Giới thiệu
Heavy Menstrual Bleeding_Disease Background
Heavy menstrual bleeding (HMB) is a common gynecological concern arising from various underlying etiologies and distinct pathophysiological mechanisms. Heavy menstrual bleeding is defined as prolonged (>7 days) or excessive (>80 mL) uterine bleeding occurring at regular intervals over several menstrual cycles. Heavy menstrual bleeding is menstrual blood loss that is excessive and interferes with the patient's physical, emotional, social, and quality of life, which may occur alone or in combination with other symptoms. The most common type of abnormal uterine bleeding (AUB) in women of reproductive age (increases with age) usually causes anemia. Heavy menstrual bleeding is the most common symptom experienced by women with bleeding disorder.
Dịch tễ học
Heavy menstrual bleeding affects 25% of women of reproductive age. Prior research indicates that abnormal uterine bleeding rates differ across populations, with global prevalence typically ranging from 10% to 30%. A study identifies nonstructural etiologies as the leading cause of abnormal uterine bleeding in Chinese women with ovulatory dysfunction, being the most common subtype.
Nguyên nhân
The causes of abnormal uterine bleeding are categorized into the following groups: Discrete structural abnormalities that can be examined with imaging techniques and/or histopathology (PALM: Polyp, Adenomyosis, Leiomyoma1, Malignancy, or hyperplasia); and non-structural abnormalities that cannot be defined by imaging or histopathology (COEIN: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified).
Coagulopathy includes von Willebrand’s disease (VWD) or platelet dysfunction. Iatrogenic causes include abnormal uterine bleeding associated with use of hormonal or non-hormonal medications (eg anticoagulation therapy), intrauterine systems or devices, or other local or systemic agents, and not otherwise classified causes include conditions that are rare or ill-defined that do not fit into any classification. Other causes include chronic endometrial infection, arteriovenous malformation, hypothyroidism, or obesity.
Patients may have >1 cause. Anovulation is the most common cause in adolescents and perimenopausal women. Structural lesions and malignancy are more common with increasing age.
1Please see Leiomyomas disease management chart for further information.
Sinh lý bệnh
Heavy menstrual bleeding is precipitated by any pathological process that disrupts endometrial endocrine, paracrine, or hemostatic mechanisms or impairs myometrial contractility.