By 今井 清一, 高橋 正衛
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Extra info for 現代史資料 4
Perimenopausal bleeding patterns and pathologic findings. J Am Med Womens Assoc 1990; 45:132–134. 7. Mencaglia L, Perino A, Hamou J. Hysteroscopy in perimenopausal and postmenopausal women with abnormal uterine bleeding. J Reprod Med 1987; 32:577–582. 8. Kaunitz AM. Abnormal uterine bleeding in the perimenopausal patient. Contemp OB/GYN 2002; April:69–88. 9. Kilbourn CL, Richards CS. Abnormal uterine bleeding—diagnostic considerations, management options. Postgrad Med 2001; 109:1–11. 10. Munro MG.
Surgical management options are directed by the type of uterine pathology, which is identified in patients. Patients with dysfunctional bleeding in which no organic pathology is found and fails to respond to medical therapy are candidates for either endometrial ablation procedures, or vaginal or abdominal hysterectomy. The decision to retain the ovaries or not should be carefully discussed with the patient and be decided prior to the surgical procedures. Perimenopausal patients who choose to undergo treatment with hysterectomy and bilateral salpingo-oophorectomy should be counseled on the recommendation for estrogen replacement therapy prior to surgery.
B Abnormal Uterine Bleeding During the Perimenopause 29 Furthermore, progesterone therapy for 21 days of the cycle resulted in significant reductions in menstrual blood loss, although women found it less acceptable than the levonorgestrel IUD (55; Level I evidence). Progestins can be administered continuously in a dose of 10 to 20 mg per day of MPA or 5 mg per day of norethindrone, which usually results long-term in amenorrhea that is highly acceptable to many perimenopausal patients. Perimenopausal women whose endometrial biopsies show hyperplastic changes that do not wish to undergo hysterectomy could be placed on high-dose progestins for three months and re-biopsied to confirm reversal of hyperplasia.
現代史資料 4 by 今井 清一, 高橋 正衛