1/6. Balloon endometrial ablation as a safe alternative to hysterectomy.Each year, 600,000 hysterectomies are performed in the united states, costing an estimated $4 billion. Approximately 50% of these hysterectomies are performed for menorrhagia or abnormal uterine bleeding. menorrhagia can have a negative impact on a woman's lifestyle and self-perception, often leading her to seek definitive treatment. Pharmacologic treatment for menorrhagia is not always successful, and dilatation and curettage provides relief for only the first few menstrual cycles. Surgical options include hysterectomy and two forms of endometrial ablation. Current research demonstrates that thermal uterine balloon therapy is the safest of these options. Uterine balloon therapy, an outpatient procedure, has resulted in successful reduction in menstrual flow in 70% to 90% of patients, and it soon may be performed as an office-based procedure.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/6. Abnormal genital tract bleeding.The etiology of abnormal genital tract bleeding encompasses a wide range of disorders that can be secondary to anatomic changes of the female genital tract, infection, endocrinologic disorders, malignancies, and systemic illness. Appropriate workup is guided by age-related differential diagnoses for abnormal bleeding. Modern diagnostic tools can quickly focus the evaluation and allow timely intervention. Most abnormal genital tract bleeding is uterine bleeding, which is one of the most common gynecologic problems that health care providers will face. It accounts for approximately 15% of office visits and 25% of gynecologic operations. Abnormal uterine bleeding in reproductive-age women is defined as bleeding at abnormal or unexpected times or by excessive flow at the time of an expected menses. The average menstrual cycle length and duration of flow is 28 days and 4 days, respectively, with an average blood loss of 35 cc (1). Any bleeding should be considered abnormal in premenarchal girls and in post-menopausal women except for those with predictable withdrawal bleeding taking hormone replacement therapy. This article will review the categories of abnormal genital tract bleeding and the diagnostic tools needed to establish the correct diagnosis. Common clinical cases will be presented to illustrate the presenting symptoms, differential diagnoses, workup, treatment, and long-term follow-up.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
3/6. High dose of tranexamic acid for treatment of severe menorrhagia in patients with von Willebrand disease.menorrhagia is one of the most important and frequent complications in women with congenital von Willebrand disease (vWD). Three cases of menorrhagia with vWD (type 1; 1 case, type 2A; 2 cases) were successfully treated with tranexamic acid at dose of 3 grams daily in four divided doses for the first 5 days of the menstrual cycle. All patients had severe menorrhagia lasted for more than 10 days with iron deficiency anemia of hemoglobin levels of 6.5-8.4 g/dl. Common dosage of tranexamic acid of 1 gram daily in 4 divided doses on days 1-5 of their menstrual cycles did not correct their menorrhagia. The treatment was then changed to the daily dose of 3 grams in 4 divided doses on days 1-5 of their menstrual cycles. Thereafter, their menorrhagia became well-controlled with improvement of their anemia up to hemoglobin of 11.5-12.4 g/dl. High dose of tranexamic acid has been administered safely in all patients for 3-5 years without significant complications. Oral high-dose administration of tranexamic acid is very convenient and useful for treatment of menorrhagia in the patients with vWD.- - - - - - - - - - ranking = 3keywords = cycle (Clic here for more details about this article) |
4/6. menorrhagia at menarche: a case report.Dysfunctional uterine bleeding is defined as abnormal endometrial bleeding without any underlying disease. It is particularly a common problem for adolescents and a majority are caused by immature hypothalamic-pituitary-ovarian axis. Usually, it presents as minor alterations of the cycle flow length, but occasionally can be severe enough to require hospitalization. A 12 year-old girl with menorrhagia at menarche was admitted to our adolescent Unit. She had heavy bleeding for 16 days causing a hemoglobin level of 5.5 gr/dl. She was first treated with blood transfusion and hemostasis was achieved rapidly through high doses of combination oral contraceptives. Whenever menorrhagia occurs at menarche, it is important to exclude an underlying hematologic disease. If there is no response to hormonal therapy in 48 hours there is a need for reevaluation of coagulopathy. In this report, we show how an acute and heavy anovulatory bleeding episode can be controlled and followed-up in an adolescent girl.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
5/6. Conservative treatment of diffuse uterine leiomyomatosis.OBJECTIVE: To describe the conservative treatment of diffuse uterine leiomyomatosis. DESIGN: Descriptive study. SETTING: tertiary care centers. PATIENT(S): Three premenopausal women with diffuse uterine leiomyomatosis associated to persistent menorrhagia, two with desire of becoming pregnant and one with desire of preservation of the uterus. INTERVENTION(S): Preoperative ultrasound showed symmetrically enlarged uteri with innumerable, poorly defined and small-sized (0.5-3 cm) myomas involving all the myometrium. An "extreme" myomectomy was performed in two cases, including the removal of a large portion of corporal myometrium. One patient was treated only medically with GnRH analogues (GnRH-a). MAIN OUTCOME MEASURE(S): Menstrual pattern and, when applicable, ability to conceive and pregnancy outcome. RESULT(S): Regular menses were restored in both patients who underwent surgery: one had no pregnancy desire and the other was not able to conceive after two IVF-ETs. The patient treated with GnRH-a conceived spontaneously as soon as medical treatment was discontinued; at 34 gestational weeks, an emergency cesarean section followed by hysterectomy was performed for vaginal bleeding and a healthy 2,400-g baby was born. CONCLUSION(S): Our experience supports the idea that a conservative approach to uterine leiomyomatosis may result in restoration of normal cycles and eventually in the birth of a viable fetus.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
6/6. menorrhagia in von Willebrand disease successfully treated with single daily dose tranexamic acid.Four cases of menorrhagia in von Willebrand disease were successfully treated with tranexamic acid given in a single daily dose of 4 g for the first 3-5 days of the menstrual cycle. The pathophysiology and pharmacokinetics are discussed. The apparent improved efficacy and acceptability of this new dosing regime have been highlighted.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |