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American Journal of Hematology Jul 2005The reported prevalence of von Willebrand's disease (vWD) is increased in women with menorrhagia, with current estimates ranging from 5% to 20%. The consistent results... (Review)
Review
The reported prevalence of von Willebrand's disease (vWD) is increased in women with menorrhagia, with current estimates ranging from 5% to 20%. The consistent results of multiple studies suggest testing should be included in the evaluation of patients with menorrhagia, especially in unexplained cases and prior to surgical intervention. Although a cyclic variation in von Willebrand's factor levels has not been confirmed, several studies suggest lower levels during menses and the early follicular phase. Menorrhagia is one of the most common bleeding manifestations of von Willebrand's disease, reported by 60-95% of women afflicted with this bleeding disorder. Menorrhagia is typically severe, often resulting in anemia and interfering with quality of life. Despite the frequency of menorrhagia, there is no consensus on optimal management. Although oral contraceptives are frequently prescribed, there are no studies confirming their efficacy using objective measures of response. Desmopressin was associated with an 80-92% response rate in several uncontrolled studies relying on patient assessment of efficacy. However, a small, randomized trial found no significant reduction in menstrual blood flow compared with placebo. There are anecdotal reports of the successful use of antifibrinolytic agents alone and in combination with other therapies. There are no studies comparing the relative efficacy and safety of the available medical therapies for von Willebrand's disease associated menorrhagia. Until these studies are completed, treatment should be individualized based on von Willebrand's disease subtype, patient age, contraceptive needs, and personal preference.
Topics: Diagnosis, Differential; Disease Management; Female; Humans; Menorrhagia; Prevalence; von Willebrand Diseases
PubMed: 15981234
DOI: 10.1002/ajh.20372 -
JSLS : Journal of the Society of... 2015Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to...
BACKGROUND AND OBJECTIVES
Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to describe the experience of adolescents who underwent laparoscopy for pelvic pain and were diagnosed with endometriosis: specifically, the symptoms, time from onset of symptoms to correct diagnosis, number and type of medical professionals seen, diagnosis, treatment, and postoperative outcomes.
METHODS
We reviewed a series of 25 females ≤21 years of age with endometriosis diagnosed during laparoscopy for pelvic pain over an 8-year period. These patients were followed up for 1 year after surgery.
RESULTS
The mean age at the time of surgery was 17.2 (2.4) years (range, 10-21). The most common complaints were dysmenorrhea (64%), menorrhagia (44%), abnormal/irregular uterine bleeding (60%), ≥1 gastrointestinal symptoms (56%), and ≥1 genitourinary symptoms (52%). The mean time from the onset of symptoms until diagnosis was 22.8 (31.0) months (range, 1-132). The median number of physicians who evaluated their pain was 3 (2.3) (range, 1-12). The adolescents had stage I (68%), stage II (20%), and stage III (12%) disease. Atypical endometriosis lesions were most commonly observed during laparoscopy. At 1 year, 64% reported resolved pain, 16% improved pain, 12% continued pain, and 8% recurrent pain.
CONCLUSIONS
Timely referral to a gynecologist experienced with laparoscopic diagnosis and treatment of endometriosis is critical to expedite care for adolescents with pelvic pain. Once the disease is diagnosed and treated, these patients have favorable outcomes with hormonal and nonhormonal therapy.
Topics: Adolescent; Adult; Dysmenorrhea; Endometriosis; Female; Follow-Up Studies; Humans; Laparoscopy; Menorrhagia; Pelvic Pain; Referral and Consultation; Retrospective Studies; Young Adult
PubMed: 26005317
DOI: 10.4293/JSLS.2015.00019 -
Acta Obstetricia Et Gynecologica... May 2003Menorrhagia is defined as a 'complaint of heavy cyclical menstrual bleeding occurring over several consecutive cycles'. Objectively it is a total menstrual blood loss... (Review)
Review
Menorrhagia is defined as a 'complaint of heavy cyclical menstrual bleeding occurring over several consecutive cycles'. Objectively it is a total menstrual blood loss equal to or greater than 80 ml per menstruation. It is estimated that approximately 30% of women complain of menorrhagia. Excessive bleeding is the main presenting complaint in women referred to gynecologists and it accounts for two-thirds of all hysterectomies, and most of endoscopic endometrial destructive surgery. Thus, menorrhagia is an important healthcare problem. Its etiology, investigation, medical and surgical management are described. In approximately 50% of cases of menorrhagia no pathology is found at hysterectomy. Abnormal levels of prostaglandins or the fibrinolytic system in the endometrium have been implicated. Effective medical treatments suitable for long-term use include intrauterine progestogens, antifibrinolytic agents (tranexamic acid) and nonsteroidal anti-inflammatory agents (mefenamic acid). Over the past decade there has been increasing use of endometrial destructive techniques as an alternative to hysterectomy. Their further refinement and the advent of fibroid embolization has increased the options available to women.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Antifibrinolytic Agents; Contraceptives, Oral, Combined; Endometrium; Female; Humans; Hysterectomy; Hysteroscopy; Menorrhagia; Menstruation; Progestins
PubMed: 12752071
DOI: 10.1034/j.1600-0412.2003.00097.x -
Taiwanese Journal of Obstetrics &... Oct 2015Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a "complaint of a large amount of bleeding during menstrual cycles that occurs over several... (Review)
Review
Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a "complaint of a large amount of bleeding during menstrual cycles that occurs over several consecutive cycles" and is objectively defined as menstrual blood loss of more than 80 mL per cycle that is associated with an anemia status (defined as a hemoglobin level of <10 g/dL). During their reproductive age, more than 30% of women will complain of or experience a heavy amount of bleeding, which leads to a debilitating health outcome, including significantly reduced health-related quality of life, and a considerable economic burden on the health care system. Although surgical treatment might be the most important definite treatment, especially hysterectomy for those women who have finished bearing children, the uterus is still regarded as the regulator and controller of important physiological functions, a sexual organ, a source of energy and vitality, and a maintainer of youth and attractiveness. This has resulted in a modern trend in which women may reconsider the possibility of organ preservation. For women who wish to retain the uterus, medical treatment may be one of the best alternatives. In this review, recent trends in the management of women with heavy menstrual bleeding are discussed.
Topics: Antifibrinolytic Agents; Female; Hemostatic Techniques; Humans; Hysterectomy; Menorrhagia; Pregnancy; Severity of Illness Index; Treatment Outcome
PubMed: 26522096
DOI: 10.1016/j.tjog.2015.08.001 -
British Medical Journal Feb 1953
Topics: Female; Humans; Menorrhagia; Metrorrhagia; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Radioactivity
PubMed: 13009221
DOI: No ID Found -
The Western Journal of Medicine Nov 1998Abnormal uterine bleeding is a common, debilitating condition. Dysfunctional uterine bleeding (DUB) is the diagnosis given to women with abnormal uterine bleeding in... (Review)
Review
Abnormal uterine bleeding is a common, debilitating condition. Dysfunctional uterine bleeding (DUB) is the diagnosis given to women with abnormal uterine bleeding in whom no clear etiology can be identified. DUB has been observed in both ovulatory and anovulatory cycles. Medical treatments include nonsteroidal anti-inflammatory drugs, oral contraceptive pills, progestins, danazol (a synthetic androgen), GnRH agonists, and antifibrinolytic drugs. The drawback to medical therapy, in addition to side effects, is that the benefit lasts only while the patient takes the medication. Surgical options have concentrated mainly on endometrial ablation and hysterectomy, and it is unclear whether one is superior to the other in terms of long-term outcome and patient satisfaction. Newer and less invasive ablation techniques, such as thermal balloon ablation, offer more treatment alternatives.
Topics: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Antifibrinolytic Agents; Contraceptives, Oral; Danazol; Endometrium; Estrogen Antagonists; Female; Gonadotropin-Releasing Hormone; Humans; Hysterectomy; Menorrhagia; Middle Aged; Ovulation; Patient Satisfaction; Progestins; Treatment Outcome
PubMed: 9830356
DOI: No ID Found -
Journal of Thrombosis and Haemostasis :... Jul 2007Historically, the pathogenesis of menorrhagia has focused on anatomic and hormonal etiologies. However, in the past decade, numerous epidemiological studies have... (Review)
Review
Historically, the pathogenesis of menorrhagia has focused on anatomic and hormonal etiologies. However, in the past decade, numerous epidemiological studies have confirmed an association of von Willebrand factor (VWF) deficiency and menorrhagia with an incidence of VWF deficiency of 13% (95% CI, 11%, 16%). Such patients have a reduced quality of life and incur a high rate of seemingly unnecessary gynecological interventions. In addition, it appears that platelet function abnormalities are c. 3- to 4-fold more common than VWF deficiency in association with menorrhagia. The management of menorrhagia with an underlying disorder of hemostasis involves consideration of the patient's age, childbearing status and preference in terms of several options: hemostatic (oral tranexamic acid, intranasal desmopressin), hormonal (oral contraceptive, levonorgestrel intrauterine system) and surgical (endometrial ablation, hysterectomy). Pending ongoing comparative trials in bleeding disorder-related menorrhagia of intranasal desmopressin (DDAVP), tranexamic acid and further study of the levonorgestrel intrauterine device, specific recommendations cannot be made at present regarding whether one intervention is superior to the other. It should also be noted that the dose and schedule and combination of intranasal DDAVP and tranexamic acid have not been well established and warrant further study. It is imperative to establish algorithms of effective menorrhagia interventions in order to justify widespread hemostasis screening of the menorrhagia patient.
Topics: Blood Coagulation Disorders; Female; Hematologic Tests; Hemostasis; Humans; Menorrhagia; Prevalence
PubMed: 17635724
DOI: 10.1111/j.1538-7836.2007.02494.x -
JSLS : Journal of the Society of... 2017For conservative surgical treatment of focal uterine adenomyosis, laparoscopic adenomyomectomy has been increasingly performed, so that reassessment to determine the...
BACKGROUND AND OBJECTIVES
For conservative surgical treatment of focal uterine adenomyosis, laparoscopic adenomyomectomy has been increasingly performed, so that reassessment to determine the safety and efficacy of the laparoscopic surgical technique in a larger number of cases and reevaluation for reproducibility for laparoscopic adenomyomectomy is needed. We evaluate the clinical outcomes of laparoscopic adenomyomectomy with transient occlusion of uterine arteries (TOUA) for focal uterine adenomyosis performed by a single surgeon at a single institute.
METHODS
Patients (N = 105) with symptomatic focal uterine adenomyosis underwent laparoscopic adenomyomectomy with TOUA by a single surgeon at Ulsan University Hospital from May 1, 2011, through September 30, 2016. Surgical outcomes included operative time; intraoperative injury to blood vessels, nerves, and pelvic organs; and intraoperative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia and relapsing or remnant adenomyosis lesion by ultrasonography at the 7-momth follow-up after the operation. Then, all patients were followed up at 6-month intervals at the outpatient clinic.
RESULTS
The mean patient age was 41.98 ± 4.73 years. The mean TOUA and operative times were 4.46 ± 2.68 and 75.14 ± 20.56 min, respectively. The mean estimated blood loss was 148.19 ± 101.69 mL. No conversion to laparotomy or major complications occurred. At the 7-month follow-up, complete remission of dysmenorrhea and menorrhagia had occurred in 93.02% and 76.92% of patients, respectively.
CONCLUSIONS
Laparoscopic adenomyomectomy with TOUA is a safe and effective surgical treatment modality for women with symptomatic focal uterine adenomyosis who want to preserve fertility.
Topics: Adenomyosis; Adult; Blood Loss, Surgical; Dysmenorrhea; Female; Humans; Laparoscopy; Length of Stay; Menorrhagia; Operative Time
PubMed: 28642638
DOI: 10.4293/JSLS.2017.00014 -
Women's Health (London, England) Jan 2016
Topics: Endometrium; Female; Humans; Menorrhagia; Primary Prevention; Women's Health
PubMed: 26767314
DOI: 10.2217/whe.15.71 -
British Journal of Haematology Sep 2013Heavy menstrual bleeding (HMB) is a common clinical problem; population-based studies estimate that approximately 10-35% of women report this symptom during their... (Review)
Review
Heavy menstrual bleeding (HMB) is a common clinical problem; population-based studies estimate that approximately 10-35% of women report this symptom during their lifetime, while about 5% of women consult a physician for evaluation of HMB. Patients with HMB account for 15% of all referrals to gynaecologists and are frequently seen by haematologists in bleeding disorder clinics as well. Heavy menstrual bleeding can be caused by a wide variety of local and systemic factors, so a careful clinical and laboratory evaluation is often necessary to determine the aetiology and guide appropriate management. This review discusses the definition, causes and clinical outcomes of HMB. It outlines a diagnostic approach and focuses on medical (as opposed to surgical) treatments. Throughout, areas of controversy and opportunities for further research are highlighted.
Topics: Female; Humans; Menorrhagia; Metrorrhagia
PubMed: 23829452
DOI: 10.1111/bjh.12447