विवरण
Abnormal uterine bleeding (AUB) refers to irregular or excessive bleeding from the uterus, often indicative of underlying health issues. Causes of AUB vary and can include hormonal imbalances, uterine fibroids, polyps, or endometrial hyperplasia. Diagnosis typically involves a thorough medical history, physical examination, and various tests such as ultrasound, endometrial biopsy, or blood tests to identify the underlying cause. Management of AUB depends on the underlying cause and may involve medications such as hormonal contraceptives, nonsteroidal anti-inflammatory drugs (NSAIDs), or surgical interventions like endometrial ablation or hysterectomy. AUB can significantly impact a person's quality of life, causing symptoms such as fatigue, anemia, and emotional distress. Early intervention and regular gynecological screenings are crucial for diagnosing and managing AUB effectively. Patient education on menstrual health and awareness of symptoms is essential for timely medical intervention and improved outcomes. Hormonal therapies, lifestyle modifications, and dietary changes may also be recommended to manage symptoms and promote overall well-being in individuals with AUB.
सारांश
- Abnormal Uterine Bleeding (AUB) is a broad term encompassing various menstrual irregularities, including heavy, irregular, and intermenstrual bleeding, as well as cycle length disorders. It's estimated that a significant proportion of women experience AUB, potentially more than previously thought, leading to iron deficiency and anemia.
- Normal endometrial function is crucial for reproduction, involving embryo reception, implantation, and pregnancy maintenance. In the absence of pregnancy, the endometrium sheds and regenerates. Hemostasis is maintained through coordinated vasoconstriction, clot formation, and endometrial repair, regulated by factors like PGF2 alpha and vascular endothelial growth factor.
- The FIGO classification system is used to categorize AUB. System One focuses on nomenclature, defining normal and abnormal bleeding patterns based on frequency, duration, regularity, and flow volume. System Two, known as PALM-COEIN, classifies potential causes or contributors to AUB symptoms, dividing them into structural (PALM) and non-structural (COEIN) categories.
- Structural causes (PALM) include polyps, adenomyosis, leiomyomas (fibroids), and malignancy. Leiomyomas are further classified based on their location within the uterus. Non-structural causes (COEIN) involve coagulopathies, ovulatory dysfunction, endometrial disorders, iatrogenic factors, and not otherwise classified conditions.
- Diagnostic steps for AUB involve excluding pregnancy, examining potential bleeding sites, and obtaining a detailed history using the FIGO System One framework. Depending on the patient's risk factors, further investigations like blood tests, imaging (ultrasound, MRI), endometrial sampling, and hysteroscopy might be necessary.
- Treatment for AUB depends on the underlying pathology, clinical condition, severity, and impact on quality of life. Treatment options range from conservative management and medical treatments (hormonal and non-hormonal) to surgical interventions (hysteroscopy, myomectomy, hysterectomy) and alternative methods.
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