may settle spontaneously (the menarche being the start and menopause being the cessation of periods). |
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If the degree of bleeding is mild, all that may be sought by the woman is the reassurance that there is no sinister underlying cause. If anemia occurs due to bleeding then [[铁|iron]] tablets may be used to help restore normal [[血红蛋白]] levels.<ref name="Munro 3–132" /> |
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The condition is often treated with hormones, particularly as abnormal uterine bleeding commonly occurs in the early and late menstrual years when contraception is also sought. Usually, oral [[生育控制|复合口服避孕药]] or {{tsl|en|Progesterone only pill||progesterone only}} pills may be taken for a few months, but for longer-term treatment the alternatives of injected {{tsl|en|Depo Provera||Depo Provera}} or the more recent [[孕酮|progesterone]] releasing [[IntraUterine System]] (IUS) may be used.<ref>{{Cite journal|title=Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis|last=Kaunitz|first=Andrew M.|last2=Meredith|first2=Susanna|date=2009-05-01|journal=Obstetrics and Gynecology|issue=5|doi=10.1097/AOG.0b013e3181a1d3ce|volume=113|pages=1104–1116|issn=0029-7844|pmid=19384127|last3=Inki|first3=Pirjo|last4=Kubba|first4=Ali|last5=Sanchez-Ramos|first5=Luis}}</ref><ref>{{Cite journal|title=Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial|last=Jensen|first=Jeffrey T.|last2=Parke|first2=Susanne|date=2011-04-01|journal=Obstetrics and Gynecology|issue=4|doi=10.1097/AOG.0b013e3182118ac3|volume=117|pages=777–787|issn=1873-233X|pmid=21422847|last3=Mellinger|first3=Uwe|last4=Machlitt|first4=Andrea|last5=Fraser|first5=Ian S.}}</ref> Fibroids may respond to hormonal treatment, and if they do not, then surgical removal may be required. |
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[[傳明酸]] tablets that may also reduce loss by up to 50%.<ref name="BonnarSheppard">{{cite journal|title=Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid|url=|date=September 1996|journal=BMJ|issue=7057|doi=10.1136/bmj.313.7057.579|volume=313|pages=579–82|pmc=2352023|pmid=8806245|vauthors=Bonnar J, Sheppard BL}}</ref> This may be combined with hormonal medication previously mentioned.<ref>{{Cite journal|title=Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial|last=Lukes|first=Andrea S.|last2=Moore|first2=Keith A.|date=2010-10-01|journal=Obstetrics and Gynecology|issue=4|doi=10.1097/AOG.0b013e3181f20177|volume=116|pages=865–875|issn=1873-233X|pmid=20859150|last3=Muse|first3=Ken N.|last4=Gersten|first4=Janet K.|last5=Hecht|first5=Bryan R.|last6=Edlund|first6=Måns|last7=Richter|first7=Holly E.|last8=Eder|first8=Scott E.|last9=Attia|first9=George R.}}</ref> |
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[[抗炎性|抗發炎藥物]]如[[非甾体抗炎药|NSAID]]等可以使用。NSAIDs are the first-line medications in ovulatory menorrhagia, resulting in an average reduction of 20-46% in menstrual blood flow.<ref>{{Cite journal|title=Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding|last=Lethaby|first=Anne|last2=Duckitt|first2=Kirsten|date=2013-01-01|journal=The Cochrane Database of Systematic Reviews|doi=10.1002/14651858.CD000400.pub3|volume=1|pages=CD000400|issn=1469-493X|pmid=23440779|last3=Farquhar|first3=Cindy}}</ref> For this purpose, NSAIDs are ingested for only 5 days of the menstrual cycle, limiting their most common adverse effect of [[消化不良]].<ref name="Shaw">{{cite web|url=http://emedicine.medscape.com/article/255540-treatment|title=Menorrhagia Treatment & Management|accessdate=2015-01-04|date=2014-09-29|publisher=|last1=A Shaw|first1=Julia|last2=|first2=|website={{tsl|en|Medscape||Medscape}}}}</ref> |
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A definitive treatment for menorrhagia is to perform [[子宮切除術]] (removal of the uterus). The risks of the procedure have been reduced with measures to reduce the risk of [[深静脉血栓]] after surgery, and the switch from the front abdominal to vaginal approach greatly minimizing the discomfort and recuperation time for the patient; however extensive fibroids may make the womb too large for removal by the vaginal approach. Small fibroids may be dealt with by local removal ({{tsl|en|myomectomy||myomectomy}}). A further surgical technique is {{tsl|en|endometrial ablation||endometrial ablation}} (destruction) by the use of applied heat ([[thermoablation]]).<ref>{{Cite journal|title=Endometrial resection and ablation techniques for heavy menstrual bleeding|last=Lethaby|first=Anne|last2=Penninx|first2=Josien|date=2013-01-01|journal=The Cochrane Database of Systematic Reviews|doi=10.1002/14651858.CD001501.pub4|volume=8|pages=CD001501|issn=1469-493X|pmid=23990373|last3=Hickey|first3=Martha|last4=Garry|first4=Ray|last5=Marjoribanks|first5=Jane}}</ref> |
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In the [[英国|UK]] the use of hysterectomy for menorrhagia has been almost halved between 1989 and 2003.<ref name="BMJ2005">{{cite journal|title=Trends in number of hysterectomies performed in England for menorrhagia: examination of health episode statistics, 1989 to 2002-3|url=http://bmj.com/cgi/content/full/330/7497/938|date=23 Apr 2005|journal=BMJ|issue=7497|doi=10.1136/bmj.38376.505382.AE|volume=330|pages=938–9|pmc=556338|pmid=15695496|vauthors=Reid P, Mukri F}}</ref> This has a number of causes: better medical management, endometrial ablation and particularly the introduction of IUS<ref name="JAMA-5yr">{{cite journal|title=Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up|date=24 Mar 2004|journal=JAMA|issue=12|doi=10.1001/jama.291.12.1456|volume=291|pages=1456–63|pmid=15039412|vauthors=Hurskainen R, Teperi J, Rissanen P, Aalto A, Grenman S, Kivelä A, Kujansuu E, Vuorma S, Yliskoski M, Paavonen J}}</ref><ref name="FertSteril">{{cite journal|title=Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection|date=August 2001|journal=Fertil Steril|issue=2|doi=10.1016/S0015-0282(01)01909-4|volume=76|pages=304–9|pmid=11476777|vauthors=Istre O, Trolle B}}</ref> which may be inserted in the community and avoid the need for specialist referral; in one study up to 64% of women cancelled surgery.<ref name="BJOG">{{cite journal|title=The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review|date=January 2001|journal=BJOG|issue=1|doi=10.1016/S0306-5456(00)00020-6|volume=108|pages=74–86|pmid=11213008|vauthors=Stewart A, Cummins C, Gold L, Jordan R, Phillips W}}</ref> |
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=== 藥物 === |
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These have been ranked by the UK's {{tsl|en|National Institute for Health and Clinical Excellence||National Institute for Health and Clinical Excellence}}:<ref name="NICE44-2007">{{cite web|url=http://www.nice.org.uk/guidance/cg44|title=CG44 Heavy menstrual bleeding: Understanding NICE guidance|date=24 January 2007|format=PDF|publisher={{tsl|en|National Institute for Health and Clinical Excellence||National Institute for Health and Clinical Excellence}} (UK)}}</ref> |
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* First line |
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** [[含孕激素宫内节育器]] |
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* Second Line |
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** [[傳明酸]] an antifibrinolytic agent |
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** [[非甾体抗炎药]] (NSAIDs). |
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** [[复合口服避孕药]]s to prevent proliferation of the endometrium |
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* Third line |
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** Oral progestogen (e.g. {{tsl|en|norethisterone||norethisterone}}), to prevent proliferation of the endometrium |
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** Injected progestogen (e.g. [[Depo provera]]) |
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* Other options |
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** {{tsl|en|Gonadotropin-releasing hormone agonist||Gonadotropin-releasing hormone agonist}} |
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=== 手術 === |
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* Dilation and curettage (D&C) is no longer performed for cases of simple menorrhagia, having a reserved role if a spontaneous abortion is incomplete |
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* {{tsl|en|Endometrial ablation||Endometrial ablation}} |
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* {{tsl|en|Uterine artery||Uterine artery}} {{tsl|en|embolisation||embolisation}} (UAE) |
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* Hysteroscopic {{tsl|en|myomectomy||myomectomy}} to remove fibroids over 3 cm in diameter |
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== 併發症 == |
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Aside from the social distress of dealing with a prolonged and heavy period, over time the blood loss may prove to be greater than the body iron reserves or the rate of blood replenishment, leading to [[贫血]].<ref name="ncbi.nlm.nih.gov2" /> Symptoms attributable to the anemia may include shortness of breath, tiredness, weakness, tingling and numbness in fingers and toes, headaches, depression, becoming cold more easily, and poor concentration. |
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==參見== |
==參見== |
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2017年11月19日 (日) 04:11的版本
| 經血過多 | |
|---|---|
| 类型 | 功能失调性子宫出血、reproductive system symptom[*] |
| 分类和外部资源 | |
| 醫學專科 | 婦科學 |
| ICD-11 | GA20.50 |
| ICD-10 | N92.0 |
| ICD-9-CM | 627.0 |
| DiseasesDB | 22575 |
| eMedicine | med/1449 |
| MeSH | D008595 |
經血過多（Menorrhagia）描述女性在月經期間經血量過多的情形，屬於功能失调性子宫出血的一種[1]。
非正常的子宮出血可能肇因於生殖道結構異常、無排卵、出血疾病、激素分泌異常（如甲狀腺素過低），或生殖道癌症。
治療方法依潛在原因、嚴重度。及對生活的影響程度決定[2]。治療初期常使用避孕藥調整，若症狀無法改善，則可以考慮手術治療[3]。約每1000名女性就有53名有功能失调性子宫出血的問題[4]。
症狀及徵象
正常月經週期約在21至35天之間，經期平均約5天，總出血量約為25至80 ml 之間。當單次經期總出血量超過 80 ml 時即稱經血過多[1]。但臨床上實際的經血量並不好評估，通常以兩小時內一片衛生棉或一條衛生棉條完全滲濕為標準。若經血量已干擾日常生活品質，也可以視為經血過多[5]。
貧血為經血過多的併發症，也可能以初始症狀表現。貧血會使患者虛弱、疲倦，以及呼吸急促。可以進行血液檢查以利診斷[5]。
病因
經血過多通常無法找到病因，大多採取症狀治療。下表列出目前已知可能造成不正常子宮出血的原因，必須事先排除：
考量
- 經血過多但月經週期正常：
- 短月經週期（少於21天），但經血量正常。這些通常是激素導致的無卵性月經。
- 短月經週期，且經血量過多。可能為卵巢功能異常導致，也可能是腫瘤阻塞血管所致。
- 月經量過多，且間隔過長
- 動情素分泌時間過長，導致卵巢激素失調
- 复合口服避孕药停藥
- 全身性原因：甲狀腺疾病、精神壓力
診斷
診斷需依據理學檢查、超音波診斷，以及完整藥物史判斷。如果必要可安排實驗室檢查或子宮鏡檢查。以下列表列出可以協助醫師診斷的方法：
- 骨盆腔及肛門檢查：確認出血地點是否位於下生殖道或直腸
- 子宮頸抹片：確認是否為子宮頸癌
- 盆腔超音波：確認是否有生殖道結構異常[6]
- 子宮內膜切片：排除癌症或異常增生
- 子宮鏡檢查
- 血中TSH及T4濃度：排除甲狀腺機能低下[7]
治療
如能找出原因，治療需針對根本原因下手， Where an underlying cause can be identified, treatment may be directed at this. Clearly heavy periods at 初潮 and 更年期 may settle spontaneously (the menarche being the start and menopause being the cessation of periods).
If the degree of bleeding is mild, all that may be sought by the woman is the reassurance that there is no sinister underlying cause. If anemia occurs due to bleeding then iron tablets may be used to help restore normal 血红蛋白 levels.[8]
The condition is often treated with hormones, particularly as abnormal uterine bleeding commonly occurs in the early and late menstrual years when contraception is also sought. Usually, oral 复合口服避孕药 or progesterone only pills may be taken for a few months, but for longer-term treatment the alternatives of injected Depo Provera or the more recent progesterone releasing IntraUterine System (IUS) may be used.[9][10] Fibroids may respond to hormonal treatment, and if they do not, then surgical removal may be required.
傳明酸 tablets that may also reduce loss by up to 50%.[11] This may be combined with hormonal medication previously mentioned.[12]
抗發炎藥物如NSAID等可以使用。NSAIDs are the first-line medications in ovulatory menorrhagia, resulting in an average reduction of 20-46% in menstrual blood flow.[13] For this purpose, NSAIDs are ingested for only 5 days of the menstrual cycle, limiting their most common adverse effect of 消化不良.[14]
A definitive treatment for menorrhagia is to perform 子宮切除術 (removal of the uterus). The risks of the procedure have been reduced with measures to reduce the risk of 深静脉血栓 after surgery, and the switch from the front abdominal to vaginal approach greatly minimizing the discomfort and recuperation time for the patient; however extensive fibroids may make the womb too large for removal by the vaginal approach. Small fibroids may be dealt with by local removal (myomectomy). A further surgical technique is endometrial ablation (destruction) by the use of applied heat (thermoablation).[15]
In the UK the use of hysterectomy for menorrhagia has been almost halved between 1989 and 2003.[16] This has a number of causes: better medical management, endometrial ablation and particularly the introduction of IUS[17][18] which may be inserted in the community and avoid the need for specialist referral; in one study up to 64% of women cancelled surgery.[19]
藥物
These have been ranked by the UK's National Institute for Health and Clinical Excellence:[6]
- First line
- Second Line
- Third line
- Oral progestogen (e.g. norethisterone), to prevent proliferation of the endometrium
- Injected progestogen (e.g. Depo provera)
- Other options
手術
- Dilation and curettage (D&C) is no longer performed for cases of simple menorrhagia, having a reserved role if a spontaneous abortion is incomplete
- Endometrial ablation
- Uterine artery embolisation (UAE)
- Hysteroscopic myomectomy to remove fibroids over 3 cm in diameter
併發症
Aside from the social distress of dealing with a prolonged and heavy period, over time the blood loss may prove to be greater than the body iron reserves or the rate of blood replenishment, leading to 贫血.[20] Symptoms attributable to the anemia may include shortness of breath, tiredness, weakness, tingling and numbness in fingers and toes, headaches, depression, becoming cold more easily, and poor concentration.
參見
- 經期不規則合併經血過多（Menometrorrhagia）
- 亂經（Metrorrhagia）
參考文獻
- ^ 1.0 1.1 Munro, Malcolm G.; Critchley, Hilary O. D.; Broder, Michael S.; Fraser, Ian S. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynecology & Obstetrics. 2011-04-01, 113 (1): 3–13. ISSN 1879-3479. PMID 21345435. doi:10.1016/j.ijgo.2010.11.011.
- ^ Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstetrics and Gynecology. 2013-07-01, 122 (1): 176–185. ISSN 1873-233X. PMID 23787936. doi:10.1097/01.AOG.0000431815.52679.bb.
- ^ Marjoribanks, Jane; Lethaby, Anne; Farquhar, Cindy. Surgery versus medical therapy for heavy menstrual bleeding. The Cochrane Database of Systematic Reviews. 2016-01-29, (1): CD003855. ISSN 1469-493X. PMID 26820670. doi:10.1002/14651858.CD003855.pub3.
- ^ Kjerulff KH, Erickson BA, Langenberg PW. Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992. Am J Public Health. 1996, 86: 195–9. PMC 1380327
. PMID 8633735. doi:10.2105/ajph.86.2.195.
- ^ 5.0 5.1 Approach to abnormal uterine bleeding in nonpregnant reproductive-age women. www.uptodate.com. [2017-11-19].
- ^ 6.0 6.1 CG44 Heavy menstrual bleeding: Understanding NICE guidance (PDF). National Institute for Health and Clinical Excellence (UK). 24 January 2007.
- ^ Weeks AD. Menorrhagia and hypothyroidism. Evidence supports association between hypothyroidism and menorrhagia. BMJ. 2000, 320: 649. PMC 1117669 . PMID 10698899. doi:10.1136/bmj.320.7235.649.
- ^ 引证错误：没有为名为
Munro 3–132的参考文献提供内容 - ^ Kaunitz, Andrew M.; Meredith, Susanna; Inki, Pirjo; Kubba, Ali; Sanchez-Ramos, Luis. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstetrics and Gynecology. 2009-05-01, 113 (5): 1104–1116. ISSN 0029-7844. PMID 19384127. doi:10.1097/AOG.0b013e3181a1d3ce.
- ^ Jensen, Jeffrey T.; Parke, Susanne; Mellinger, Uwe; Machlitt, Andrea; Fraser, Ian S. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial. Obstetrics and Gynecology. 2011-04-01, 117 (4): 777–787. ISSN 1873-233X. PMID 21422847. doi:10.1097/AOG.0b013e3182118ac3.
- ^ Bonnar J, Sheppard BL. Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid. BMJ. September 1996, 313 (7057): 579–82. PMC 2352023 . PMID 8806245. doi:10.1136/bmj.313.7057.579.
- ^ Lukes, Andrea S.; Moore, Keith A.; Muse, Ken N.; Gersten, Janet K.; Hecht, Bryan R.; Edlund, Måns; Richter, Holly E.; Eder, Scott E.; Attia, George R. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstetrics and Gynecology. 2010-10-01, 116 (4): 865–875. ISSN 1873-233X. PMID 20859150. doi:10.1097/AOG.0b013e3181f20177.
- ^ Lethaby, Anne; Duckitt, Kirsten; Farquhar, Cindy. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. The Cochrane Database of Systematic Reviews. 2013-01-01, 1: CD000400. ISSN 1469-493X. PMID 23440779. doi:10.1002/14651858.CD000400.pub3.
- ^ A Shaw, Julia. Menorrhagia Treatment & Management. Medscape. 2014-09-29 [2015-01-04].
- ^ Lethaby, Anne; Penninx, Josien; Hickey, Martha; Garry, Ray; Marjoribanks, Jane. Endometrial resection and ablation techniques for heavy menstrual bleeding. The Cochrane Database of Systematic Reviews. 2013-01-01, 8: CD001501. ISSN 1469-493X. PMID 23990373. doi:10.1002/14651858.CD001501.pub4.
- ^ Reid P, Mukri F. Trends in number of hysterectomies performed in England for menorrhagia: examination of health episode statistics, 1989 to 2002-3. BMJ. 23 Apr 2005, 330 (7497): 938–9. PMC 556338 . PMID 15695496. doi:10.1136/bmj.38376.505382.AE.
- ^ Hurskainen R, Teperi J, Rissanen P, Aalto A, Grenman S, Kivelä A, Kujansuu E, Vuorma S, Yliskoski M, Paavonen J. Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up. JAMA. 24 Mar 2004, 291 (12): 1456–63. PMID 15039412. doi:10.1001/jama.291.12.1456.
- ^ Istre O, Trolle B. Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection. Fertil Steril. August 2001, 76 (2): 304–9. PMID 11476777. doi:10.1016/S0015-0282(01)01909-4.
- ^ Stewart A, Cummins C, Gold L, Jordan R, Phillips W. The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review. BJOG. January 2001, 108 (1): 74–86. PMID 11213008. doi:10.1016/S0306-5456(00)00020-6.
- ^ 引证错误：没有为名为
ncbi.nlm.nih.gov2的参考文献提供内容
延伸閱讀
- Continuous Identification of Research Evidence (collaborative of the WHO, and US CDC & Johns Hopkins Hospital) - Search of Evidence about the IUS
- Abnormal vaginal bleeding National Guideline Clearinghouse
- Menorrhagia - Menstrual Abnormalities and Abnormal Uterine Bleeding Menstrual Abnormalities and Abnormal Uterine Bleeding - Armenian Medical Network
- Abnormal uterine bleeding/dysfunctional uterine bleeding. Intracorp - Public For Profit Organization. 2005. Various pagings. NGC:004390
- Working group on inherited bleeding disorders rbdd - Rare Bleeding Disorders database
- Project Red Flag Information About Women and Bleeding Disorders
- [1] Adenomyosis Information from MayoClinic.com
- Working group on menorrhagia Menorrhagia and other gynaecological problems in women affected by bleeding disorders
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