Lutheran General Hospital, Park Ridge, and Clinical Associate Professor, Department of Obstetrics and Gynecology, University of Chicago, and Clinical Associate Professor, Department of Obstetrics and Gynecology,. Department of Obstetrics and Gynecology David Geffen School of Medicine at UCLA Kaiser Permanente Southern California Los Angelos, CA.
Preface
Acknowledgments
Just a few years ago, reviews on the history of menstruation were relaxing reading, with little relevance to current practice. For example, Aristotle (384–322 BC) believed that the ideal human form was male and that the female body was... a distortion of the ideal.
Menstruation: historical perspective
Menstruation is the sign of ovulation; It is preparatory for the reception of the egg. This attitude was challenged by Mary Putnam Jacobi, one of the first women to graduate from medicine in the US.
Physiology of menstruation
Activin is produced by the granulosa cells during the early part of the follicular phase. The remaining epithelium is in the area of the tubal ostia and at the isthmus, i.e.
Terminologies and definitions
He further observes, “but it is an excessive current if the faculties of the body are weakened by it.” Many authors reflected a broader understanding of the variation in bleeding symptoms, using terms such as.
The first authoritative use of the term 'heavy menstrual bleeding' appears to have been in the New Zealand Guidelines on Heavy Menstrual Bleeding. A review of the confusion in current and historical use of terminologies and definitions for menstrual bleeding disorders.
Epidemiology of abnormal uterine bleeding
Interestingly, tubal sterilization was found to decrease the amount and length of menstrual blood loss as well as its associated pain. 3 , 4 These women sometimes even had difficulty assessing changes in the volume of menstrual blood loss from one day to the next.
Practical assessment and
It is clear from some of the previous discussions that objective assessment of menstrual loss in a person. It is clear from some of the previous discussions that objective assessment of menstrual loss in an individual patient is very difficult, but the complaint of heavy bleeding is very common.
Pathogenesis of abnormal uterine bleeding
Change in the concentration of plasminogen activators during the menstrual cycle and its relation to menstrual blood loss. Given the irregularity of menstruation in postmenarchal life, it is most useful to use 6 months without menstruation as a time frame.
Menstrual problems in adolescence
5 Referring to management (Figure 7.1), patients will then be divided into two groups: girls with delayed puberty, where secondary sexual development has not occurred or is minimal, and girls with normal puberty. Again, in patients intolerant to the oral contraceptive pill, or in whom control of bleeding continues to be difficult, the levonorgestrel IUS can be used.
Menstrual dysfunction secondary to medical diseases
Von Willebrand disease (VWD) is one of the most common inherited bleeding disorders, affecting 0.8-1.3% of women. The management of women with menorrhagia and bleeding disorders depends on the woman's age, reproductive status and individual preferences. Hormonal status of postmenopausal women with alcohol-induced cirrhosis; further findings and a review of the literature.
The role of ultrasound in
In addition, it offers the ability to image the entire pelvis and detect co-existing pathology such as ovarian masses and cervical pathology. Where this is most useful in the investigation of AUB is in women taking tamoxifen and in cases of suspected adenomyosis where the pathologies are subendometrial. Bourne et al demonstrated low impedance in the uterine arteries in cases of endometrial carcinoma, thereby reducing the false-positive rates of B-mode scans.
Color Doppler is a useful additional function for determining the nature of a focal lesion in the endometrial cavity. Conventional TVS involves gentle insertion of the probe up to the cervix and views taken in the coronal and sagittal planes. The probe is reinserted and a sagittal view of the endometrial cavity is obtained - saline is then instilled at this point and further coronal and sagittal views are taken to evaluate any focal endometrial pathology visualized.
The role of hysteroscopy in investigating abnormal uterine
Hysteroscopy should be performed in the early follicular phase of the menstrual cycle just after menstruation has subsided. A prospective comparative study between hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in patients with infertility. Office hysteroscopy versus transvaginal ultrasound in the evaluation of patients with excessive uterine bleeding.
Medical management of abnormal uterine bleeding
Effect of ethamsylate and aminocaproic acid on menstrual blood loss in women using intrauterine devices. Comparison between antifibrinolytic and antiprostaglandin treatment in reducing increased menstrual blood loss in women with intrauterine contraceptive devices. Preliminary results in clinical and endocrine studies in the treatment of menorrhagia with danazol.
The levonorgestrel intrauterine system
However, when direct and indirect costs were calculated, using the IUS was cheaper than hysterectomy. Long-term comparative studies are required to confirm the effectiveness of the IUS in endometriosis sufferers. Comparative, prospective studies are required to investigate the use of the IUS in women with endometrial hyperplasia.
Current surgical treatment options
However, there have been concerns that unnecessary surgery is being performed and that treating this condition is not an evidence-based approach. Hysterectomy has been considered the definitive surgical treatment of HMB/AUB and has been a very commonly performed operation. Where traditional medicine has been largely based on authority, the idea of EBM is research-based practice.
Comparison of the latest types of hysterectomy with endometrial ablation techniques is yet to be done. 26 However, the problem with many of the second generation techniques is still related to the reliability of the equipment. A national survey of complications of endometrial destruction for menstrual disorders: the MISTLETOE study.
The use of contemporary energy modalities during operative
Since the beginning of operative laparoscopic surgery, the use of energy has remained an essential component of the surgical armamentarium. Ideally, the surgeon's final view of the operative field should accurately approximate the topography that may be discovered after postoperative healing. Most importantly, the risk for inadvertent thermal injury during electrosurgery can be reduced by a good understanding of the predictable behavior of electricity in living tissue.
Regardless of the selected waveform, the current density is dramatically reduced when an active electrode makes significant contact with a tissue surface. Capacitive coupling does not occur during bipolar electrosurgery due to the bidirectional flow of current along the active electrode. 3 This system, unlike the urological resectoscope, allowed continuous irrigation of the uterine cavity.
Hysteroscopic rollerball endometrial ablation
In the USA, electrocoagulation of the endometrium with the rollerball electrode was first reported in 1989 by Vancaillie. Using this technique, reuse of the surgeon's hand on the resectoscope occurs only once. The larger surface area of the weighted speculum dissipates these currents without harm to the patient.
Hysteroscopic electrosurgical resection
Resection of the endometrium is started at the fundus with a forward oblique loop, or alternatively the area is rolled. Excessive bleeding at the end of the procedure can be managed with a urinary catheter balloon, as already discussed. A randomized comparison of microwave endometrial ablation with transcervical resection of the endometrium; follow-up at a minimum of five years.
Hysteroscopic laser ablation technique
The tip of the laser fiber can be seen in the middle of the image. The effect of the laser on the endometrium and its myometrium is poorly documented. A multicenter collaborative study in the treatment of menorrhagia by Nd:YAG laser ablation of the endometrium.
According to a review by Garside et al., the mean rate of endometritis after thermal balloon ablation was 2%. Life table analysis of the success of endometrial ablation with thermal balloon in the treatment of menorrhagia. Prognostic factors for the success of thermal balloon ablation in the treatment of menorrhagia.
Cavaterm thermal balloon ablation
The Cavaterm thermoballoon ablation system (manufactured by Pnn Medical SA, formerly Wallsten Medical, Switzerland) was developed for the treatment of dysfunctional uterine bleeding. If performed in a doctor's office, the cost of Cavaterm treatment should be even lower. There are no published studies comparing the cost of Cavaterm treatment with other drugs.
Thermablate EAS balloon endometrial ablation
In the event of a sudden contraction of the uterus, the system immediately withdraws fluid from the balloon. There have been five cohort studies conducted to evaluate the safety and efficacy of the thermable EAS device for the treatment of menorrhagia. The safety and efficacy of Thermablate EAS was also assessed by Vilos and colleagues.
Microwave endometrial ablation
However, the applicator thermocouple is thermally sunk onto the applicator shaft and covered with a fluoropolymer sheath, and the actual tissue temperature at the applicator–tissue interface is 100 °C; this creates micro-pockets of superheated steam – the effect of this is the formation of craters in the coagulum, visible by MEA (see Figure 21.4). The brevity of MEA treatment quickly led to the use of a local anesthetic approach. A cervical block is then started with a single injection of local anesthetic (2.2ml) administered as deeply as possible into each cervical quadrant – the aim being to establish a 'ring block' on the inner cervix.
NovaSure endometrial ablation
An automatic power calculation is made according to the geometry (length and width) of the treated cavity. At this 5-year follow-up, data were available for 103 of the 107 patients included in the study. Of the patients lost to follow-up, two were amenorrheic, one patient was eumenorrheic, and one patient reported menorrhagia at 3-year follow-up.
Hydrothermablation
This was in accordance with the protocol submitted to the FDA for the Phase III clinical trials of the HTA System. Fortunately, this is changing in the US, with the publication of the 2006 National Physician Fee Schedule Relative Value Guide. First, 2 mL is administered into the anterior lip of the cervix before grasping it with a single-pronged tenaculum.
