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At least 19 recordsLinked to original sources
PubMed1996

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↗
PubMed1999

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↗
PubMed1991

[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↗
PubMed1979

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↗
PubMed1992

[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↗
PubMed1988

[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↗
PubMed1986

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↗
PubMed1979

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↗
PubMed1981

[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↗
PubMed2000

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↗
PubMed2001

[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↗
PubMed1992

[The value of ultrasound examination for diagnosing postmenopausal metrorrhagia].

The results of transvaginal ultrasound diagnostic assessment of endometrium were compared with histopathological examination of endometrium by following diagnostic abrasion on examined group of 54 postmenopausal women. The method seems to be useful for diagnosis of postmenopausal metrorrhagia, when the "safe" thickness of endometrium layer is taken as 5 mm. It occurs in effect of our study the transvaginal ultrasound examination may decrease the number of subsequent diagnostic abrasions in those cases.

Aged↗
PubMed1992

[Role of vaginal echography in the investigation of menorrhagia and metrorrhagia in the reproductive years].

Eighty non-menopausal patients who had troubles of menorrhagia or metrorrhagia who were neither pregnant nor had cervical pathology, were investigated first by vaginal ultrasound and then by hysteroscopy. In 43 of the cases a hysterosalpingogram had been carried out before hand. All patients had histological examination of tissues. The main pathological ultrasound features were clearly made out. Vaginal ultrasound, and the conditions under which the study was undertaken, gives much more information than hysterosalpingography and will be able in future to a greater extent, to replace conventional radiography. Vaginal ultrasound manages to achieve information about the endometrium and the uterine cavity almost equal to that obtained by hysteroscopy and furthermore it gives more precise information about the state of the myometrium. Vaginal ultrasound therefore seems to be an excellent first stage examination to investigate menstrual disturbances in reproductive life, and so long as it is carried out under good conditions will limit the indications for hysteroscopy and will be able to indicate when it is necessary to carry out simple exploratory hysteroscopy or operative hysteroscopy.

Adult↗
PubMed1991

[Endometrial resection for metrorrhagia: 45 cases].

Treatment of metrorrhagia has recently been modified because of the use of the hysteroscope which allows two methods to be used: diathermy and endometrial ablation or laser destruction of the endometrium. This retrospective study of ablation of the endometrium was carried out on 45 cases: the patients had excessive bleeding or menorrhagia that had been developing and in an average about 18 months. The mean age of the patients was 48 years with a deviation of 7 years. More than half the women were overweight, a quarter weighing more than 80 kgs with a height of 1 metre 60. A third of the cases had pathology associated with the condition. In 24 cases endometrial resection was carried out by itself but in 21 cases endometrial resection was accompanied with removal of polyps or of submucous myomata. The results were: There was no anaesthetic complication or accident; The operation was complicated only once by perforation of a cornu; Bleeding stopped completely in 94% of cases with an average duration of follow-up of 7 1/2 months; Control hysterosalpingography showed synechiae in 70% of the cases; The histology showed a preponderance of mucosal hyperplasia and of small fibroids. The authors point out: that it is important to learn carefully the operative technique to lessen the risks of complications, but the clinical results compare with the best in the literature but with the price to pay of a high incidence of synechiae. The following questions will have to be answered in the future: What is the risk of cancer after endometrial ablation? Is it possible to avoid synechiae so that the whole cavity of the uterus can be assessed later? What is the role of medical as opposed to surgical treatment in heavy bleeding at the time of the menopause?

Adult↗
PubMed1990

[Metrorrhagia and tamoxifen. Apropos of 22 patients treated for cancer of the breast].

The authors report 22 cases of metrorrhagia occurring in the course of adjuvant hormonal therapy for breast cancer using tamoxifen. The anti-oestrogenic effect of this drug is associated with a variable agonistic effect that has been observed in organs with steroid receptors, and especially in the uterus. In this series, the cause of the abnormal bleeding is explained in 17 out of the 22 cases (ie, 3 out of 4) as a paradoxical oestrogen-like effect on the mucosa of the uterus. Two cancers of the endometrium were diagnosed.

Adult↗
PubMed1989

[Emergency ambulatory treatment of dysfunctional metrorrhagia in adolescents].

The authors compared the therapeutic efficacy of oestrogen-progestogen combinations with pure progestagen in the urgent treatment of adolescent metrorrhagia. Two groups of adolescents were studied whose haemorrhages were attributed exclusively to disfunction. Every medicine was evaluated as to: 1) effectiveness in completely spotting haemorrhage, 2) any persistence of bleeding, 3) side effects. The therapy was given during 2 consecutive menstrual cycles. Results following treatment with oestrogen-progestogen combinations were favourable, even though side effects were more noticeable.

Adolescent↗
PubMed1989

[Post-menopausal metrorrhagia. Use of danazol in endometrial hyperplasia].

The Authors, after a careful examination of the literature on endometrial hyperplasias, review the results of a preliminary study on 15 patients affected with postmenopausal metrorrhagia, cured by Danazol (200 mg/die) through 90 consecutive days. Also recognizing the best tolerance to the drug and the low incidence of the side effects, they think the results obtained by Danazol need further confirmation by more protracted controls.

Danazol↗