Resumo
Definição
History and exam
Key diagnostic factors
- sangramento uterino
Other diagnostic factors
- uso de medicamentos
- irregularidade menstrual
- anemia
- molime pré-menstrual
- hirsutismo, acne, acantose nigricans
- Afecção clínica existente
Risk factors
- mulheres nos extremos da idade reprodutiva (logo após a puberdade e antes da menopausa)
- síndrome do ovário policístico
- endocrinopatias
- outros transtornos anovulatórios
- obesidade
Diagnostic investigations
1st investigations to order
- teste de gravidez
- Hemograma completo
Investigations to consider
- perfil de coagulação
- nível de hormônio estimulante da tireoide (TSH) sérico
- ultrassonografia
- histeroscopia
- biópsia do endométrio
Treatment algorithm
tratamento emergencial do sangramento uterino excessivo
SUA anovulatório: progestogênios e estrogênios não contraindicados
SUA anovulatório: progestogênios e estrogênios contraindicados
sangramento uterino significativo resistente ao tratamento clínico; desejo de fertilidade futura
sangramento uterino significativo resistente ao tratamento clínico; sem desejo de fertilidade futura
Contributors
Authors
Janesh Gupta, MSc, MD, FRCOG
Professor of Obstetrics and Gynaecology
Centre for Women's and Newborn Health
Institute of Metabolism and Systems Research
University of Birmingham
Birmingham Women’s and Children’s Hospital
Birmingham
UK
Disclosures
JG is a clinical advisor for Femcare UK.
Akanksha Sood, MBBS, MS (OBGY), DNB, MRCOG, FACOG
Senior Clinical Fellow
Department of Reproductive Medicine
St. Mary’s Hospital
Manchester
UK
Disclosures
AS declares that she has no competing interests.
Rohan Chodankar, MBBS, MD, MRCOG
ST6 Obstetrics and Gynaecology
Royal Infirmary of Edinburgh
Scotland
UK
Disclosures
RC is supported as a Clinical Research Fellow by Bayer AG; RC is an author of references cited in this topic.
Acknowledgements
Professor Gupta, Dr Sood, and Dr Chodankar would like to gratefully acknowledge Dr Mohamed Mitwally and Dr Intisar Elnahhas, the previous contributors to this topic.
Disclosures
MM owns a patent on the use of aromatase inhibitors for endometrial thinning before hysteroscopic surgery. The patent is licensed to Meditrina Company. IE declares that she has no competing interests.
Peer reviewers
Janet Albers, MD
Associate Professor
Department of Family and Community Medicine
Southern Illinois University School of Medicine
Springfield
IL
Disclosures
JA is an author of a reference cited in this topic.
Sarina Schrager, MD, MS
Associate Professor (CHS)
Department of Family Medicine
University of Wisconsin
WI
Disclosures
SS declares that she has no competing interests.
References
Key articles
Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011 Apr;113(1):3-13. Abstract
National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. May 2021 [internet publication].Full text
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Jul 2012 [internet publication].Full text
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Apr 2013 [internet publication].Full text
American College of Obstetricians and Gynecologists. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Jul 2013 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Sangramento relacionado à gestação
- Enxaqueca menstrual
- Lesões genitais
More DifferentialsGuidelines
- General approaches to medical management of menstrual suppression
- Heavy menstrual bleeding: assessment and management
More GuidelinesPatient information
Menstruação intensa
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer