小结
定义
病史和体格检查
关键诊断因素
- 子宫出血
其他诊断因素
- 药物使用
- 月经不规则
- 贫血
- 经前期紧张
- 多毛症、痤疮、黑棘皮症
- 现有躯体疾病
危险因素
- 处于生育年龄两端（青春期后和绝经前）的女性
- 多囊卵巢综合征
- 内分泌系统疾病
- 其他无排卵性疾病
- 肥胖
诊断性检查
首要检查
- 妊娠试验
- 全血细胞计数（FBC）
需考虑的检查
- 凝血指标
- 血清 TSH 水平
- 超声检查
- 宫腔镜检查
- 子宫内膜活检
治疗流程
子宫出血过多的紧急管理
无排卵性 AUB：无孕激素和雌激素禁忌证
无排卵性 AUB：禁忌使用孕激素和雌激素
对药物治疗耐药的显著子宫出血；希望未来有生育能力
对药物治疗耐药的显著子宫出血；未来无生育需求
撰稿人
作者
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
利益声明
JG has received honouraria for consultancy for Femcare-Nikomed and Bayer, and support for attending meetings and travel from Medicem.
Akanksha Sood, MBBS, MS (OBGY), DNB, MRCOG, FACOG
Senior Clinical Fellow
Department of Reproductive Medicine
St. Mary’s Hospital
Manchester
UK
利益声明
AS declares that she has no competing interests.
Rohan Chodankar, MBBS, MD, MRCOG
Clinical Research Fellow
MRC Centre for Reproductive Health
The Queen's Medical Research Institute
University of Edinburgh
Scotland
UK
利益声明
RC is supported as a Clinical Research Fellow by Bayer AG; RC declares that he has no other competing interests.
鸣谢
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. 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.
同行评议者
Janet Albers, MD
Associate Professor
Department of Family and Community Medicine
Southern Illinois University School of Medicine
Springfield
IL
利益声明
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
利益声明
SS declares that she has no competing interests.
鉴别诊断
- 妊娠相关性出血
- 生殖器病变
更多 鉴别诊断指南
- 严重月经出血：评估与管理
- ACR 适用标准：异常阴道出血
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