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7 results

  • Chapter 2 - Abnormal Uterine Bleeding

  • Edited by Laurie J. Mckenzie, University of Texas MD Anderson Cancer Center, Houston, Denise R. Nebgen, University of Texas MD Anderson Cancer Center, Houston
  • Book:
    Caring for the Female Cancer Patient
    Published online:
    23 October 2024
    Print publication:
    17 October 2024, pp 24-37

  • Summary

    Obstetrician-gynecologists are frequently consulted during an episode of abnormal uterine bleeding (AUB) to stop bleeding acutely and to prevent further bleeding during cancer treatment. Women with hematologic malignancies, such as acute myelogenous leukemia (AML), are the most frequently affected and new onset heavy menstrual bleeding may be the chief complaint leading to their diagnosis. Cancer and cancer treatments including chemotherapy, total body irradiation, and conditioning regimens for bone marrow or stem cell transplant can induce thrombocytopenia and lead to AUB. Main treatment options include oral contraceptive pills (OCPs), gonadotropin-releasing hormone (GnRH) agonists, and progestin-only hormone therapy. Algorithms are available to guide treatment and medical management is first line, especially in patients who have not completed childbearing. The risk of venous thromboembolism and need for contraception are special considerations when choosing a treatment for AUB in this patient population.

  • Case 44 - A 42-Year-Old Woman with Abnormal Uterine Bleeding Who Desires In-Office Ablation

  • Edited by Todd R. Jenkins, University of Alabama, Birmingham, Lisa Keder, Abimola Famuyide, Kimberly S. Gecsi, David Chelmow
  • Book:
    Surgical Gynecology
    Published online:
    19 November 2021
    Print publication:
    02 December 2021, pp 134-136

  • Summary

    A 42-year-old multiparous woman with heavy menstrual bleeding desires in-office endometrial ablation. She has regular but heavy menses that lasts 10 days and occurs every 28 days. Menses are so heavy that she passes large clots and has missed work on occasions. She denies any dysmenorrhea or intermenstrual bleeding. She has had a complete evaluation and no cause of abnormal uterine bleeding was identified. She denies fatigue, shortness of breath, or lightheadedness. She has intolerable side effects with systemic contraceptives and has previously trialed tranexamic acid and a levonorgestrel intrauterine device without success. She would like to avoid hysterectomy and requests in-office endometrial ablation. She has no history of chronic pain, anxiety, or intolerance of office procedures or anesthesia. Her partner has had a vasectomy. She has no medical comorbidities and does not take any daily medications.

  • 9 - Chronic pelvic pain

  • Mary Ann Lumsden, University of Glasgow, Margaret Rees, University of Oxford
  • Book:
    Menstrual Problems for the MRCOG and Beyond
    Published online:
    05 June 2014
    Print publication:
    27 February 2014, pp 103-114

  • Summary

    This introduction discusses the aetiology of menstrual problems, their presentation and investigation as well as medical and surgical management. Specific problems such as fibroid-associated bleeding, adolescent and perimenopausal bleeding and breakthrough bleeding are covered, as are other critically important problems such as premenstrual disorders, pelvic pain and dysmenorrhoea. The most common presenting menstrual problem is heavy menstrual bleeding (HMB). A woman's approach to her periods will vary through her reproductive life. After childbearing is completed, the view of the menses will alter dramatically. The longest intermenstrual interval occurs at the menarche. Menstrual irregularity is most likely to occur at the extremes of reproductive life, the incidence of anovulation increasing as the menopause approaches. Classical primary spasmodic dysmenorrhoea occurs at the onset of the menses and gets better after 1 or 2 days, whereas secondary dysmenorrhoea tends to start prior to the menses and worsens as it proceeds.

  • 10 - Delayed menarche

  • Mary Ann Lumsden, University of Glasgow, Margaret Rees, University of Oxford
  • Book:
    Menstrual Problems for the MRCOG and Beyond
    Published online:
    05 June 2014
    Print publication:
    27 February 2014, pp 115-118

  • Summary

    Excessive menstrual bleeding describes the clinical problems of heavy menstrual blood loss together with frequent or irregular menstruation. This chapter addresses endometrial morphology, the mechanism of menstruation and the aetiology and management of menstrual problems. A very common cause relates to ovulatory dysfunction, which typically leads to a combination of irregular bleeding and a variable volume of menstrual flow, which can lead to heavy menstrual bleeding (HMB). Clotting disorders such as von Willebrand's disease are another cause of HMB. Reduced clotting is a known feature at the time of menstruation. Pelvic pathologies such as fibroids are common, affecting between 20 and 25% of women. It is reported that around a third of women with fibroids complain of heavy menstrual blood loss. There are a number of terminologies to describe menstrual complaints such as menorrhagia, polymenorrhoea, oligomenorrhoea, polymenorrhagia and metrorrhagia.

  • 16 - Newdevelopments in female sterilization

  • Edited by Paula Briggs, Gabor Kovacs, Monash University, Victoria
  • Edited in consultation with John Guillebaud, University College London
  • Book:
    Contraception
    Published online:
    05 August 2013
    Print publication:
    11 July 2013, pp 142-148

  • Summary

    A review of the qualitative literature on young women's experiences of menarche revealed that menarche had a major impact on lives physically, psychologically, socially and culturally. Pubertal development before the age of eight and menarche before the age of nine should be investigated by an endocrinologist. Early menarche is associated with an increase in all cancer mortality, whereas late menarche is associated with increased risk of osteoporosis and fractures. Sometimes girls will continue to have heavy bleeding on combined hormonal contraception (CHC). A recent addition to treatment options is oestradiol valerate with dienogest (Qlaira) with a license to treat heavy menstrual bleeding. The authors have found it useful in the treatment of peri-menarchal dysfunctional uterine bleeding (DUB) and also useful for young girls who find it difficult to tolerate oestrogenic side effects including headache and nausea.

  • CHAPTER 7 - Heavy menstrual bleeding

  • Edited by Tahir Mahmood, Allan Templeton, University of Aberdeen, Charnjit Dhillon
  • Book:
    Models of Care in Women's Health
    Published online:
    05 July 2014
    Print publication:
    01 June 2009, pp 67-80

  • Summary

    Heavy menstrual bleeding interferes with a woman's physical, social and emotional quality of life. The National Institute for Health and Clinical Excellence (NICE) guideline on heavy menstrual bleeding provides the most up-to- date evidence-based recommendations both on provision of care and the areas that need to be researched further. All health professionals undertaking surgical or radiological procedures to diagnose and treat heavy menstrual bleeding should demonstrate their technical and counselling competence, either during their training or during subsequent practice. Clinical governance policies should be able to monitor treatment complications, patient choice, patient satisfaction and uptake rate. Staff involvement in risk management exercises should be monitored to ensure that appropriate incident forms have been completed and that the staffs involved have received feedback. NICE has suggested several research recommendations in this important aspect of women's health.