[Metrorrhagias; examination technic in emergency metrorrhagias].
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Female↗
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[Ambulatory metrorrhagias of non-pregnant young women; prepuberal, menopausal and postmenopausal metrorrhagias].
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Female↗
Pubertal metrorrhagia.
OBJECTIVE: To determine the clinical characteristics of pubertal metrorrhagia and its treatment, depending on severity; to evaluate the frequency of etiologies and the influence of hemostatic abnormalities; and to describe severe pubertal metrorrhagia. Design, setting and participants. This retrospective study examined all the files (n = 105) of adolescents presenting for pediatric gynecology consultation at a children's hospital between January 1979 and June 1993. RESULTS: The mean age of patients at the first consultation was 13 years. Metrorrhagia began in the year after the first menstrual period in 85% of cases. The causes were functional (83 cases), primary hemostatic disorder (14 cases), hemostatic disorder secondary to renal or hepatic disease (7 cases), or tumor (1 case). The cases were assigned to one of three groups, according to the severity of anemia; group I, mild anemia, hemoglobin Hb > 11 g%, 64 cases; group II, moderate anemia, Hb 8-11 g%, 23 cases; and group III, severe anemia, Hb < 8 g%, 18 cases. Of the 14 patients suffering from primary hemostatic disorders, 7 had been diagnosed before the onset of metrorrhagia; the disorder was revealed by the metrorrhagia in the remaining 7. Only 1 of these patients was severely anemic (known factor X deficiency). Four patients suffering from moderate von Willebrand's disease were discovered after specific tests; they were mildly or moderately anemic. The severe anemias (group III) all occurred during the first three periods. This group had functional disorders in 15 of 18 cases. Treatment continued to be required in 10 of 18 cases followed for more than 3 years. Treatment was progestin for group I and II patients or an estroprogestin, followed by a progestin, for group III. Curettage was never required. CONCLUSIONS: The most common cause of pubertal metrorrhagia is a functional disorder (80% of cases). Hemostatic disorders likely to cause severe menstrual hemorrhage were known before the age of menarche; these disorders must be controlled by hormone treatment begun before or at the time of the first menstrual period. Severe forms that arise during the initial three menstrual cycles are functional in most cases. These should be given a course of treatment lasting several years. There is a high risk of recurrence. Treatment is medical and hormonal in all cases.
Adolescent↗
Transvaginal sonohysterography and hysteroscopy in the evaluation of female infertility, habitual abortion or metrorrhagia. A comparative study.
BACKGROUND: To assess the diagnostic value of sonohysterography in the evaluation of metrorrhagia and infertility with hysteroscopy as the standard. METHODS: Sixty-six women, 41 with metrorrhagia, 20 with infertility and five with habitual abortion, were examined by sonohysterography and hysteroscopy. Sterile saline instilled through a baby-feeding tube was used to distend the uterine cavity during sonohysterography. Hysteroscopy was performed with a 4 mm hysteroscope under general anesthesia. The endometrial polyps and submucous myomas were recorded and the findings subsequently compared. RESULTS: Of the 66 women, 60 were successfully examined by both sonohysterography and hysteroscopy. The overall sensitivity and specificity for sonohysterography was 90.9% and 100%, respectively. The positive and negative predictive values were 100% and 90%, respectively. When examining the metrorrhagia and infertility groups separately the sensitivity and specificity and predictive values were found to be 88.5%, 100%, 100% and 76.9% (metrorrhagia) and 100% for all parameters in cases of infertility. No complications were recorded during the procedures. CONCLUSION: Sonohysterography is a simple, fast, well tolerated and accurate method to evaluate the uterine cavity in patients with metrorrhagia or infertility.
Abortion, Habitual↗
[Metrorrhagia treated by radio frequency ablation: report of 36 cases].
OBJECTIVE: To observe the effect of radio frequency ablation (RFA) for treating metrorrhagia. METHOD: In-36 metrorrhagia patients, who failed to respond to both traditional Chinese medicine and western medicine, and who did not seek child-bearing with malignant changes of the uterus shown by gynecological examination, B-ultrasonic, diagnostic curettage, and pathological examination, the width and depth of the uterine cavity were measured while sending the coagulator to the bottom of the uterus, followed by coagulation of the uterine cavity for two times. The whole process was carried out under the supervision of B-ultrasonic, whose strong echo-band was between 0.8 and 1.0 cm. RESULT: Within one year, the effective rate was 100%, and no recurrence was found. CONCLUSION: RFA is easy, economical, safe and efficient in treating metrorrhagia.
Adult↗
[Course of metrorrhagia after biopsy curettage of the endometrium in women in reproductive age ].
Authors working in the department of gynaecology and obstetrics in the university hospital of Caen with non-pregnant, non-menopausal women who were followed-up for at least 2 years after curettage have been able to carry out a retrospective study of 102 curettage and biopsies carried out either for diagnosis or to lessen bleeding in cases of metrorrhagia, menorrhagia or menometrorrhagia. Histology of the endometrium showed 40 cases of hyperplasia, 17 cases of polyps in the cavity of the uterus, 19 cases of atrophy, 6 cases of endometritis, 3 cases of atypical hyperplasia and 17 cases of normal endometrium. Hysterectomy was carried out in 22 cases because of recurrence of metrorrhagia. Anatomopathological examination of the operation specimens had shown iatrogenic atrophy of the mucosa in 13 cases (59%). The authors believe that this hypoplasia can be responsible for some recurrences and suggest that the state of the endometrium should be reassessed when metrorrhagia reappears in spite of well controlled treatment with progestagens. In the case of atrophy a cycle of oestrogens and progestagens should be started as it should be immediately after the curettage. The authors hope in this way to lessen the number of hysterectomies that have to be carried out because of failure of medical treatment.
Adult↗
Morphologic studies on IUD-induced metrorrhagia. I. Endometrial changes and clinical correlations.
Morphologic studies on human hysterectomy specimens indicate the IUD elicits a vascular reaction which is most pronounced in the endometrium adjacent to the device. This reaction includes increased vascularity, congestion and increased permeability, and degeneration with defect formation. In addition, there is poor hemostatic responsiveness to vascular permeability and damage. The reaction leads to interstitial hemorrhage which undoubtedly causes metrorrhagia. A likely cause for initial vascular damage is mechanical stress transmitted by the IUD through the endometrium to its vascular network. Vascular reaction and poor hemostatic responsiveness may be perpetuated during each cycle by the products released from endothelial cell degeneration and necrosis. Bleeding is one of the most frequent complications leading to discontinuation of an otherwise effective form of long-term contraception and family spacing. Therefore, its solution could be of crucial importance to world-wide population control. Our findings suggest that better understanding of the mechanism of IUD-induced metrorrhagia should result from closer study of the endometrium adjacent to that which is compressed by the IUD.
Endometrium↗
[Results of histopathologic findings of endometrial changes in metrorrhagia].
Endometrium is a tissue which is in permanent changes in the active gynaecological period of a female. This can be followed-up through histological, custological and histochemical changes. In determining the morphologic changes and disturbances in endometrium, pathohistological examinations were and still are necessary and irreplaceable in defining the real causes of this phenomenon. The aim of our work is to show the pathohistological results of the material obtained by explorative curettage in metrorrhagia, to determine the aetiology of the pathological process in endometrium, which provokes irregular bleeding, and to check the possible increase in precancerogenic and malignant endometrial conditions over a period of three years. The examinations covered 786 patients who asserted that bleeding was the main symptom of their illness. In all of them explorative curettage was performed mainly in diagnostic and often in therapeutic purposes. The number of examinations are in constant increase. The age of the largest number of patients was from 41 to 50 years, a period when the anovulary cycle is most frequent which, in turn, causes changes in endometrium which results in irregular bleeding i.e. in metrorrhagia (Tables 1, 2 and 3). The most frequent histopathological changes were manifested by adenomatic hyperplasia (160), then glandular (136) and cystic hyperplasia (92). Eleven cases of endometrial carcinoma were detected. In two of these patients the finding was not confirmed by pathohistological result after the operation or repeated explorative currettage. In 64 patients atypical hyperplasia i.e. Ca in situ was found. Acute endometritis followed by irregular bleeding was observed during inflammatory process of the internal genital organs. In 35 patients chronic endometritis was found after curettage following the extraction of the intrauterine device (in one case after 40 years of carrying). In 103 patients with hyperplasia myomatous changes were noted; this finding correlated with hyperoestrogenism, which is usually present in both disorders. All authors agree that pathohistological examination of endometrium is the most reliable in the search for a correct diagnosis. Despite of all modern diagnostic and technical means, difficulties always arise in the assessment of malignant potential of endometrial hyperplasia. Therefore, the patients with recurrent bleeding caused by hyperplasia should be under intensive gynaecological control.
Adult↗
[Treatment of dysfunctional metrorrhagia with GnRH analogs].
Thirty patients diagnosed as affected by dysfunctional metrorrhagia were treated with goserelin in a registered formulation of 3.6 mg injected subcutaneously into the anterior abdominal wall. These patients suffered from hypochromic anemia secondary to metrorrhagia with asthenic symptoms. After six months' treatment there was a significant improvement in hemocrasia and symptoms resolved without collateral effects requiring the suspension of treatment. The 10 patients who subsequently underwent surgery were in excellent condition and did not require blood transfusions.
Abdominal Muscles↗
[Isolated metrorrhagia in a prepubertal child caused by functional ovarian cyst].
The authors report the case of a 10-year-old girl, without any sign of pubertal development, who showed repeated metrorrhagia, related to a functional ovarian cyst. Cyproterone acetate therapy gave only a transient remission of the metrorrhagia. A complete remission was obtained with a 6 months treatment with an LHRH analog.
Child↗
Therapeutic effect of danazol on metrorrhagia in patients with idiopathic thrombocytopenic purpura (ITP).
Idiopathic thrombocytopenic purpura (ITP) is more frequently seen in young females than in any other age or sex group. Danazol, an impeded androgen with a decreased masculinizing potential, has been described as useful in ITP. A total of 25 women 16 to 41 years of age, with chronic ITP were studied. All patients were refractory to treatments with glucocorticoids and splenectomy; 19 were inadequately controlled by immunosuppressants, vinblastine or vincristine-loaded platelets, the radioimmune method, colchicine, plasmapheresis, or surgery for accessory spleens. Danazol was given at a daily dosage of 600 mg for 4 months. All showed clinical improvement, as indicated by cessation or decrease of bleeding, and 12 (48%) cases obtained a drug-dependent excellent or good response of their ITP. Therapy produced amenorrhea or oligomenorrhea in 21 patients (84%) and 7 cases of chronic metrorrhagia were successfully controlled. The drug was well tolerated. Accordingly, danazol may be an effective treatment for ITP or related conditions, especially in adult females with uncontrollable metrorrhagia.
Adolescent↗
Morphologic studies on IUD-induced metrorrhagia. II. Surface changes of the endometrium and microscopic localization of bleeding sites.
Surface changes were extensively studied by light and electron microscopy in human endometrium exposed to IUD's. A wide variety of alterations in the covering epithelium and its basal lamina (basement membrane) was observed. These ranged from essentially no alteration to a covering basement membrane completely denuded of its epithelium. Erosions or discontinuities of the surface basement membrane were uncommon, and when they occurred were most often associated with extrusion of fluid and cellular elements from the stroma into the uterine lumen. Metrorrhagia associated with IUDs probably results from two basic types of hemorrhage through the endometrial surface. Tissue adjacent to the IUD with interstitial hemorrhage bleed into the uterine cavity by (1) red cell transmigration through surface membranes (surface epithelium and its basal lamina), and (2) high interstitial pressure breaks in these same membranes.
Basement Membrane↗
Premenopausal metrorrhagia as a symptom of sarcoidosis.
Sarcoidosis rarely affects the female genitalia. We report a 36-year-old woman who had a hysterectomy for metrorrhagia. Histologic examination showed sarcoid granulomas in the endometrium and myometrium. Subsequent examinations revealed pulmonary sarcoidosis as well.
Adult↗
[Juvenile metrorrhagia by Willebrand Jürgens syndrome (author's transl)].
Juvenile bleeding is a symptom frequently observed in a children's gynecologic outpatient clinic. In rare cases this symptom does not represent a disturbance of hormonal regulation systems, but may be due to a coagulopathy. We represent a patient of an age of 12 years, who was admitted with the diagnosis: juvenile metrorrhagia. The final diagnosis: Willebrand-Jürgens syndrome would be established after invasive examinations and a series of blood tests. The presentation of this case suggests to consider coagulopathies as a cause of bleeding in similar cases. The special condition should be tested in cooperation with hematologists.
Blood Coagulation Factors↗
Metrorrhagia and precocious puberty revealing primary hypothyroidism in a child with Down's syndrome.
We report a child with Down's syndrome in whom metrorrhagia and precocious puberty revealed primary autoimmune hypothyroidism. The patient had a decreased growth velocity, exaggerated weight gain, bone age delay, and bilaterally enlarged multicystic ovaries. Delays in the diagnosis and treatment of hypothyroidism can lead to this peculiar presentation.
Child↗
The role of antibiotics after dilatation and curettage in women with metrorrhagia in the prevention of pelvic inflammatory disease.
A follow-up study was carried out in 67 healthy women with negative vaginal-cervical cultures after an endometrial curettage for metrorrhagia. The women were separated into two treatment groups and clinically followed for one month after the operation. The first group included 33 women (aged 23-67, mean 43) who received doxycycline 200 mg daily for a period of one week after the procedure. The second group included 34 women (aged 28-70, mean 43.5) who did not receive any antibiotic regimen after the dilatation and curettage. Four and three women from the 1st and 2nd group, respectively, developed PID during follow-up; a difference not statistically significant.
Adult↗
[Metrorrhagia during the third trimester disclosing Munchausen syndrome].
Metrorrhagia during the third trimester of pregnancy similar to that observed in placenta praevia may be a signal to the physician that the patient is calling for help. This clinical situation is one where the patient mimics an illness, playing the role of a patient. The risk is that an unnecessary surgical procedure may be triggered, in this case cesarean section. The main difficulty in caring for these patients is to make the diagnosis. Treatment relies on psychotherapy which can contribute to an improved mother-infant relationship and perhaps prevent acts of self-mutilsation.
Adult↗
[Using of Therma-Choice system in treatment of metrorrhagia in case of porphyria].
The authors present the use of Uterine Balloon Therapy in the long term metrorrhagia resistant to conservative treatment, in the case of porphyria. The method was used on a 44 year old female, suffering from acute intermittent liver porphyria for 9 years.
Adult↗