PDF(Pubmed)
Abstract：
Abnormal uterine bleeding (AUB) is a bleeding from the uterine corpus that is abnormal in regularity, volume, frequency or duration. It encompasses heavy menstrual bleeding, irregular menstrual bleeding and intermenstrual bleeding, which are common symptoms among women of reproductive age, impacting their overall well-being. Menstruation involves interactions between endometrial epithelial and stromal cells, immune cell influx, and changes in endometrial vasculature. These events resemble an inflammatory response with increased vessel permeability, tissue breakdown, and the arrival of innate immune cells. However, the mechanisms of menstrual cessation are poorly understood. AUB can be related to structural causes (polyp, adenomyosis, leiomyoma, malignancy/hyperplasia) and nonstructural conditions (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic). While transvaginal ultrasound is the primary method for the screening of intracavitary lesions, saline infusion sonohysterography is more accurate to detect endometrial polyps and submucous leiomyomas, while hysteroscopy with biopsy remains the reference method for a definitive diagnosis. The main goals in managing AUB are addressing and correcting the underlying primary cause, if possible, and establishing a regular bleeding pattern or amenorrhea, which can be done with antifibrinolytic agents, progestins, gonadotropin-releasing hormone agonists and antagonists, or surgical interventions, each one with specific indications and limitations. Further research is necessary to assess the effectiveness and the long-term effects of various medical and surgical treatments. Meanwhile, the availability of diagnostic methods such as transvaginal ultrasound and hysteroscopy and the universal distribution of medical treatments for AUB should be prioritized by policymakers to minimize the diagnostic and treatment delay and thus reduce the risk of AUB-related anemia and the need of hysterectomy.
摘要：
异常子宫出血（AUB）是子宫体出血的规律性异常，volume,频率或持续时间。它包括大量月经出血，月经不调出血和经期出血，这是育龄妇女的常见症状，影响他们的整体福祉。月经涉及子宫内膜上皮细胞和基质细胞之间的相互作用，免疫细胞流入，和子宫内膜脉管系统的变化。这些事件类似于血管通透性增加的炎症反应，组织破裂,和先天免疫细胞的到来。然而,对月经停止的机制知之甚少。AUB可能与结构原因(息肉，子宫腺肌病,平滑肌瘤,恶性肿瘤/增生)和非结构性疾病(凝血病，排卵障碍,子宫内膜,医源性）。虽然经阴道超声是筛查腔内病变的主要方法，生理盐水灌注超声宫腔造影更准确地检测子宫内膜息肉和粘膜下平滑肌瘤，而宫腔镜活检仍是明确诊断的参考方法。管理AUB的主要目标是解决和纠正潜在的主要原因，如果可能,建立有规律的出血模式或闭经，这可以用抗纤维蛋白溶解剂完成，孕激素,促性腺激素释放激素激动剂和拮抗剂，或手术干预，每个都有特定的适应症和局限性。需要进一步的研究来评估各种医学和外科治疗的有效性和长期效果。同时,政策制定者应优先考虑经阴道超声和宫腔镜等诊断方法的可用性以及AUB药物治疗的普遍分布,以最大限度地减少诊断和治疗延迟,从而降低AUB相关性贫血的风险和子宫切除术的需要.
