Sangrado que dura más de 8 días. • Ciclos menstruales que duran más de 38 días o menos de 24 días. Sangrado uterino anormal. The American College of. PDF Download PDF. Members Only. 3. Sangrado uterino anormal sexuales • Sangrado intenso durante el período menstrual — Sangrado que empapa uno o . O sangramento vaginal anormal pode ser relacionado à menstruação (por exemplo, menorragia) ou não relacionado a ela (por exemplo, sangramento.
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O sangramento uterino anormal é uma afecção frequente que pode afetar negativa- mente aspectos físicos gramento uterino anormal, tanto na fase aguda quanto na crônica. A apresentação edingpdf. O sangramento uterino anormal é uma afecção frequente que pode afetar negativamente aspectos físicos, emocionais, sexuais e profissionais. Tratamento do sangramento uterino anormal: uma análise sob a perspectiva dos custos no Sistema Único de Saúde e da medicina suplementarTreatment of.
The most common adverse effects related to the human papillomavirus vaccine were effects with no severity pain, erythema, edema, and fever. Conclusions: The recombinant human papillomavirus types 6, 11, 16 and 18 vaccine was safe and well tolerated. The main adverse effects related to vaccination were pain, erythema, edema and fever. The low frequency of severe adverse effects encourages the administration of the vaccine in the population at risk.
Keywords: Papillomavirus vaccines, Adverse effects, Adolescent, Meta-analysis, Safety Introduction Cervical cancer is the second most common type of cancer that affects women worldwide, with an incidence of approximately , cases and , deaths each year.
The infection may be transient and not clinically detectable, but can also cause genital warts and a variety of pre-malignant and malignant anogenital lesions in both genders. Studies indicate a very similar safety profile for severe and mild adverse effects for each one of the vaccines. Concerns about the adverse effects is considered a barrier to vaccination and one of the reasons for low adherence to the recommendations for human papillomavirus quadrivalent types 6, 11, 16, 18 recombinant vaccine administration.
Several debates have been carried out with persistent controversies about the advantages and disadvantages of its use. Therefore, the knowledge of the possible local and systemic adverse effects can subsidize adherence strategies and guide health care actions for the population at risk. Therefore, the objective of this study is to identify and quantify the adverse effects associated with the administration of the human papillomavirus quadrivalent types 6, 11, 16, 18 recombinant vaccine, as a tool to determine the safety of its use in adolescents.
Injectable progestogen There is no conclusive evidence for the use of depot injectable progestogen medroxyprogesterone acetate mg for IM use every 3 months in AUB.
The side effects often lead to discontinuation of the use, mainly due to irregular bleeding, weight gain, and headache. The LNG-IUS releases 20 mcg of levonorgestrel daily, resulting, through several mechanisms, in endometrial atrophy with reduced bleeding. It is considered more effective than the oral treatments for AUB control. The most commonly reported adverse effect is the occurrence of unexpected bleeding, which is more frequent within the first months of use.
In this situation, the use of tranexamic acid or anti-inflammatory drugs can bring benefits. Regarding hysterectomy, even considering irregular bleedings with the LNG-IUS, the literature shows similar satisfaction rates for these treatments. After extensive evaluation of the current literature, they concluded no therapy can be recommended with confirmed efficacy based on high-quality scientific evidence.
At the end of the study, compared with the placebo, they found a reduction in the time the bleeding stopped with the combination of tranexamic acid, and mifepristone combined with estrogen and doxycycline, even though it was weak evidence based on three small studies.
It is particularly indicated for women who do not wish to use hormones or who have contraindications to use them, and those who want to get pregnant. Antifibrinolytics Studies have shown women with increased menstrual flow may have the fibrinolytic system activated during menstruation with accelerated degradation of the fibrin clot formed to contain the bleeding.
Medications acting by reducing fibrinolysis may reduce bleeding.
Tranexamic acid medication is often indicated in these cases. Since its market launch, it has been prescribed for women with hemophilia, Von Willebrand disease, Glanzmann's thrombasthenia, and AUB with good results. However, there are still questions regarding the dose and the contraindications.
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Tranexamic acid is an antifibrinolytic with a short half-life, and according to different literature sources, it should be used 3 to 4 times a day with a variable recommended dose: 39 D Swedish Medical Products Agency MPA : 1 to 1. All of these recommendations are for use in days of bulky bleeding.
The side effects are few and related to gastrointestinal symptoms. History of thromboembolism or renal failure are contraindications to tranexamic acid. Studies comparing normal and increased bleeding have shown that increased inflammation in the endometrium is associated with increased blood loss during menstruation, serving as basis for the indication of NSAIDs in the treatment of AUB, since they limit the production of inflammatory mediators.
They can also be used alone or as an adjunctive therapy for the hormonal treatment. It should be used during menstruation, and has the benefit of reducing dysmenorrhea.
The most common side effects are related to gastrointestinal symptoms, so it should be avoided in women with a history of ulcer.
Anti-inflammatories were also compared with Danazol, which causes greater bleeding reduction, but has more obvious side effects. The same review compared mefenamic acid with naproxen, and found no difference between the two. If the control is adequate, the use can be maintained. Other therapeutic options Gonadotropin-releasing hormone analogs may be considered prior to surgery, in myomas, for example, particularly to enable the recovery of the organism and a reduction in volume. They are used when other hormonal methods are contraindicated, for a short period of time until the conditions for surgery are adequate.
It is necessary to consider the costs and frequent side effects. Evidences for the use of desmopressin in AUB are scarce and still inconclusive for its recommendation.
Among the forms of surgical treatment, there are endometrial ablation and hysterectomy.
Endometrial ablation The development of hysteroscopic techniques for endometrial ablation inaugurated the phase of the conservative treatment of AUBs without structural lesion, constituting a less invasive alternative to hysterectomy. The purpose of this technique is to promote the destruction of the endometrium with damage in its basal layer, hence preventing its regeneration.
There are several methods of endometrial destruction laser, vaporization, thermal balloon, cryoablation, microwave ablation, bipolar radiofrequency. Currently, endometrial ablation is classified as first generation hysteroscopic route or second generation non-hysteroscopic route performed with thermal balloons.
Although newer techniques are easier to perform than traditional techniques based on hysteroscopy, they all have similar results.
However, some require special equipment and specific training, making their routine performance difficult. Both endometrial ablation and hysterectomy are effective procedures in the treatment of AUB, with high satisfaction rates. Although hysterectomy is associated with a longer surgical time, longer recovery period and higher rates of postoperative complications, it offers better and more definitive results for the treatment of AUB.
In turn, the cost of endometrial ablation is significantly lower than that of hysterectomy, but repetition of the surgical procedure is often necessary, and, therefore, the difference in cost narrows over time.
In randomized studies comparing hysterectomy with endometrial ablation, higher satisfaction rates among women undergoing hysterectomy were found. However, the analysis of the high costs of the surgical treatment, the prolonged time away from daily activities, the risk of infection, and the surgical complications results in the recommendation of this method uniquely for cases in which all therapeutic alternatives have failed, and when the patient no longer wants children.
Women's Health Care Physicians
In some cases, blood transfusion may be necessary. At the same time, it is essential to stop the bleeding. In the literature, there are different schemes with this indication. The following medications should be considered: Intravenous estrogen; Multidose monophasic combined oral contraceptive; Multidose oral progestogen; and Tranexamic acid. Using high doses of intravenous estrogen causes rapid growth of the endometrium, stimulates the contraction of the uterine arteries, and promotes platelet aggregation and coagulation.
Unfortunately, currently there is no estrogen available for intravenous use in Brazil. Thus, we use the other hormonal options, as explained below. Theoretically, all combined oral contraceptives can be used to treat the acute form of AUB, but the amount of evidence in the literature is relatively restricted.
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Medroxyprogesterone acetate 20 mg may be used 3 times a day for a week followed by a daily dose for 3 weeks. After controlling bleeding and maintaining the therapy at smaller doses for a time similar to that of a menstrual cycle, discuss the need to maintain control of the cycle with medication for three consecutive months, and proceed with the etiological investigation.
Other options suggested in the literature are the use of a GnRH antagonist associated with an aromatase inhibitor or a GnRH antagonist to prevent initial stimulation by the release of estrogen. Intrauterine tamponade can also be considered, using the Foley probe with an inflated balloon with 3—10 mL. The use of antifibrinolytic substances, such as tranexamic acid, may greatly aid in the control of bulky bleeding, usually used adjunctively and associated with other alternatives.
If there is acute bleeding with impairment of the patient's general condition, her hemodynamic stabilization should be prioritized, followed by the immediate start of treatment, whether clinical or surgical, even if the bleeding cause is not completely established, ruling out only vaginal and cervical lesions and pregnancy.
In cases of AUB without systemic repercussion, identifying the cause of the bleeding is mandatory before the start of treatment.
Considering the main diagnosis of this clinical manifestation, pregnancy and the presence of vaginal and cervical lesions should be excluded by physical examination.
Afterwards, an evaluation of the uterine cavity by imaging exams should be performed to identify the presence of organic lesions in the endometrial cavity. In the presence of endometrial lesions such as endometrial polyps and submucosal leiomyomas, surgical treatment may be indicated.
The only definitive treatment for adenomyosis is hysterectomy, but the control of symptoms by medical drug treatment is not rare.
In cases of intramural myomas, with an increase of uterine bleeding, the first therapeutic option is pharmacological, and there may be an improvement in the bleeding in some cases, avoiding an unnecessary surgical procedure.
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If there is no response to the clinical treatment, surgical treatment should be recommended. The surgical access route and type of surgery will depend on the number, location and size of the myoma, and the patient's desire for pregnancy.
If there is an AUB of non-structural cause, clinical treatment is always the first option. The main therapeutic options are described in Table 2 If there is no response to the clinical treatment in bleedings of non-structural cause, there are also surgical therapeutic options, such as endometrial ablation by thermal balloon or hysteroscopy , or even hysterectomy.
среда, 9 марта 2016 г.
The various therapeutic options available for the treatment of AUB should be used rationally to allow their control, leaving surgical procedures for specific situations and avoiding unnecessary surgical procedures. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years.
Fertil Steril ; 95 07 , Comparison of transvaginal ultrasonography and hysteroscopy in the diagnosis of uterine pathologies. A systematic review of transvaginalultrasonography,sonohysterographyandhysteroscopy fortheinvestigationofabnormaluterinebleedinginpremenopausal women.
Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women. Adenomyosis and abnormal uterine bleeding AUB-A pathogenesis, diagnosis, and management. Hysteroscopy and treatment of uterine polyps. Uterine fibroid management: from the present to the future.This is an open-access article distributed under the terms of the Creative Commons Attribution License Av.
Oral contraceptive pills for heavy menstrual bleeding. 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. Afterwards, an evaluation of the uterine cavity by imaging exams should be performed to identify the presence of organic lesions in the endometrial cavity. Published by Elsevier Editora Ltda This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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The main adverse effects related to vaccination were pain, erythema, edema and fever. After controlling bleeding and maintaining the therapy at smaller doses for a time similar to that of a menstrual cycle, discuss the need to maintain control of the cycle with medication for three consecutive months, and proceed with the etiological investigation. NICE says hysterectomy must be last option for heavy menstrual bleeding.
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