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Journal für Gynäkologische Endokrinologie/Schweiz

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26.06.2024 | Gynäkologische Endokrinologie

Die starke Monatsblutung: Behandeln wir richtig?

verfasst von: PD Dr. Susan Halimeh

Erschienen in: Journal für Gynäkologische Endokrinologie/Schweiz | Ausgabe 3/2024

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Zusammenfassung

Dieser Artikel erläutert die korrekte Behandlung von starken Monatsblutungen aus der Perspektive einer Gerinnungsmedizinerin. Es werden die verschiedenen Begriffe und Definitionen im Zusammenhang mit Menstruationsbeschwerden diskutiert, wobei die Terminologie der Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) verwendet wird. Es wird betont, dass starke Monatsblutungen und abnormale uterine Blutungen (AUB) Symptome sind, die eine genaue Diagnose erfordern. Die Ursachen für AUB können struktureller oder nichtstruktureller Natur sein. Die Autorin schlägt sechs mögliche Schritte zur Behandlung von AUB‑C (AUB-Coagulopathy) und AUB‑E (AUB-Endometriumpathologie) vor und hebt dabei Ausnahmen hervor. Auch die Behandlung von AUB‑I (AUB-Iatrogen) im Zusammenhang mit Antikoagulation wird erörtert. Abschliessend werden Vorschläge zur Überwindung von Versorgungshürden diskutiert. Dazu gehört die Förderung von Menstruationsgesundheitskompetenz bei Frauen sowie die Verbesserung der Diagnose- und Therapiefähigkeiten von Ärzten. Als zentrale Hürde wird das Menstruationstabu identifiziert, das es zu überwinden gilt, um die Versorgungslücken im Bereich der menstruellen Gesundheit zu schliessen.

Vorheriger Artikel Neue Kontrazeptiva: Estetrol, NOMAC und Drospirenon-only-Pille: Einfluss auf Hämostase, endokrinologische und metabolische Faktoren

Nächster Artikel Erratum zu: Die starke Monatsblutung: Behandeln wir richtig?

Henry C, Filoche S (2023) Reflections on access to care for heavy menstrual bleeding: Past, present, and in times of the COVID-19 pandemic. Int J Gynecol Obstet 162(S2):23–28. https://doi.org/10.1002/ijgo.14945CrossRef

Homepage | Figo. https://www.figo.org/. Zugegriffen: 5. Jan. 2024

Munro MG, Critchley HOD, Fraser IS (2012) The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol 207(4):259–265. https://doi.org/10.1016/j.ajog.2012.01.046CrossRefPubMed

Munro MG, Critchley HOD, Fraser IS, Menstrual Disorders Committee (2018) The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet 143(3):393–408. https://doi.org/10.1002/ijgo.12666CrossRefPubMed

Fraser IS, Critchley HOD, Broder M, Munro MG (2011) The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med 29(5):383–390. https://doi.org/10.1055/s-0031-1287662CrossRefPubMed

Kapoor A, McKinnon M (2021) The elephant in the room: tackling taboos in women’s healthcare. J Sci Commun 20(1):C10. https://doi.org/10.22323/2.20010310CrossRef

Johnston-Robledo I, Sheffield K, Voigt J, Wilcox-Constantine J (2007) Reproductive Shame: self-objectification and young women’s attitudes toward their reproductive functioning. Women Health 46(1):25–39. https://doi.org/10.1300/J013v46n01_03CrossRefPubMed

Gottlieb A (2020) Menstrual taboos: moving beyond the curse. In: Bobel C, Winkler IT, Fahs B, Hasson KA, Kissling EA, Roberts TA (Hrsg) The Palgrave Handbook of Critical Menstruation Studies. Palgrave Macmillan, In (http://www.ncbi.nlm.nih.gov/books/NBK565616/)

Henry C, Ekeroma A, Filoche S (2020) Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research. BMC Womens Health 20:123. https://doi.org/10.1186/s12905-020-00986-8CrossRefPubMedPubMedCentral

10.

Bitzer J, Serrani, Lahav (2013) Women's attitudes towards heavy menstrual bleeding, and their impact on quality of life. Open Access J Contracept. https://doi.org/10.2147/OAJC.S38993CrossRef

11.

Low EL, Whitaker KL, Simon AE, Sekhon M, Waller J (2015) Women’s interpretation of and responses to potential gynaecological cancer symptoms: a qualitative interview study. BMJ Open 5(7):e8082. https://doi.org/10.1136/bmjopen-2015-008082CrossRefPubMedPubMedCentral

12.

Cook C, Brunton M, Pukepuke T, Tan AL (2018) Exploring communication during the journey from noticing bodily changes to a diagnosis of endometrial cancer. J Clin Nurs 27(5–6):1262–1275. https://doi.org/10.1111/jocn.14173CrossRefPubMed

13.

Nosa V, Taufa N, Paynter J, Tan AL (2018) A qualitative study of Pacific women’s knowledge and awareness of gynaecological cancers in Auckland, New Zealand. Pac J Reprod Health 1(7):356. https://doi.org/10.18313/pjrh.2018.904CrossRef

14.

Woolcock JG, Critchley HOD, Munro MG, Broder MS, Fraser IS (2008) Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding. fertil Steril 90(6):2269–2280. https://doi.org/10.1016/j.fertnstert.2007.10.060CrossRefPubMed

15.

UpToDate. https://www.uptodate.com/contents/uterine-fibroids-leiomyomas-differentiating-fibroids-from-uterine-sarcomas. Zugegriffen: 14. Dez. 2023

16.

Varol N, Healey M, Tang P, Sheehan P, Maher P, Hill D (2001) Ten-year review of hysterectomy morbidity and mortality: can we change direction? Aust N Z J Obstet Gynaecol 41(3):295–302. https://doi.org/10.1111/j.1479-828x.2001.tb01231.xCrossRefPubMed

17.

Farquhar CM, Sadler L, Harvey SA, Stewart AW (2005) The association of hysterectomy and menopause: a prospective cohort study. BJOG 112(7):956–962. https://doi.org/10.1111/j.1471-0528.2005.00696.xCrossRefPubMed

18.

Smith P, Roberts M, Slade N (1970) Urinary symptoms following hysterectomy. Br J Urol 42(1):3–9. https://doi.org/10.1111/j.1464-410x.1970.tb11900.xCrossRefPubMed

19.

Welz AN, Emberger-Klein A, Menrad K (2018) Why people use herbal medicine: insights from a focus-group study in Germany. BMC Complement Altern Med 18(1):92. https://doi.org/10.1186/s12906-018-2160-6CrossRefPubMedPubMedCentral

20.

Rashrash M, Schommer JC, Brown LM (2017) Prevalence and predictors of herbal medicine use among adults in the united states. J Patient Exp 4(3):108–113. https://doi.org/10.1177/2374373517706612CrossRefPubMedPubMedCentral

21.

Vickers KA, Jolly KB, Greenfield SM (2006) Herbal medicine: women’s views, knowledge and interaction with doctors: a qualitative study. BMC Complement Altern Med 6:40. https://doi.org/10.1186/1472-6882-6-40CrossRefPubMedPubMedCentral

22.

OECD The proportion of female doctors has increased in all OECD countries over the past two decades. https://www.oecd.org/gender/data/the-proportion-of-female-doctors-has-increased-in-all-oecd-countries-over-the-past-two-decades.htm

23.

eCareers H More women populate obstetrics and gynecology. healthecareers.com. https://www.healthecareers.com/career-resources/trends-and-data/more-women-populate-obstetrics-and-gynecology. Zugegriffen: 14. Dez. 2023

24.

da Silva Filho AL, Caetano C, Lahav A, Grandi G, Lamaita RM (2021) The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey. Eur J Contracept Reprod Health Care 26(5):390–398. https://doi.org/10.1080/13625187.2021.1925881CrossRefPubMed

25.

Bitzer J, Heikinheimo O, Nelson AL, Calaf-Alsina J, Fraser IS (2015) Medical management of heavy menstrual bleeding: a comprehensive review of the literature. Obstet Gynecol Surv 70(2):115–130. https://doi.org/10.1097/OGX.0000000000000155CrossRefPubMed

26.

Davies J, Kadir RA (2017) Heavy menstrual bleeding: an update on management. thromb Res 151(Suppl 1):S70–S77. https://doi.org/10.1016/S0049-3848(17)30072-5CrossRefPubMed

27.

Marjoribanks J, Lethaby A, Farquhar C (2016) Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev 2016(1):CD3855. https://doi.org/10.1002/14651858.CD003855.pub3CrossRefPubMedPubMedCentral

28.

Tabish SA (2008) Complementary and alternative healthcare: is it evidence-based? Int J Health Sci 2(1):V–IX

29.

Traditional medicine has a long history of contributing to conventional medicine and continues to hold promise. https://www.who.int/news-room/feature-stories/detail/traditional-medicine-has-a-long-history-of-contributing-to-conventional-medicine-and-continues-to-hold-promise. Zugegriffen: 20. Dez. 2023

30.

Dhami N (2013) Trends in pharmacognosy: a modern science of natural medicines. J Herb Med 3(4):123–131. https://doi.org/10.1016/j.hermed.2013.06.001CrossRef

31.

Eshaghian R, Mazaheri M, Ghanadian M, Rouholamin S, Feizi A, Babaeian M (2019) The effect of frankincense (Boswellia serrata, oleoresin) and ginger (Zingiber officinale, rhizoma) on heavy menstrual bleeding: A randomized, placebo-controlled, clinical trial. Complement Ther Med 42:42–47. https://doi.org/10.1016/j.ctim.2018.09.022CrossRefPubMed

32.

Kashefi F, Khajehei M, Alavinia M, Golmakani E, Asili J (2015) Effect of ginger (Zingiber officinale) on heavy menstrual bleeding: a placebo-controlled, randomized clinical trial. Phytother Res 29(1):114–119. https://doi.org/10.1002/ptr.5235CrossRefPubMed

33.

Khodabakhsh M, Mahmoudinia M, Mousavi Bazaz M et al (2020) The effect of plantain syrup on heavy menstrual bleeding: a randomized triple blind clinical trial. Phytother Res 34(1):118–125. https://doi.org/10.1002/ptr.6502CrossRefPubMed

34.

Naafe M, Kariman N, Keshavarz Z, Khademi N, Mojab F, Mohammadbeigi A (2018) Effect of hydroalcoholic extracts of capsella bursa-pastoris on heavy menstrual bleeding: a randomized clinical trial. J Altern Complement Med 24(7):694–700. https://doi.org/10.1089/acm.2017.0267CrossRefPubMed

35.

Rahnama P, Montazeri A, Huseini HF, Kianbakht S, Naseri M (2012) Effect of Zingiber officinale R. rhizomes (ginger) on pain relief in primary dysmenorrhea: a placebo randomized trial. BMC Complement Altern Med 12:92. https://doi.org/10.1186/1472-6882-12-92CrossRefPubMedPubMedCentral

36.

Leung PL, Ng PS, Tam WH, Yuen PM (2005) Preference on the treatments for menorrhagia in Hong Kong chinese women. Gynecol Obstet Invest 59(2):97–101. https://doi.org/10.1159/000082577CrossRefPubMed

37.

Ray S, Ray A (2016) Non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women with bleeding disorders. Cochrane Database Syst Rev 2016(11):CD10338. https://doi.org/10.1002/14651858.CD010338.pub3CrossRefPubMedCentral

38.

Matteson KA, Rahn DD, Wheeler TL et al (2013) Nonsurgical management of heavy menstrual bleeding: a systematic review. Obstet Gynecol 121(3):632–643. https://doi.org/10.1097/AOG.0b013e3182839e0eCrossRefPubMedPubMedCentral

39.

Liang E Why should women try to avoid hysterectomies? Risks and Side Effects. https://www.sydneyfibroidclinic.com.au/why-should-women-try-to-avoid-hysterectomies-risks-and-side-effects/#:~:text=Hysterectomy%20Long%2Dterm%20Side%2Deffects,by%20ligation%2C%20spasm%20or%20thrombosis

40.

Ekanayake C, Pathmeswaran A, Herath R, Wijesinghe P (2020) Vaginal, sexual and urinary symptoms following hysterectomy: a multi-centre randomized controlled trial. Womens Midlife Health 6(1):1. https://doi.org/10.1186/s40695-020-0049-2CrossRefPubMedPubMedCentral

41.

Smith AN, Varma JS, Binnie NR, Papachrysostomou M (1990) Disordered colorectal motility in intractable constipation following hysterectomy. br J Surg 77(12):1361–1365. https://doi.org/10.1002/bjs.1800771214CrossRefPubMedPubMedCentral

42.

Farrell SA, Kieser K (2000) Sexuality after hysterectomy. Obstet Gynecol 95(6 Pt 2):1045–1051. https://doi.org/10.1016/s0029-7844(00)00784-5CrossRefPubMed

43.

Katz A (2002) Sexuality after hysterectomy. J Obstet Gynecol Neonatal Nurs 31(3):256–262. https://doi.org/10.1111/j.1552-6909.2002.tb00047.xCrossRefPubMed

44.

Yang Y, Zhang X, Fan Y et al (2023) Correlation analysis of hysterectomy and ovarian preservation with depression. Sci Rep 13(1):9744. https://doi.org/10.1038/s41598-023-36838-2CrossRefPubMedPubMedCentral

45.

Kitahara Y, Hiraike O, Ishikawa H et al (2023) National survey of abnormal uterine bleeding according to the FIGO classification in Japan. J Obstet Gynaecol Res 49(1):321–330. https://doi.org/10.1111/jog.15464CrossRefPubMed

46.

Zhang CY, Li H, Zhang S et al (2023) Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women’s Health Study. Am J Obstet Gynecol 228(2):213.e1–213.e22. https://doi.org/10.1016/j.ajog.2022.10.029CrossRefPubMed

47.

Sun Y, Wang Y, Mao L, Wen J, Bai W (2018) Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age: A cross-sectional study. Medicine 97(31):e11457. https://doi.org/10.1097/MD.0000000000011457CrossRefPubMedPubMedCentral

48.

Gerema U, Kene K, Abera D et al (2022) Abnormal uterine bleeding and associated factors among reproductive age women in Jimma town, Oromia Region, Southwest Ethiopia. Womens Health 18:17455057221077577. https://doi.org/10.1177/17455057221077577CrossRef

49.

Wouk N, Helton M (2019) Abnormal uterine bleeding in premenopausal women. Am Fam Physician 99(7):435–443PubMed

50.

Vannuccini S, Jain V, Critchley H, Petraglia F (2022) From menarche to menopause, heavy menstrual bleeding is the underrated compass in reproductive health. fertil Steril 118(4):625–636. https://doi.org/10.1016/j.fertnstert.2022.07.021CrossRefPubMed

51.

Clarke MA, Long BJ, Sherman ME et al (2020) Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms. Am J Obstet Gynecol 223(4):549.e1–549.e13. https://doi.org/10.1016/j.ajog.2020.03.032CrossRefPubMed

52.

Chi C, Kadir RA (2012) Inherited bleeding disorders in pregnancy. Best Pract Res Clin Obstet Gynaecol 26(1):103–117. https://doi.org/10.1016/j.bpobgyn.2011.10.005CrossRefPubMed

53.

Khrouf M, Terras K (2014) Diagnosis and management of formerly called “Dysfunctional Uterine Bleeding” according to PALM-COEIN FIGO classification and the new guidelines. J Obstet Gynaecol India 64(6):388–393. https://doi.org/10.1007/s13224-014-0641-1CrossRefPubMedPubMedCentral

54.

Munro MG, Critchley HOD, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. (2011) FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113(1):3–13. https://doi.org/10.1016/j.ijgo.2010.11.011CrossRefPubMed

55.

Boonyawat K, Lensing AWA, Prins MH et al (2021) Heavy menstrual bleeding in women on anticoagulant treatment for venous thromboembolism: Comparison of high- and low-dose rivaroxaban with aspirin. Res Pract Thromb Haemost 5(2):308–313. https://doi.org/10.1002/rth2.12474CrossRefPubMedPubMedCentral

56.

James AH, Kouides PA, Abdul-Kadir R et al (2011) Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol 158(2):124–134. https://doi.org/10.1016/j.ejogrb.2011.04.025CrossRefPubMed

57.

Mansour D, Hofmann A, Gemzell-Danielsson K (2021) A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding. Adv Ther 38(1):201–225. https://doi.org/10.1007/s12325-020-01564-yCrossRefPubMed

58.

Yavarikia P, Shahnazi M, Hadavand Mirzaie S, Javadzadeh Y, Lutfi R (2013) Comparing the effect of mefenamic acid and vitex agnus on intrauterine device induced bleeding. J Caring Sci 2(3):245–254. https://doi.org/10.5681/jcs.2013.030CrossRefPubMedPubMedCentral

59.

Niroumand M, Heydarpour F, Farzaei M (2018) Pharmacological and therapeutic effects of Vitex agnus-castus L.: a review. Pharmacogn Rev 12(23):103. https://doi.org/10.4103/phrev.phrev_22_17CrossRef

60.

Posadzki P, Watson LK, Ernst E (2013) Adverse effects of herbal medicines: an overview of systematic reviews. Clin Med 13(1):7–12. https://doi.org/10.7861/clinmedicine.13-1-7CrossRef

Titel: Die starke Monatsblutung: Behandeln wir richtig?
verfasst von: PD Dr. Susan Halimeh
Publikationsdatum: 26.06.2024
Verlag: Springer Vienna
Erschienen in: Journal für Gynäkologische Endokrinologie/Schweiz / Ausgabe 3/2024
Print ISSN: 1995-6924
Elektronische ISSN: 2520-8500
DOI: https://doi.org/10.1007/s41975-024-00351-0

Neue Kontrazeptiva: Estetrol, NOMAC und Drospirenon-only-Pille: Einfluss auf Hämostase, endokrinologische und metabolische Faktoren

Gynäkologische Endokrinologie

Éditorial

Éditorial

Darmmikrobiom und Menopause

Orthomolekulare Medizin

Editorial

Editorial

Postmenopausale Hyperandrogenämie: Seltene Sertoli-Leydig-Zell-Tumoren können die Ursache sein

Noch gewusst…?

Erratum zu: Die starke Monatsblutung: Behandeln wir richtig?

Erratum

Springer Medizin Österreich

Die starke Monatsblutung: Behandeln wir richtig?

Zusammenfassung

Weitere Artikel der Ausgabe 3/2024

Neue Kontrazeptiva: Estetrol, NOMAC und Drospirenon-only-Pille: Einfluss auf Hämostase, endokrinologische und metabolische Faktoren

Éditorial

Darmmikrobiom und Menopause

Editorial

Postmenopausale Hyperandrogenämie: Seltene Sertoli-Leydig-Zell-Tumoren können die Ursache sein

Erratum zu: Die starke Monatsblutung: Behandeln wir richtig?

Springer Medizin Österreich

Zusammenfassung

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Neue Kontrazeptiva: Estetrol, NOMAC und Drospirenon-only-Pille: Einfluss auf Hämostase, endokrinologische und metabolische Faktoren

Éditorial

Darmmikrobiom und Menopause

Editorial

Postmenopausale Hyperandrogenämie: Seltene Sertoli-Leydig-Zell-Tumoren können die Ursache sein

Erratum zu: Die starke Monatsblutung: Behandeln wir richtig?