月经过多是指每个月经周期出血量≥80 mL。[1]Oehler MK, Rees MC. Menorrhagia: an update. Acta Obstet Gynecol Scand. 2003 May;82(5):405-22.
http://www.ncbi.nlm.nih.gov/pubmed/12752071?tool=bestpractice.com
由于月经出血量较难衡量，因此月经过多指月经期出血极多或月经期过长（>1周）。 育龄期妇女多见。 该病患病率随年龄增长，多见于30~49岁女性，每年大约每20位患者中有一位因出血过多而咨询医生。[2]Philipp CS, Faiz A, Dowling N, et al. Age and the prevalence of bleeding disorders in women with menorrhagia. Obstet Gynecol. 2005 Jan;105(1):61-6.
http://www.ncbi.nlm.nih.gov/pubmed/15625143?tool=bestpractice.com
[3]Jayasinghe Y, Moore P, Donath S, et al. Bleeding disorders in teenagers presenting with menorrhagia. Aust N Z J Obstet Gynaecol. 2005 Oct;45(5):439-43.
http://www.ncbi.nlm.nih.gov/pubmed/16171484?tool=bestpractice.com
[4]Day Baird D, Dunson DB, Hill MC, et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003 Jan;188(1):100-7.
http://www.ncbi.nlm.nih.gov/pubmed/12548202?tool=bestpractice.com
[5]Garside R, Stein K, Wyatt K, et al. The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling. Health Technol Assess. 2004 Feb;8(3):iii, 1-155.
https://www.journalslibrary.nihr.ac.uk/hta/hta8030/#/abstract
http://www.ncbi.nlm.nih.gov/pubmed/14754561?tool=bestpractice.com
AAFP: heavy periods (menorrhagia)
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流行病学
在英国，20%的女性在60岁时因月经过多切除子宫，但在病理检查中40%的子宫未见明显异常。[6]Maresh MJ, Metcalfe MA, McPherson K, et al. The VALUE national hysterectomy study: description of the patients and their surgery. BJOG. 2002 Mar;109(3):302-12.
http://www.ncbi.nlm.nih.gov/pubmed/11950186?tool=bestpractice.com
在美国，20％至25％的健康绝经前妇女出现异常子宫出血。[7]Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstet Gynecol. 2002 Feb;99(2):229-34.
http://www.ncbi.nlm.nih.gov/pubmed/11814502?tool=bestpractice.com
在非西方国家月经过多的发生率是未知的。 异常子宫出血占妇科手术的25%。[8]Carlson KJ, Nichols DH, Schiff I. Indications for hysterectomy. N Engl J Med. 1993 Mar 25;328(12):856-60.
http://www.ncbi.nlm.nih.gov/pubmed/8357364?tool=bestpractice.com
病理生理学
在正常月经周期中，卵巢的雌孕激素诱导产生前列腺素、细胞因子、基质金属蛋白酶（MMPs）。 这些都直接影响子宫内膜功能层的循环再生。[9]Sivridis E, Giatromanolaki A. New insights into the normal menstrual cycle-regulatory molecules. Histol Histopathol. 2004 Apr;19(2):511-6.
http://www.ncbi.nlm.nih.gov/pubmed/15024712?tool=bestpractice.com
异常子宫出血代表这种有序的循环再生被打断。[10]Munro MG. Abnormal uterine bleeding in the reproductive years: pathogenesis and clinical investigation. J Am Assoc Gynecol Laparosc. 1999 Nov;6(4):393-416.
http://www.ncbi.nlm.nih.gov/pubmed/10548698?tool=bestpractice.com
在月经过多的女性通常会发现螺旋小动脉的血管-平滑肌层变薄、前列腺素分泌向血管舒张性前列腺素分泌转化、子宫内膜的凝血机制受到干扰。 在排卵的月经周期，月经过多是正常的。 不规则月经周期相关的月经过多通常代表无排卵性功血。 月经过多的女性可能并没有任何结构、激素、血液或其他系统的异常。[11]Speroff L, Fritz M. Dysfunctional uterine bleeding. In: Speroff L, Fritz M, eds. Clinical gynecologic endocrinology and infertility. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2005:547-71.
