Veterans Administration
- PDF / 195,818 Bytes
- 15 Pages / 547.087 x 765.354 pts Page_size
- 100 Downloads / 200 Views
Abnormal uterine bleeding is a common and significant problem during puberty, adolescence, reproductive, and postmenopausal years. Approximately 10 million women annually suffer from abnormal bleeding—many suffer in silence. Menstrual‐related complaints account for almost one‐third of all visits to gynecologists. Among postmenopausal women, the new onset of bleeding will require an urgent visit to the gynecologist to exclude malignancy, while heavy and prolonged bleeding in the adolescent will lead to an emergency room visit. During the reproductive years, pregnancy‐related concerns and uterine pathology must be addressed. The impact of abnormal uterine bleeding and subsequent treatment can be profound. In the most extreme circumstances, heavy bleeding can be associated with low blood pressure, anemia, fast heart rate, blood transfusions, and inability to enjoy work, hobbies, or sexual intercourse. Women who experience unpredictable and heavy menses often complain of a poor quality of life, with restrictions in work, travel, or sports. Often they have decreased psychological well‐ being. They feel confined and afraid to leave their homes or need quick access to bathrooms, because of their fear of social embarrassment from soiling through clothing and furniture due to unpredictable and uncontrolled bleeding. Normal menstruation begins between ages 10 and 17 years. Menopause occurs between ages 45 and 55 years of age. By age 51 years, 80% of women cease having menstrual cycles and by age 58 years, 95% of women stop menstruation. Less than 10% of women stop menstruation before 45 years. Once ovulatory cycles ensue, women will have regular and predictable bleeding every 24–35 days, lasting 3–7 days with a predictable amount of flow. Most women lose 2–4 tablespoons of blood with each menses (30–40 ml). The majority of blood loss occurs over 1–2 days, and scantier amounts of bleeding will occur during the remainder of the cycle. Some women may have 1–2 days during the course of menstruation, when menstruation stops and then resumes. Subjectively, each woman serves as her own control—experiencing menstruation individually and uniquely. Slight variations in pattern, duration, and amount will be alarming and lead a patient to seek an evaluation. Most problems #
Springer-Verlag Berlin Heidelberg 2008
with abnormal uterine bleeding will occur within the first 5–10 years after menarche or prior to menopause. Sanitary pad requirements are usually minimal, and for most patients do not seem oppressively burdensome. Most women change a pad or tampon every 3–4 h on their heaviest days of flow. Subsequent days of bleeding will be noticeably less heavy. However, hygienic concerns (odors and moisture) may make sanitary protection changes more frequent. Recently, the American College of Obstetrics and Gynecology (ACOG) recommended the more descriptive terminology of anovulatory uterine bleeding (AUB) to refer to bleeding not caused by anatomic, organic, or systemic pathological conditions. The spectrum of menstrual aberrations associ
Data Loading...
