James Andra H
Department of Obstetrics and Gynecology, Duke University, Durham, NC.
Hematology Am Soc Hematol Educ Program. 2016 Dec 2;2016(1):236-242. doi: 10.1182/asheducation-2016.1.236.
Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects ∼90% of women with an underlying bleeding disorder and ∼70% of women on anticoagulation. HMB can be predicted on the basis of clots of ≥1 inch diameter, low ferritin, and "flooding" (a change of pad or tampon more frequently than hourly). The goal of the work-up is to determine whether there is a uterine/endometrial cause, a disorder of ovulation, or a disorder of coagulation. HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. The evaluation will include the patient's history, pelvic examination, and/or pelvic imaging, and a laboratory assessment for anemia, ovulatory dysfunction, underlying bleeding disorder, and in the case of the patient on anticoagulation, assessment for over anticoagulation. The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility. Hemostatic therapy for HMB may serve as an alternative to hormonal or surgical therapy, and may even be life-saving when used to correct an abnormality of coagulation.
月经过多的首选术语是“严重月经出血”（HMB），它影响了约90%患有潜在出血性疾病的女性以及约70%正在接受抗凝治疗的女性。HMB可根据直径≥1英寸的血块、低铁蛋白以及“大出血”（更换卫生巾或卫生棉条的频率超过每小时一次）来预测。检查的目的是确定是否存在子宫/子宫内膜病因、排卵障碍或凝血障碍。以大出血和/或经期延长为表现的HMB，或伴有个人或家族出血史的HMB，很可能提示出血性疾病，应促使患者转诊至血液科医生处。评估将包括患者病史、盆腔检查和/或盆腔影像学检查，以及针对贫血、排卵功能障碍、潜在出血性疾病的实验室评估，对于正在接受抗凝治疗的患者，还需评估抗凝过度情况。治疗的目标是减少HMB。治疗策略不仅取决于是否存在排卵功能障碍、子宫病变或凝血异常，还取决于患者的年龄以及她对近期或长期生育的意愿。HMB的止血治疗可作为激素或手术治疗的替代方法，在用于纠正凝血异常时甚至可能挽救生命。
