Sangramento uterino disfuncional pdf

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Sangrado que dura más de 8 días. • Ciclos menstruales que duran más de 38 días o menos de 24 días. Sangrado uterino anormal. The American College of. PDF Download PDF. Members Only. 3. Sangrado uterino anormal sexuales • Sangrado intenso durante el período menstrual — Sangrado que empapa uno o . O sangramento vaginal anormal pode ser relacionado à menstruação (por exemplo, menorragia) ou não relacionado a ela (por exemplo, sangramento.

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Sangramento Uterino Disfuncional Pdf

O sangramento uterino anormal é uma afecção frequente que pode afetar negativa- mente aspectos físicos gramento uterino anormal, tanto na fase aguda quanto na crônica. A apresentação edingpdf. O sangramento uterino anormal é uma afecção frequente que pode afetar negativamente aspectos físicos, emocionais, sexuais e profissionais. Tratamento do sangramento uterino anormal: uma análise sob a perspectiva dos custos no Sistema Único de Saúde e da medicina suplementarTreatment of.

Literature studies are more frequent with formulations containing 30 mcg of ethinyl estradiol associated with levonorgestrel, but theoretically various formulations may be used. In the literature, there are studies with different combinations in different regimens through oral route or vaginal ring proving the reduction of bleeding. Given the diversity of the associations, the comparison between them is difficult, but studies have shown more efficacy in monophasic oral regimens compared with mefenamic acid, naproxen, or danazol. Continuous regimens were also superior to the cyclic use of combined formulations. In Brazil, the indication for menstrual flow reduction is in the package insert. In the treatment of AUB, the use of CCs is also guided by the World Health Organization's WHO eligibility criteria for contraceptive methods, respecting the contraindications for estrogen use, such as hypertension, migraine with aura, smoking habits after 35 years, thrombophilia, among others. Isolated systemic progestogen Progesterone is a hormone produced in the female organism during the luteal phase of the menstrual cycle, and is responsible for the secretory transformation of the endometrium. When there is no fertilization, estrogen and progesterone levels fall, and menstruation occurs.

After controlling bleeding and maintaining the therapy at smaller doses for a time similar to that of a menstrual cycle, discuss the need to maintain control of the cycle with medication for three consecutive months, and proceed with the etiological investigation. Other options suggested in the literature are the use of a GnRH antagonist associated with an aromatase inhibitor or a GnRH antagonist to prevent initial stimulation by the release of estrogen.

Intrauterine tamponade can also be considered, using the Foley probe with an inflated balloon with 3—10 mL. The use of antifibrinolytic substances, such as tranexamic acid, may greatly aid in the control of bulky bleeding, usually used adjunctively and associated with other alternatives. If there is acute bleeding with impairment of the patient's general condition, her hemodynamic stabilization should be prioritized, followed by the immediate start of treatment, whether clinical or surgical, even if the bleeding cause is not completely established, ruling out only vaginal and cervical lesions and pregnancy.

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In cases of AUB without systemic repercussion, identifying the cause of the bleeding is mandatory before the start of treatment. Considering the main diagnosis of this clinical manifestation, pregnancy and the presence of vaginal and cervical lesions should be excluded by physical examination. Afterwards, an evaluation of the uterine cavity by imaging exams should be performed to identify the presence of organic lesions in the endometrial cavity. In the presence of endometrial lesions such as endometrial polyps and submucosal leiomyomas, surgical treatment may be indicated.

The only definitive treatment for adenomyosis is hysterectomy, but the control of symptoms by medical drug treatment is not rare. In cases of intramural myomas, with an increase of uterine bleeding, the first therapeutic option is pharmacological, and there may be an improvement in the bleeding in some cases, avoiding an unnecessary surgical procedure. If there is no response to the clinical treatment, surgical treatment should be recommended.

The surgical access route and type of surgery will depend on the number, location and size of the myoma, and the patient's desire for pregnancy. If there is an AUB of non-structural cause, clinical treatment is always the first option.

The main therapeutic options are described in Table 2 If there is no response to the clinical treatment in bleedings of non-structural cause, there are also surgical therapeutic options, such as endometrial ablation by thermal balloon or hysteroscopy , or even hysterectomy.

The various therapeutic options available for the treatment of AUB should be used rationally to allow their control, leaving surgical procedures for specific situations and avoiding unnecessary surgical procedures.

A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril ; 95 07 , Comparison of transvaginal ultrasonography and hysteroscopy in the diagnosis of uterine pathologies. A systematic review of transvaginalultrasonography,sonohysterographyandhysteroscopy fortheinvestigationofabnormaluterinebleedinginpremenopausal women.

Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women.

Adenomyosis and abnormal uterine bleeding AUB-A pathogenesis, diagnosis, and management. Hysteroscopy and treatment of uterine polyps. Uterine fibroid management: from the present to the future. Submucous myomas: a new presurgical classification to evaluate the viability of hysteroscopic surgical treatment-preliminary report.

Hysteroscopy and the treatment of uterine fibroids. Operative office hysteroscopy without anesthesia: analysis of cases performed with mechanical instruments. The management of uterine leiomyomas. A clinician's guide to the use of gonadotropinreleasing hormone analogues in women. Arterial embolisation totreatuterinemyomata. Embolization of uterine fibroids from the point of view of the gynecologist: pros and cons. Current role of uterine artery embolization in the management of uterine fibroids.

The impact of uterine artery embolization on ovarian function. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Adenomyosis: a systematic review of medical treatment.

The medical management of abnormal uterine bleeding in reproductive-aged women. ACOG committee opinion no. The efficacy of non-contraceptive uses for hormonal contraceptives.

Hormonal contraception as treatment for heavy menstrual bleeding: a systematic review. Oral contraceptive pills for heavy menstrual bleeding. Adding low-dose estrogen to the hormone-free interval: impact on bleeding patterns in users of a day extended regimen oral contraceptive.

Economics of reducing menstruation with trimonthly-cycle oral contraceptive therapy: comparison with standard-cycle regimens.

The effects of mefenamic acid and norethisterone on measured menstrual blood loss. Nonsurgical management of heavy menstrual bleeding: a systematic review. Efficacy of micronised vaginal progesterone versus oral dydrogestrone in the treatment of irregular dysfunctional uterine bleeding: a pilot randomised controlled trial.

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Progestogens with or without oestrogen for irregular uterine bleeding associated with anovulation. Final report. The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Levonorgestrel-releasing and copper-releasing Nova T IUDs during five years of use: a randomized comparative trial.

Surgery versus medical therapy for heavy menstrual bleeding. Management of unscheduled bleeding in women using hormonal contraception. London: Faculty of Sexual and Reproductive Healthcare; Treatment of vaginal bleeding irregularities induced by progestin only contraceptives. Tranexamic acid-an old drug still going strong and making a revival. An objective evaluation of flurbiprofen and tranexamic acid in the treatment of idiopathic menorrhagia.

The effect of tranexamic acid on measured menstrual loss and endometrial fibrinolytic enzymes in dysfunctional uterine bleeding. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Medical management of heavy menstrual bleeding.

Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Non-surgical interventions for treating heavy menstrual bleeding menorrhagia in women with bleeding disorders. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Levonorgestrelreleasing intrauterine system vs. Clinical trial of the uterine thermal balloon for treatment of menorrhagia.

Endometrial resection and ablation techniques for heavy menstrual bleeding. Heavy menstrual bleeding. Mechanisms of abnormal uterine bleeding.

Cost-utility of levonorgestrel intrauterine system compared with hysterectomy and second generation endometrial ablative techniques in managing patients with menorrhagia in the UK. Hysterectomy, endometrial ablation and Mirena r for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis. Hysterectomy after endometrial ablation. NICE says hysterectomy must be last option for heavy menstrual bleeding. Use of intravenous Premarin in the treatment of dysfunctional uterine bleeding-a double-blind randomized control study.

Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial.


Conflicts of Interest The authors have no conflicts of interest to declare. This is an open-access article distributed under the terms of the Creative Commons Attribution License Av. The low frequency of severe adverse effects encourages the administration of the vaccine in the population at risk. Keywords: Papillomavirus vaccines, Adverse effects, Adolescent, Meta-analysis, Safety Introduction Cervical cancer is the second most common type of cancer that affects women worldwide, with an incidence of approximately , cases and , deaths each year.

Manual de Ginecologia - UNIFESP - 1ed

The infection may be transient and not clinically detectable, but can also cause genital warts and a variety of pre-malignant and malignant anogenital lesions in both genders.

Studies indicate a very similar safety profile for severe and mild adverse effects for each one of the vaccines. Concerns about the adverse effects is considered a barrier to vaccination and one of the reasons for low adherence to the recommendations for human papillomavirus quadrivalent types 6, 11, 16, 18 recombinant vaccine administration. Several debates have been carried out with persistent controversies about the advantages and disadvantages of its use.

Therefore, the knowledge of the possible local and systemic adverse effects can subsidize adherence strategies and guide health care actions for the population at risk.

Therefore, the objective of this study is to identify and quantify the adverse effects associated with the administration of the human papillomavirus quadrivalent types 6, 11, 16, 18 recombinant vaccine, as a tool to determine the safety of its use in adolescents. The study design filter "RCTs" was added to the obtained results. Subsequently, the identified articles were analyzed by reading the titles and abstracts.

All other studies were read in full, analyzed by five independent investigators and classified according to the Jadad score.

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