Treatment of Uterine Pathology

2021 ◽  
pp. 305-320
Author(s):  
Dimitrios Tsolakidis ◽  
Maria Lantzanaki
Keyword(s):  
Chronic Pelvic Pain ◽  
Negative Impact ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Laparoscopic Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Uterine Bleeding ◽  
Trophoblastic Disease ◽  
Life Threatening

Hysterectomy is the most common gynecological operation after cesarean section. The majority of hysterectomies are performed for the treatment of benign diseases, which, although not life-threatening, may have a negative impact on the quality of patient's life. Abnormal uterine bleeding is the most common indication for hysterectomy in premenopausal women and is usually a result of myomas and adenomyosis. Another indication is chronic pelvic pain that is usually caused by endometriosis and/or adenomyosis. A simple hysterectomy can be the treatment of choice in early stages of endometrial, cervical cancer, sarcomas, or gestational trophoblastic disease. Laparoscopic hysterectomy is superior to laparotomy when a vaginal hysterectomy is contraindicated.

scholarly journals An Immunohistochemical Study of Estrogen and Progesterone Receptors in Endometrium of Women with Dysfunctional Uterine Bleeding

2021 ◽  
pp. 55-65
Author(s):  
A. Kavitha ◽  
J. Thanka
Keyword(s):  
Progesterone Receptors ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Reproductive Age ◽  
Dysfunctional Uterine Bleeding ◽  
Estrogen And Progesterone Receptors ◽  
Large Numbers ◽  
Er Alpha

Abnormal Uterine Bleeding (AUB) is a common complaint that affects large numbers of women from puberty to menopause. It negatively affects health and quality of life of women affected. AUB also has an economic impact for both women and society Abnormal uterine bleeding in premenopausal women is one of the most frequent problems in gynecological practice. Although some of the cases may be due to an organic cause, over 50% of the patients undergoing hysterectomy for menorrhagia have dysfunctional uterine bleeding (DUB). To analyze the percentage and intensity of estrogen receptors (ER) and progesterone receptors (PR) in endometrium of patients with DUB. This study suggests that estrogen and progesterone receptors have an important role in etiopathogenesis of dysfunctional uterine bleeding and alteration in the morphology of endometrium such as development of endometrial hyperplasia. Women in the reproductive age who are complaining of abnormal uterine bleeding, usually have an increase in ER alpha and PR expression in their endometrium.

scholarly journals Study of hysteroscopic evaluation in patients with abnormal uterine bleeding

2017 ◽  
Vol 6 (4) ◽  
pp. 1413
Author(s):  
Ashok Kumar K. ◽  
Sathya P. ◽  
Sreelatha Sampathkumar
Keyword(s):  
Diagnostic Accuracy ◽  
Histopathological Examination ◽  
Financial Burden ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Appropriate Treatment ◽  
Diagnostic Hysteroscopy ◽  
Sensitivity Specificity

Background: Abnormal uterine bleeding in women is the commonest presenting complaint which accounts for one third of all gynecological consultations. It not only causes discomfort, inconvenience to healthy women but also affects their quality of life and impose financial burden on them. This insists the physician to diagnose its etiology and provide appropriate treatment. Hysteroscopy guided biopsy is a simple, safe, reliable procedure in the diagnosis of abnormal uterine bleeding. The objective of the study was to evaluate the uterine pathology in premenopausal women with abnormal uterine bleeding by hysteroscopy.Methods: This prospective study was conducted at ESIC-MC and PGIMSR, Rajajinagar, Bangalore, in 50 premenopausal women with abnormal uterine bleeding over 18 months from Dec 2012 to May 2014. All 50 women were subjected to diagnostic hysteroscopy followed by curettage. The sample was sent to histopathological examination. Data was collected and analyzed.Results: In the present study, abnormal uterine bleeding was more common in 41-45yrs of age. The commonest presenting complaint was heavy menstrual bleeding (menorrhagia) in 54% of cases. The abnormal findings on hysteroscopy were: Hyperplasia 42%, endometrial polyp 22%, sub-mucous myoma 4%, carcinoma endometrium 2%, synechiae 2% and endometritis 2%. Negative hysteroscopic view was seen in 26%. The sensitivity, specificity, positive and negative predictive value of hysteroscopy was 91.89%, 92.31%, 97.14% and 80% respectively. The overall diagnostic accuracy of hysteroscopy was 92%.Conclusions: Hysteroscopy and its directed biopsy renders high diagnostic accuracy in patients with abnormal uterine bleeding and thereby guiding them for further management.

scholarly journals The Predictive Value of Endometrial Thickness in Endometrial Pathologies in Premenopausal Women with Abnormal Uterine Bleeding

2013 ◽  
Vol 2 (4) ◽  
pp. 141-145
Author(s):  
Roksana Darabi ◽  
Mitra Mohit ◽  
Hengameh Mohammadkhani ◽  
Fathemeh Mohammadyari ◽  
Soheila Yadollah-Damavandi
Keyword(s):  
Predictive Value ◽  
Endometrial Thickness ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Endometrial Polyps ◽  
Low Area ◽  
Area Under Roc Curve ◽  
Sensitivity Specificity

AbstractBackground: Abnormal uterine bleeding (AUB) is one of the most common complains in women of any age seeking gynecologic health care and needs early diagnosis and proper management due to its impacts on the quality of life. This study was conducted to investigate the cut-off value of endometrial thickness (ET) by trans-vaginal ultra-sonography (TVUS) and evaluate its accuracy in the diagnosis of the endometrial abnormalities in premenopausal women with AUB.Materials and Methods: In this descriptive  study, 64 married women between 35-50 years old were evaluated due to AUB during 2011-2012; TVUS and fractional curettage were done. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the ET were calculated in different cut-off values.Results: The pathological evaluations of the biopsies were normal in 37 (57.8%) patients and were abnormal in 27 (42.2%) patients, 19 endometrial polyps, 6 hyperplastic lesions and 2 endometrial cancers. ET=4 mm had 100% sensitivity, 100% NPV, 10% specificity and 28% PPV in the detection of endometrial abnormalities. ET<10 mm had a proper sensitivity (67%-100%) and NPV (78.6%-100%) but specificity was low (%10-%44). ET=10 mm with sensitivity=63%, specificity=60%, NPV=65.8% and PPV=48.2% was introduced as the cut-off point with the best area under curve (LR+=2.22 LR- =0.77).Conclusion: Although an ET<10 mm was less likely to be associated with an endometrial abnormality, the low PPV of ET and low area under ROC curve shows sonography has high false positivity in premenopausal women. ET≤4 mm was more reliable and could reduce unnecessary biopsies.

scholarly journals Abnormal Uterine Bleeding in Adolescents: A Multidisciplinary Approach

2021 ◽  
Vol 34 (4) ◽  
pp. 291
Author(s):  
Inês Ramalho ◽  
Helena Leite ◽  
Fernanda Águas
Keyword(s):  
Social Life ◽  
Multidisciplinary Approach ◽  
Healthcare Providers ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Female Adolescents ◽  
Health Concern ◽  
Potential Health ◽  
Life Threatening

Abnormal uterine bleeding is the most common complaint that motivates female adolescents to seek medical advice. Abnormal uterine bleeding has a significant impact on quality of life, promoting school absenteeism and limitations in social life. Moreover, episodes can vary from mild to life threatening events if not recognized and treated promptly. Healthcare providers should be able to distinguish between a normal and abnormal menstrual pattern, as this may provide early diagnosis of a potential health concern. The PALM-COEIN classification system should be used in the evaluation. Anovulation is the most frequent cause, frequently due to immaturity of the hypothalamic-pituitary-ovarian axis. A careful history and physical examination are crucial in the differential diagnosis. Management is based on both the underlying cause and the severity of bleeding. Most patients improve with pharmacological treatment, frequently requiring a multidisciplinary approach. First line treatment consists of hormonal therapy. Surgery is rarely needed. Although the prevalence of abnormal uterine bleeding is higher in adolescents compared to adults, most recommendations are not specific for this age, which makes the diagnosis and management challenging. The literature reveals lack of standardized care for adolescents and regimens vary widely. Future studies on efficacy and safety of treatments specifically in adolescents are needed.

scholarly journals ABNORMAL UTERINE BLEEDING IN ADOLESCENTS: CURRENT STATE OF THE PROBLEM

2020 ◽  
Vol 73 (8) ◽  
pp. 1752-1755
Author(s):  
Iryna O. Tuchkina ◽  
Liudmyla A. Vygivska ◽  
Anastasia A. Novikova
Keyword(s):  
Negative Impact ◽  
Reproductive Function ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
The Body ◽  
Reproductive Age ◽  
Current State ◽  
Literary Sources ◽  
Made In

The aim: To summarize the literature data on abnormal uterine bleeding in adolescents. Materials and methods: This article presents an assessment of 32 literary sources from 2003 to 2018, which raise the issues of etiology and pathogenesis of abnormal uterine bleeding in adolescents. Abnormal uterine bleeding in adolescents (AUBA) is a risk factor for disorders of menstrual and generative function, hormone-related abnormalities in the reproductive age. Despite the progress made in the development of methods for the diagnosis and treatment of AUBA, the criteria for selecting a particular method of diagnosis and therapy have not yet been made sufficiently clear. Conclusions: AUBA is a complex polyetiological disease affecting all parts of the hypothalamic-pituitary-adrenal-ovarian system. It has a negative impact on the girl’s health and quality of life. Abnormal uterine bleeding is a “signal” to the body of an organic or functional disorder. If this feature is ignored, the pathology can progress and lead to severeconsequences. The urgency of the problem of AUBA is further explained by the fact that this disease indicates the presence of serious disorder of the reproductive system, which in the future may be transformed into impaired reproductive function.

scholarly journals Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Luca Giannella ◽  
Lillo Bruno Cerami ◽  
Tiziano Setti ◽  
Ezio Bergamini ◽  
Fausto Boselli
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Prediction Model ◽  
Endometrial Hyperplasia ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Stepwise Logistic Regression ◽  
Simultaneous Presence ◽  
Endometrial Pathology

Objective. To create a prediction model including clinical variables for the prediction of premalignant/malignant endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB). Methods. This is an observational retrospective study including 240 premenopausal women with AUB referred to diagnostic hysteroscopy. Based on the presence of endometrial hyperplasia (EH) or cancer (EC), the women were divided into cases (EH/EC) and controls (no EH/EC). Univariate, stepwise logistic regression and ROC curve analysis were performed. Results. 12 women had EH/EC (5%). Stepwise logistic regression analysis showed that EH/EC associated significantly with BMI ≥ 30 (OR=7.70, 95% CI 1.90 to 31.17), diabetes (OR=9.71, 95% CI 1.63 to 57.81), and a thickened endometrium (OR=1.20, 95% CI 1.08 to 1.34, criterion > 11 mm). The AUC was 0.854 (95% confidence intervals 0.803 to 0.896, p<0.0001). Considering the pretest probability for EH/EC of 5%, the prediction model with a positive likelihood ratio of 8.14 showed a posttest probability of 30%. The simultaneous presence of two or three risk factors was significantly more common in women with EH/EC than controls (50% vs. 6.6 and 25% vs. 0%, respectively, p<0.0001). Conclusion. When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the percentage of premalignant/malignant endometrial pathology increases by 25%. It is likely that the simultaneous presence of several risk factors is necessary to significantly increase the probability of endometrial pathology.

scholarly journals Endometrial Volume Measured by VOCAL Compared to Office Hysteroscopy for Diagnosis of Endometrial Polyps in Premenopausal Women with Abnormal Uterine Bleeding

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Mohamed Laban ◽  
Sherif H. Hussain ◽  
Alaa S. Hassanin ◽  
Waleed M. Khalaf ◽  
Mohamed K. Etman ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Final Analysis ◽  
Uterine Bleeding ◽  
Endometrial Polyps ◽  
Predictive Values ◽  
Endometrial Volume ◽  
Sensitivity Specificity

The aim is to compare hysteroscopy, two-dimensional transvaginal ultrasound (2D TVUS), and three-dimensional (3D) Virtual Organ Computer-aided AnaLysis™ (VOCAL) to detect endometrial polyps (EPs) in premenopausal women with abnormal uterine bleeding (AUB). This prospective study was done at Ain Shams Maternity Hospital, Egypt, from March 5, 2015, to December 30, 2015, enrolling 118 premenopausal women with AUB. 2D TVUS, 3D VOCAL, and hysteroscopy were done. 109 patients reached final analysis. 36 women (33%) were diagnosed with EP by 2D TVUS. 50 (45.9%) had EP by hysteroscopy. Endometrial thickness was 10.1 mm by 2D TVUS and endometrial volume was 4.92 mL by VOCAL in women with EP by hysteroscopy compared to 9.9 mm and 3.50 mL in women with no EP, respectively (P=0.223;P=0.06). 2D TVUS has sensitivity, specificity, and positive and negative predictive values of 54%, 84.7%, 75%, and 68.5%, respectively. Endometrial thickness of >7.5 mm has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 82%, 37.3%, 52.6%, 71%, and 57.8%, respectively. Endometrial volume of >1.2 mL has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 90%, 42.4%, 57%, 83.3%, and 64.2%, respectively. 3D VOCAL may be used as a noninvasive method for the diagnosis of EP in premenopausal women with AUB.

What Do Women With Gestational Trophoblastic Disease Understand About the Condition?

2011 ◽  
Vol 21 (1) ◽  
pp. 161-166 ◽  
Author(s):  
Lesley Stafford ◽  
Fiona Judd
Keyword(s):  
Health Literacy ◽  
Negative Impact ◽  
Hydatidiform Mole ◽  
Complementary Therapy ◽  
Gestational Trophoblastic Disease ◽  
Self Report ◽  
Medical Procedure ◽  
Healthy Children ◽  
Cross Sectional ◽  
Trophoblastic Disease

Introduction:Little is known about patients' understanding of the causes, treatments, and implications of gestational trophoblastic disease (GTD). Clinical observation suggests that such health literacy is limited. We report on the perceptions of causes and treatment of GTD and its impact on fertility and reproductive outcomes.Methods:Cross-sectional analysis of 176 Australian women previously diagnosed with GTD (no longer receiving follow-up/treatment) recruited from a state-wide registry. Participants comprised 149 (85%) women with GTD who did not require chemotherapy and 27 (15%) women who required chemotherapy for malignancy or persistent molar disease. Data were collected from medical records and via self-report questionnaire.Results:Participants were 94 women (53%) with partial mole, 75 (43%) with complete mole, 4 (2%) with choriocarcinoma, and 3 (2%) with hydatidiform mole not otherwise specified. Mean (SD) age at diagnosis and time since diagnosis were 32.1 (6.3) and 4.7 (3.3) years, respectively. Chance/bad luck was the most endorsed cause (n = 146, 83%); 23 (13%) thought GTD was hereditary and 10 (6%) identified a chromosomal etiology. Between 24% and 32% were unsure of the role of alcohol/drugs, venereal diseases, smoking, pollution, contraceptives, and lowered immunity. Surgical/medical procedure (n = 127, 72%) and healthy diet (n = 53, 30%) were the most endorsed treatments. Between 18% and 23% were unsure of the treatment effectiveness of diet, vitamins, exercise, complementary therapy, and contraception. All women treated with chemotherapy understood the rationale thereof; 23 (85%) perceived chemotherapy to be successful, and 19 (70%) could name the agent. Few women perceived a negative impact on their fertility (n = 28, 16%); 52 (30%) were reluctant to conceive again and 100 (57%) questioned their ability to have healthy children. After diagnosis, 111 (63%) had at least 1 live birth.Conclusions:Notwithstanding limitations, this study is the largest of its type to date. These descriptive data enhance our understanding of patients' experience on GTD, highlight the scope of GTD health literacy, and may be useful for clinicians to adjust the content of their patient education.

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