經血過多

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(重定向自子宫出血
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經血過多
分类和外部资源
醫學專科 婦科學
ICD-10 N92.0
ICD-9-CM 627.0
DiseasesDB 22575
eMedicine med/1449
Patient UK 經血過多
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、無排卵英语anovulation、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[编辑]

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[编辑]

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[编辑]


診斷[编辑]

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[编辑]

如果沒有排除惡性腫瘤的可能性,不建議開始進行治療。未經評估過的經驗療法可能導致忽略惡性腫瘤。如能找出原因,治療需針對根本原因下手。初潮更年期若有經血過多的情形,可再繼續觀察,日後可能會自行改善。

若出血情形不嚴重,僅需再檢查是否有惡性病變可能,若有貧血情形可補充口服鐵劑[1]

經血過多一般由避孕藥等激素治療,特別是初潮或更年期前後的出血症狀。一般來說,复合口服避孕药純黃體素英语Progesterone only pill可以服用幾個月。但更長期的治療可考慮注射長效性醋酸甲羥孕酮,或置入含黃體素的子宮內避孕器[8][9]。子宮肌瘤也可以使用賀爾蒙治療,但若沒有效果,則可以考慮手術摘除。

口服傳明酸最多可減輕50%的出血[10]。可與前文提到的激素類藥物合併使用[11]

抗發炎藥物NSAID等可以使用。NSAID為有卵月經出血過多的第一線用藥,可減少20-46%的經血量[12]。此類藥品僅建議在月經來的五天給予,以避免消化不良等副作用[13]

子宮切除術可完全根除經血過多的情形,過去常發生的深静脉血栓風險已大幅下降。經陰道子宮切除術比起過往的經腹手術能大幅減少不適恢復時間,然而子宮肌瘤可能造成子宮過大,若小型的肌瘤可執行局部切除。現金則有子宮內膜燒灼術英语endometrial ablation[14]

在英國,因經血過多執行的子宮切除術比例已大幅下降[15]。可能是因為子宮內膜燒灼術英语endometrial ablation和含黃體素的子宮內避孕器的發展[16][17]

藥物[编辑]

本用藥指引來自英國英國國家健康與照顧卓越研究院英语National Institute for Health and Clinical Excellence(NICE):[6]

手術[编辑]

參見[编辑]

參考文獻[编辑]

  1. ^ 1.0 1.1 1.2 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. 
  2. ^ 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. 
  3. ^ 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. 
  4. ^ 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. ^ 5.0 5.1 Approach to abnormal uterine bleeding in nonpregnant reproductive-age women. www.uptodate.com. [2017-11-19]. 
  6. ^ 6.0 6.1 CG44 Heavy menstrual bleeding: Understanding NICE guidance (PDF). National Institute for Health and Clinical Excellence英语National Institute for Health and Clinical Excellence (UK). 24 January 2007. 
  7. ^ 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. 
  8. ^ 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. 
  9. ^ 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. 
  10. ^ 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. 
  11. ^ 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. 
  12. ^ 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. 
  13. ^ A Shaw, Julia. Menorrhagia Treatment & Management. Medscape英语Medscape. 2014-09-29 [2015-01-04]. 
  14. ^ 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. 
  15. ^ 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. 
  16. ^ 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. 
  17. ^ 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. 

延伸閱讀[编辑]