Non-surgical management options for menorrhagia

Menorrhagia is a common problem in women and increasing numbers are seeking help and advice regarding management. In many cases, surgery is not appropriate and so awareness of alternative treatments is important. The aim of this review is to summarise the evidence available regarding current medical therapies.     

Management of uncontrolled menorrhagia with the resectoscope

Summary. Menorrhagia is a common problem. It is the pre-operative diagnosisfor at least 25% of the estimated 700 000 hysterectomies performed in the United States each year. This paper will review management of menorrhagia including endometrial ablation with the resectoscope, an out-patient alternative to hysterectomy for thousands of women.     

Migraine is associated with menorrhagia and endometriosis

OBJECTIVE: To evaluate the frequency of menorrhagia and endometriosis in female migraineurs compared to age-matched women without headache. BACKGROUND: Migraine predominantly affects women of childbearing age and is often associated with the menstrual period, yet there is a paucity of data regarding the relationship of migraine and menstrual disorders. METHODS: Women diagnosed with migraine, using International Headache Society criteria and an age- and sex-matched control group, were administered a semistructured questionnaire regarding migraine and migraine-related disability, menstrual history, other bleeding history, vascular event history, and vascular risk factors. RESULTS: Fifty female migraineurs between the ages of 22 and 50 years and 52 age-matched women (mean age 37 years) were enrolled in the study. Similar proportions of women in each group reported using hormone contraceptives (30% vs. 33%, P = .77) and hormone replacement therapy (12% vs. 8%, P = .69). The proportions presently menstruating (64 % vs. 80%, P = .20) and status after hysterectomy were similar (24% vs. 14%, P = .84). Menorrhagia (defined as at least three consecutive heavy periods), both current and prior, was more commonly reported in migraineurs (63% vs. 37%, P = .009), with higher likelihood of staining clothes by menses (35% vs. 8%, P = .003), and significant impact of menses on activities of daily living (on a 10-point Likert scale) with work/school participation (P = .02), family activities (P < .0001), sleep (P = .003), life enjoyment (P = .001), mood (P = .02), and overall quality of life (P = .003). Endometriosis, which may be associated with menorrhagia, was also more commonly diagnosed in the migraineurs (30% vs. 4%, P = .001). The migraineurs more frequently described bruising (40% vs. 10%, P < .001) and rectal bleeding (18% vs. 2%, P = .017) but not more serious bleeding problems. Nonsteroidal anti-inflammatory drug (NSAID) use was more frequent in the migraine group (28% vs. 12%, P = .036), and significance for increased menorrhagia, endometriosis, menstrual interference, and bruising was maintained, even when controlling for the use of NSAIDs. With logistic regression, menorrhagia was significantly associated with migraine, adjusted odds ratio (OR) = 2.8 (95% CI 1.2 to 6.5), and with endometriosis, adjusted OR = 10.5 (95% CI 2.2 to 51.4). There were no differences in vascular events and risk factors, except for trends of increased hypertension (25% vs. 10%, P = .05), transient ischemic attack/stroke (10% vs. 2%, P = .08), and Raynaud's disease (10% vs. 2%, P = .08) in the migraineurs. CONCLUSION: Women with migraine have a higher frequency of menorrhagia, endometriosis, and associated psychosocial consequences. These findings suggest that there should be further study of factors influencing endometriosis and menstrual blood flow, such as eicosanoids and platelet function, in migraineurs.     

曼月乐治疗月经过多的临床应用

目的探讨左炔诺孕酮宫内缓释系统（商品名曼月乐）治疗月经过多的临床疗效。方法观察103例月经量〉80 m l的患者宫内放置LNG-IUS后月经周期、月经期、月经量、血红蛋白及子宫内膜厚度的变化情况。结果放置LNG-IUS后3个月,患者月经周期未出现显著变化,月经期表现为放置后1个月显著延长,但随后恢复正常;月经量较治疗前显著减少,差异有统计学意义（P〈0.05）;治疗前、后子宫内膜厚度也显著变小,差异有统计学意义（P〈0.05）;患者治疗后血红蛋白水平也较治疗前显著增加。结论 LNG-IUS治疗月经过多疗效显著。     

微波子宫内膜去除术治疗月经过多疗效分析

目的探讨微波子宫内膜切除术治疗月经过多的疗效、安全性、可行性。方法采用微波频率为9.2HGz的全自动电脑控制微波治疗仪,对44例月经过多患者施行子宫内膜去除术,并对其治疗效果进行随访分析。结果平均手术时间(195.95±2.77)s,平均住院时间(1.00±0.45)d。术后3￣12个月各组月经评分均低于术前组,各比较组P值均<0.001,差异有显著性。术后成功率,满意率在术后3￣12个月内基本稳定于90%以上。结论MEA治疗月经过多有效、安全、简单、快捷。     

Platelet functional defects in women with unexplained menorrhagia

Summary.  Menorrhagia is a common clinical problem and is unexplained in more than 50% of women. Although studies suggest that von Willebrand's Disease (VWD) is found in a substantial number of women with unexplained menorrhagia, the prevalence of platelet defects in women with menorrhagia is unknown. To determine the prevalence of platelet and other hemostatic defects, we evaluated women ages 17–55 diagnosed with unexplained menorrhagia. Seventy-four women (52 white, 16 black, six other) were studied. Bleeding time was prolonged in 23 women (31.5%). Maximal percent platelet aggregation was decreased with one or more agonists in 35 (47.3%) women. The most commonly found platelet function defects were reduced aggregation responses to ristocetin in 22 women and to epinephrine in 16 women. Sixteen of 22 women with reduced ristocetin aggregation had von Willebrand ristocetin cofactor (VWF:RCo) and von Willebrand factor antigen (VWF:Ag) > 60%. Platelet ATP release was decreased with one or more agonists in 43 (58.1%) women. Of the black women studied, 11/16 (69%) had abnormal platelet aggregation studies compared with 20/52 white women (39%) ( P  = 0.06). Black women with menorrhagia had a higher prevalence of decreased platelet aggregation in response to ristocetin and epinephrine than did white women ( P  = 0.0075, P  = 0.02). Ten women (13.5%) had VWF:RCo and/or VWF:Ag < 60%. Using race and blood group specific ranges, 5 (6.8%) women had decreased VWF:RCo, VWF:Ag and/or collagen binding (VWF:CB). Mild factor XI deficiency was found in two women and one woman with mild factor V deficiency and one hemophilia A carrier were identified. We conclude that the prevalence of platelet function defects and other inherited bleeding disorders is substantial in a multiracial US population of women with unexplained menorrhagia.     

宫腔镜下双极汽化治疗月经过多临床观察

目的观察宫腔镜下双极汽化治疗月经过多的临床效果。方法月经过多患者40例,≥45岁为第一组,行双极汽化子宫内膜去除术;35～45岁为第二组,根据患者月经量过多程度行双极汽化去除1/3～4/5子宫内膜。结果第一组10例中8例闭经治愈,2例好转;第二组30例中28例治愈,2例好转。两组有效(治愈+好转)率均为100%。结论宫腔镜下双极汽化治疗月经过多是一种简单、快速、安全、经济、有效的微创手术方法。对围绝经期月经过多患者采用第一组治疗方案可达到闭经、可保留子宫且经济,避免开刀之苦;对年龄较轻月经过多患者采用第二组治疗方案可达到减少过多经量且保留子宫及恢复正常月经的效果。     

琥珀酸亚铁治疗妇女月经过多所致缺铁性贫血的疗效观察

１引言缺铁性贫血（IDA）是最常见的一种贫血类型,尤其多见于育龄妇女及婴幼儿,传统的硫酸亚铁是以往治疗IDA的常用药物,价格便宜。但有部分患者服药后出现胃肠道反应而不能耐受及药物有极易受潮的缺点。我们自１９９９年３月至２０００年６月,采用琥珀酸亚铁（ferroussuccinate）治疗妇女月经过多所致IDA,效果较好,不良反应少,现将结果报告如下。２对象与方法２．１一般资料５４例患者均为我院门诊及住院初诊妇女,全部病例均符合张之南主编的《血液病诊断与疗效标准》犤１犦：①血液分析示小细胞低色素性贫血;②全部病例均行…     

微波子宫内膜消除术治疗9例严重内科疾病伴月经过多

目的　探讨微波子宫内膜消除术 (microwaveendometrialablation ,MEA)对严重内科疾病伴月经过多的急救治疗价值及应用研究。方法　对 9例严重内科疾病伴月经过多患者在经期大出血时施行MEA进行急救治疗 ,并进行 1～ 12个月随访。结果　 9例中 6例术中、术后均无阴道出血 ,3例术后出现周期性点滴状出血 ,1例死于原有内科疾病 ,所有各例均达到即时止血目的 ,无一例出现术中、术后并发症 ,使病人生活质量明显改善。结论　MEA是一种安全、快速、高效治疗月经过多的新技术 ,对有严重内科疾病伴月经过多病人急性失血的急救有重要应用价值     

MRI电影对月经过多子宫肌瘤患者子宫蠕动的研究

目的应用MR电影成像技术(cine MRI)探讨月经过多子宫肌瘤患者排卵期子宫蠕动情况及肌瘤位置对子宫蠕动的影响。材料与方法采用1.5 T MRI仪对30名健康志愿者及30例月经过多子宫肌瘤患者于排卵期行盆腔T1轴面、T2-抑脂轴面、T2矢状面及子宫cine MR扫描。比较健康志愿者与月经过多肌瘤患者子宫正常蠕动存在率及蠕动频率,分析肌瘤位置与蠕动形式的关系。结果月经过多子宫肌瘤患者排卵期子宫正常蠕动存在率及蠕动频率较健康志愿者显著降低,两者均有统计学意义(P值均0.01),黏膜下肌瘤患者主要表现为无蠕动,肌壁间肌瘤患者蠕动形式多样。结论月经过多子宫肌瘤患者排卵期子宫正常蠕动显著减少,不利于排卵期精子快速进入输卵管;Cine MRI有助于月经过多子宫肌瘤患者子宫蠕动的评价,为临床提供子宫蠕动的功能信息。