metrorragia postmenopausia
TRANSCRIPT
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Docente Adscripta Dra. Alicia Monterroso Prof. Titular Dr. Sergio Provenzano
UBAHospital de Clínicas
Ginecología2016
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The North American Menopause Society Recommendations for Clinical Care of Midlife Women• Jan L. Shifren, MD, NCMP, Margery L.S. Gass,
MD, NCMP,for the NAMS Recommendations for Clinical Care of Midlife Women Working Group
• Menopause, Vol. 21, No. 10, 2014 Menopause Practice: A Clinician_s Guide,
• 5th edition, available through the NAMS website.
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CHAPTER 1: MENOPAUSE OVERVIEW OF MENOPAUSE Key Points
4. According to STRAW + 10, the term menopause transition refers to the span of time when menstrual cycle and endocrine changes occur, beginning with variation in the length of the menstrual cycle and ending with the FMP.
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Menopause: The Journal of The North American Menopause Society. Vol. 8, No. 6, pp. 402–407, © 2001 The North American Menopause SocietyPublished simultaneously in Fertility and Sterility, Climacteric, and Journal of Women’s Health.
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CHAPTER 1: MENOPAUSE OVERVIEW OF MENOPAUSE Key Points
6. By the year 2025, the number of postmenopausal women is expected to rise to 1.1 billion worldwide.
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Recomendaciones de la FIGO sobre las terminologías y definiciones del sangrado uterino normal y anormal
Ian S. Fraser, M.D., Hilary O. D. Critchley, M.D., Michael Broder, M.D., y Malcolm G. Munro, M.D.
Semin Reprod Med. 2011, 29(5):383-90
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Se denomina SUA a cualquier desviación del patrón menstrual normal.
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La clasificación terminológica de la FIGO diferencia entre:
ALTERACIONES DE LA REGULARIDAD• Sangrado uterino irregular• Ausencia de sangrado menstrual
ALTERACIONES DE LA CANTIDAD• Sangrado menstrual abundante• Sangrado menstrual escaso
ALTERACIONES DE LA DURACIÓN• Sangrado menstrual prolongado• Sangrado menstrual acortado
SANGRADO IRREGULAR NO MENSTRUAL SANGRADO FUERA DE LA EDAD REPRODUCTIVA
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sangrado acíclico
-sangrados erráticos, sin un patrón discernible
- se asocian con cáncer cervical o endometrial
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Sangrado fuera de la edad reproductiva
MENARCA PRECOZ (ANTES DE LOS 9 AÑOS) - poco frecuente - se asocia a otros signos de pubertad precoz SANGRADO DE LA POSMENOPAUSIA - sangrado que ocurre luego de 1 año de la
menopausia - menopausia es el último período menstrual y se determina retrospectivamente
- frecuente -se asocia con patología estructural uterina
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PROTOCOLOS SEGO Sangrado menstrual abundante
(SMA) (actualizado 2013) Heavy menstrual bleeding (HMB)
(updated 2013) Sociedad Española de Ginecología y
Obstetricia Como citar este artículo: Sangrado menstrual
abundante (SMA) (actualizado 2013). Prog Obstet Ginecol. 2013. http://dx.doi.org/10.1016/ j.pog.2013.06.005
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Pólipos Adenomiosis Leiomioma Malignidad e
hiperplasia (PALM)
Coagulopatía Disfunción
ovulatoria Endometrial Iatrogénica No clasificado (COEI)
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Factores involucrados en la decisión del tratamiento Cantidad de la hemorragia Edad Estado clínico Problemas ginecológicos coexistentes Importancia para la paciente Resultado de la Biopsia de endometrio
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Histeroscopía operatoria • +BP Endometrio /LEC (RUFT)
Ablación endometrial• Puede eliminar pequeñas lesiones (pólipos, miomas submucosos)• Contraindicado en Hiperplasias ó Carcinoma
Histerectomía• Hiperplasia Atípica• Carcinoma• Comorbilidades: Miomatosis, Prolapso, IOE,
Endometriosis
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25Muchas Gracias