经血过多
经血过多 | |
---|---|
类型 | 功能失调性子宫出血、reproductive system symptom[*] |
分类和外部资源 | |
医学专科 | 妇科学 |
ICD-11 | GA20.50 |
ICD-10 | N92.0 |
eMedicine | 255540 |
经血过多(Menorrhagia)描述女性在月经期间经血量过多的情形,属于功能失调性子宫出血的一种[1]。
非正常的子宫出血可能肇因于生殖道结构异常、无排卵、出血疾病、激素分泌异常(如甲状腺素过低),或生殖道癌症。
治疗方法依潜在原因、严重度。及对生活的影响程度决定[2]。治疗初期常使用避孕药调整,若症状无法改善,则可以考虑手术治疗[3]。约每1000名女性就有53名有功能失调性子宫出血的问题[4]。
症状及征象
[编辑]正常月经周期约在21至35天之间,经期平均约5天,总出血量约为25至80 ml 之间。当单次经期总出血量超过 80 ml 时即称经血过多[1]。但临床上实际的经血量并不好评估,通常以两小时内一片卫生棉或一条卫生棉条完全渗湿为标准。若经血量已干扰日常生活品质,也可以视为经血过多[5]。
贫血为经血过多的并发症,也可能以初始症状表现。贫血会使患者虚弱、疲倦,以及呼吸急促。可以进行血液检查以利诊断[5]。
病因
[编辑]经血过多通常无法找到病因,大多采取症状治疗。下表列出目前已知可能造成不正常子宫出血的原因,必须事先排除:
考量
[编辑]- 经血过多但月经周期正常:
- 短月经周期(少于21天),但经血量正常。这些通常是激素导致的无卵性月经。
- 短月经周期,且经血量过多。可能为卵巢功能异常导致,也可能是肿瘤阻塞血管所致。
- 月经量过多,且间隔过长
- 动情素分泌时间过长,导致卵巢激素失调
- 复合口服避孕药停药
- 全身性原因:甲状腺疾病、精神压力
诊断
[编辑]诊断需依据理学检查、超声波诊断,以及完整药物史判断。如果必要可安排实验室检查或子宫镜检查。以下列表列出可以协助医师诊断的方法:
- 骨盆腔及肛门检查:确认出血地点是否位于下生殖道或直肠
- 子宫颈抹片:确认是否为子宫颈癌
- 盆腔超声波:确认是否有生殖道结构异常[6]
- 子宫内膜切片:排除癌症或异常增生
- 子宫镜检查
- 血中TSH及T4浓度:排除甲状腺机能低下[7]
治疗
[编辑]如果没有排除恶性肿瘤的可能性,不建议开始进行治疗。未经评估过的经验疗法可能导致忽略恶性肿瘤。如能找出原因,治疗需针对根本原因下手。初潮和更年期若有经血过多的情形,可再继续观察,日后可能会自行改善。
若出血情形不严重,仅需再检查是否有恶性病变可能,若有贫血情形可补充口服铁剂[1]。
经血过多一般由避孕药等激素治疗,特别是初潮或更年期前后的出血症状。一般来说,复合口服避孕药或纯黄体素可以服用几个月。但更长期的治疗可考虑注射长效性醋酸甲羟孕酮,或置入含黄体素的子宫内避孕器[8][9]。子宫肌瘤也可以使用贺尔蒙治疗,但若没有效果,则可以考虑手术摘除。
口服传明酸最多可减轻50%的出血[10]。可与前文提到的激素类药物合并使用[11]。
抗发炎药物如NSAID等可以使用。NSAID为有卵月经出血过多的第一线用药,可减少20-46%的经血量[12]。此类药品仅建议在月经来的五天给予,以避免消化不良等副作用[13]。
子宫切除术可完全根除经血过多的情形,过去常发生的深静脉血栓风险已大幅下降。经阴道子宫切除术比起过往的经腹手术能大幅减少不适恢复时间,然而子宫肌瘤可能造成子宫过大,若小型的肌瘤可执行局部切除。现今则有子宫内膜烧灼术[14]。
在英国,因经血过多执行的子宫切除术比例已大幅下降[15]。可能是因为子宫内膜烧灼术和含黄体素的子宫内避孕器的发展[16][17]。
药物
[编辑]本用药指引来自英国英国国家健康与照顾卓越研究院(NICE):[6]
- 第一线
- 第二线
- 第三线
- 其他选择
手术
[编辑]参见
[编辑]- 经期不规则合并经血过多(Menometrorrhagia)
- 乱经(Metrorrhagia)
参考文献
[编辑]- ^ 1.0 1.1 1.2 Munro, Malcolm G.; Critchley, Hilary O. D.; Broder, Michael S.; Fraser, Ian S.; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. 2011-04, 113 (1): 3–13 [2022-01-14]. ISSN 1879-3479. PMID 21345435. doi:10.1016/j.ijgo.2010.11.011. (原始内容存档于2022-02-26).
- ^ Practice Bulletin No. 136: Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction. Obstetrics & Gynecology. 2013-07, 122 (1): 176–185. ISSN 0029-7844. PMID 23787936. doi:10.1097/01.AOG.0000431815.52679.bb (英语).
- ^ Marjoribanks, Jane; Lethaby, Anne; Farquhar, Cindy. Cochrane Gynaecology and Fertility Group , 编. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database of Systematic Reviews. 2016-01-29. PMC 7104515
. PMID 26820670. doi:10.1002/14651858.CD003855.pub3 (英语).
- ^ Kjerulff, K H; Erickson, B A; Langenberg, P W. Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992.. American Journal of Public Health. 1996-02, 86 (2): 195–199 [2022-01-14]. ISSN 0090-0036. PMC 1380327
. PMID 8633735. doi:10.2105/AJPH.86.2.195. (原始内容存档于2022-01-14) (英语).
- ^ 5.0 5.1 Approach to abnormal uterine bleeding in nonpregnant reproductive-age women. www.uptodate.com. [2017-11-19]. (原始内容存档于2017-12-01).
- ^ 6.0 6.1 CG44 Heavy menstrual bleeding: Understanding NICE guidance (PDF). National Institute for Health and Clinical Excellence (UK). 24 January 2007 [2017-11-19]. (原始内容存档于2017-07-11).
- ^ Weeks, A. D. Menorrhagia and hypothyroidism. BMJ. 2000-03-04, 320 (7235): 649–649. PMC 1117669
. PMID 10698899. doi:10.1136/bmj.320.7235.649.
- ^ 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 & Gynecology. 2009-05, 113 (5): 1104–1116. ISSN 0029-7844. PMID 19384127. doi:10.1097/AOG.0b013e3181a1d3ce (英语).
- ^ 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 & Gynecology. 2011-04, 117 (4): 777–787. ISSN 0029-7844. PMID 21422847. doi:10.1097/AOG.0b013e3182118ac3 (英语).
- ^ Bonnar, J.; Sheppard, B. L. Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid. BMJ. 1996-09-07, 313 (7057): 579–582. ISSN 0959-8138. PMC 2352023
. PMID 8806245. doi:10.1136/bmj.313.7057.579 (英语).
- ^ 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 & Gynecology. 2010-10, 116 (4): 865–875. ISSN 0029-7844. PMID 20859150. doi:10.1097/AOG.0b013e3181f20177 (英语).
- ^ Lethaby, Anne; Duckitt, Kirsten; Farquhar, Cindy. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. The Cochrane Database of Systematic Reviews. 2013-01-31, (1): CD000400 [2022-01-14]. ISSN 1469-493X. PMID 23440779. doi:10.1002/14651858.CD000400.pub3. (原始内容存档于2022-02-09).
- ^ A Shaw, Julia. Menorrhagia Treatment & Management. Medscape. 2014-09-29 [2015-01-04]. (原始内容存档于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. 2013-08-30, (8): CD001501 [2022-01-14]. ISSN 1469-493X. PMID 23990373. doi:10.1002/14651858.CD001501.pub4. (原始内容存档于2022-01-14).
- ^ Reid, Peter C; Mukri, Faizah. Trends in number of hysterectomies performed in England for menorrhagia: examination of health episode statistics, 1989 to 2002-3. BMJ. 2005-04-23, 330 (7497): 938–939. ISSN 0959-8138. PMC 556338
. PMID 15695496. doi:10.1136/bmj.38376.505382.AE (英语).
- ^ Hurskainen, Ritva; Teperi, Juha; Rissanen, Pekka; Aalto, Anna-Mari; Grenman, Seija; Kivelä, Aarre; Kujansuu, Erkki; Vuorma, Sirkku; Yliskoski, Merja. Clinical Outcomes and Costs With the Levonorgestrel-Releasing Intrauterine System or Hysterectomy for Treatment of Menorrhagia: Randomized Trial 5-Year Follow-up. JAMA. 2004-03-24, 291 (12): 1456. ISSN 0098-7484. PMID 15039412. doi:10.1001/jama.291.12.1456 (英语).
- ^ Istre, Olav; Trolle, Birgitta. Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection. Fertility and Sterility. 2001-08, 76 (2): 304–309 [2022-01-14]. PMID 11476777. doi:10.1016/S0015-0282(01)01909-4. (原始内容存档于2022-01-20) (英语).
延伸阅读
[编辑]- 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 (页面存档备份,存于互联网档案馆) Menstrual Abnormalities and Abnormal Uterine Bleeding - Armenian Medical Network
- Abnormal uterine bleeding/dysfunctional uterine bleeding. (页面存档备份,存于互联网档案馆) Intracorp - Public For Profit Organization. 2005. Various pagings. NGC:004390
- Working group on inherited bleeding disorders (页面存档备份,存于互联网档案馆) rbdd - Rare Bleeding Disorders database
- Project Red Flag Information About Women and Bleeding Disorders
- Adenomyosis Information (页面存档备份,存于互联网档案馆) from MayoClinic.com
- Working group on menorrhagia (页面存档备份,存于互联网档案馆) Menorrhagia and other gynaecological problems in women affected by bleeding disorders
外部链接
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