Hurskainen R, Grenman S, Komi I, Kujansuu E, Luoto R, Orrainen M, Patja K, Penttinen J, Silventoinen S, Tapanainen J, Toivonen J
Department of Obstetrics and Gynecology, University of Helsinki, Finland.
Acta Obstet Gynecol Scand. 2007;86(6):749-57. doi: 10.1080/00016340701415400.
One-third of all women experience heavy menstrual bleeding at some point in their life. In western countries, about 5% of women of reproductive age will seek help for menorrhagia annually. Half of all women who consult for hypermenorrhea have some uterine abnormality, most often fibroids (among patients under 40 years of age) and endometrial polyps (above 40 years of age). Appropriate treatment considerably improves the quality of life of these patients, and it is important to make a rigorous assessment of the patient to provide the best treatment options. This guideline provides instructions on how to examine and treat women of fertile age who have menorrhagia. The subject's own assessment of the amount of menstrual blood loss does not generally reflect the true amount. All patients should undergo a pelvic examination and, if the menstrual pattern has changed substantially or if anaemia is present, a vaginal sonography should be carried out as the most important supplemental examination. Vaginal sonography combined with an endometrial biopsy is a reliable method for diagnosing endometrial hyperplasia or carcinoma, but it is insufficient for diagnosing endometrial polyps and fibroids; these can be diagnosed more reliably by sonohysterography or hysteroscopy. Non-steroidal anti-inflammatory drugs and tranexamic acid reduce menstrual blood loss by 20-60%, and the effectiveness of a hormonal intrauterine system (IUS) is comparable with that of endometrial ablation or hysterectomy. Cyclic progestogens do not significantly reduce menstrual bleeding of women who ovulate. Treatment should be started with one of the drug therapies, i.e. the IUS, tranexamic acid, anti-inflammatory drugs, or oral contraceptive. Drug treatment should be used and evaluated before surgical interventions are considered. With an effective training and feedback system, it is possible to organise the diagnostics, medical treatment and follow-up of heavy menstrual bleeding in the primary health care setting or in outpatient clinics, which reduces the burden on specialist health care.
三分之一的女性在一生中的某个阶段会经历月经过多。在西方国家，约5%的育龄女性每年会因月经过多寻求帮助。因月经过多前来咨询的女性中，一半存在某种子宫异常，最常见的是肌瘤（40岁以下患者）和子宫内膜息肉（40岁以上患者）。恰当的治疗能显著改善这些患者的生活质量，对患者进行严格评估以提供最佳治疗方案很重要。本指南提供了关于如何检查和治疗有月经过多问题的育龄女性的指导。患者自身对月经量的评估通常不能反映真实量。所有患者都应接受盆腔检查，如果月经模式有显著变化或存在贫血，应进行阴道超声检查作为最重要的补充检查。阴道超声联合子宫内膜活检是诊断子宫内膜增生或癌的可靠方法，但对于诊断子宫内膜息肉和肌瘤不够充分；通过子宫输卵管超声造影或宫腔镜检查能更可靠地诊断这些疾病。非甾体抗炎药和氨甲环酸可使月经量减少20% - 60%，激素宫内节育系统（IUS）的效果与子宫内膜切除术或子宫切除术相当。周期性孕激素对有排卵的女性的月经量减少作用不显著。治疗应从药物治疗之一开始，即IUS、氨甲环酸、抗炎药或口服避孕药。在考虑手术干预之前应先使用并评估药物治疗。通过有效的培训和反馈系统，有可能在初级卫生保健机构或门诊组织月经过多的诊断、医疗和随访，从而减轻专科医疗保健的负担。
