Fazio Sara B, Ship Amy N
Harvard Medical School, Division of General Internal Medicine E-CC63 IH, Boston, MA 02215, USA.
South Med J. 2007 Apr;100(4):376-82; quiz 383, 402. doi: 10.1097/SMJ.0b013e31802f35f2.
Disorders of the menstrual cycle are common problems in ambulatory medicine. Abnormal uterine bleeding describes bleeding that is excessive or outside the normal menstrual cycle. In the premenopausal woman, the differential diagnosis is broad, and pregnancy must always be considered. Determining whether the bleeding is ovulatory or anovulatory is a central part of the evaluation, as anovulation is one of the most common causes of abnormal uterine bleeding. In patients with anovulatory bleeding, the goal of treatment is to minimize blood loss and prevent complications from chronic unopposed estrogen. In women with oligomenorrhea or amenorrhea, after establishing the etiology, it is necessary to maintain adequate estrogen to support bone health. In the peri- and postmenopausal population, because the incidence of endometrial hyperplasia and malignancy rises, it is important to have a low threshold for endometrial assessment.
月经周期紊乱是门诊医学中的常见问题。异常子宫出血是指月经量过多或不在正常月经周期内的出血。对于绝经前女性，鉴别诊断范围广泛，必须始终考虑妊娠因素。确定出血是排卵性还是无排卵性是评估的核心部分，因为无排卵是异常子宫出血最常见的原因之一。对于无排卵性出血的患者，治疗目标是尽量减少失血并预防长期无对抗雌激素引起的并发症。对于月经过少或闭经的女性，在确定病因后，有必要维持足够的雌激素以支持骨骼健康。在围绝经期和绝经后人群中，由于子宫内膜增生和恶性肿瘤的发生率上升，对子宫内膜进行评估的阈值要低，这一点很重要。
