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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Of the oral contraceptives in current use, the most practical and effective are: 1) the combination pill (estrogen and progesterone in various combinations), with a contraceptive effect of almost 100%; 2) 2-phase treatment (estrogen and progesterone administered sequentially), which produces less negative side effects, but is slightly less reliable as an ovulation inhibitor; and 3) the minipill (containing only progesterone), which eliminates any estrogen-induced side effects, but is slightly more complicated as a medication. Continuous treatment with large combination dosages may be tried when complete elimination of menstruation is desirable. The monthly and weekly pills are still being tested. High dosages before or after coitus may be used in certain situations. Clinically undesirable side effects of oral contraceptives include urinary tract infections, fluor vaginalis, moniliasis, hypertension, water retention, lactation changes, and, less frequently, liver and skin disorders and modifications of the carbohydrate metabolism system. These can often be lessened or eliminated by changing to the minipill or to another preparation. A table indicates signs of excessive estrogen or progesterone influence. Extremely serious (sometimes life-threatening) side effects include persistent anovulation, thromboembolic disorders, liver tumors, and severe hypertension. Often the beneficial side effects of oral contraceptives are not mentioned, e.g., improvement or elimination of menstrual disorders, anemia, and acne, and prevention of benign breast and uterine tumors and ovarian cysts. The psychological benefits must also be taken into account. Fear of pregnancy is eliminated and birth control spacing results in improved health for mothers and children.
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PMID:[Oral contraceptives (author's transl)]. 79 88

Management of abnormal genital bleeding in girls, adolescents and women, in pregnancy, and in postmenopausal women is reviewed under the headings of evaluation and treatment. In childhood all genital bleeding is clinically significant: it is due to acute infection, foreign bodies, trauma, prolapsed urethra or precocious puberty, rarely to tumors. Bleeding in adolescents and adults is most often due to anovulation, usually estrogen-breakthrough bleeding. Other causes are submucosal leiomyomas, cervical or endometrial polyps, lacerations, uterine or cervical cancer, or systemic disorders such as hypothyroidism or bleeding disorders. Evaluation of bleeding in children requires skill and often general anesthesia, especially if peritoneal laceration is suspected. The 1st step in adolescents and adults is to rule out pregnancy. Pap smears are insufficient: biopsies are advised, especially endometrial biopsies in women 40. Hemoglobin, hematocrit and thyroid status, should also be ordered. Specific treatments involve antibiotics for infection, correction of anemia and orthostatic hypotension, reversal of unopposed estrogen, and medical treatment of menorrhagia and dysfunctional bleeding that does not involve hemodynamic instability. Sometimes curettage, endometrial ablation or hysterectomy is needed. Medical management of breakthrough bleeding caused by unopposed estrogen is high dose estrogen followed by progestin therapy to bring about withdrawal, curettage if necessary, then cyclic combined therapy. In young women 4 birth control pills per day for 5-7 days are often prescribed, with cyclic therapy after withdrawal bleeding is obtained. Prostaglandin inhibitors reduce menstrual loss 50%. Endometrial atrophy in post-menopausal women is treated with cyclic conjugated estrogens and then medroxyprogesterone acetate for 10-13 days per month, or continuous combined therapy for those who can tolerate it.
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PMID:Management of abnormal genital bleeding in girls and women. 194 58

We reviewed the clinical and histologic records of 61 consecutive premenopausal women with abnormal uterine bleeding and moderate to severe iron-deficiency anemia investigated in a tertiary care and referral center. Excessive bleeding was caused by benign lesions in 67% of the cases and by anovulation in 25% and was unexplained in 8%. Hysteroscopy revealed an organic intrauterine lesion (submucous myomas in 38%, endometrial polyps in 13%, submucous adenomyomas in 3%) that could be treated endoscopically in more than half the patients. In populations without nutritional deficiencies, a woman of reproductive age with sideropenic anemia and no other evident cause of blood loss or systemic disease should be considered menorrhagic until proven otherwise. Hysteroscopy should be included in evaluations of abnormal uterine bleeding.
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PMID:Abnormal uterine bleeding associated with iron-deficiency anemia. Etiology and role of hysteroscopy. 841 Aug 41

Menorrhagia--menstrual periods lasting longer than 7 days and totaling blood losses greater than 80mL--affects 9%-14% of otherwise healthy women, and it can signal cancer, an endocrinologic disorder, or gynecologic disease. Blood loss can be high enough to result in anemia, fatigue, and syncope. Most often, abnormal uterine bleeding such as menorrhagia involves a disruption in the hypothalamic-pituitary axis, the ovary, and/or the uterus. Other identified causes include medications (especially psychotropics) that cross the blood-brain barrier; chronic diseases such as cancer, diabetes, and liver and kidney dysfunction; endocrine disorders, perimenopausal anovulation, polycystic ovary disease, pituitary tumors, and abnormal estrogen cycling caused by morbid obesity; and anatomic abnormalities of the uterus. Routine tests include hematocrit or hemoglobin to detect and evaluate anemia, thyroid stimulating hormone (TSH) level to evaluate thyroid function as a possible cause, and a pregnancy test to rule out an incomplete, spontaneous abortion as a cause. A Pap test is recommended to screen for dysplasia that can suggest a gynecologic cancer cause. Additional screening for endocrine disorders that may be causing menorrhagia include tests of thyroid, liver, and kidney function, and tests of follicle stimulating hormone (FSH), prolactin, and cortisol levels. Treatment can be medical or surgical. Medical treatment includes prostaglandin inhibitors, specifically nonsteroidal antiinflammatory drugs (NSAIDs), and hormonal therapy with estrogen, progesterone, gonadotropin-releasing hormone agonists, or oral contraceptives such as medroxyprogesterone (Depo-Provera). Surgical treatment includes hysteroscopic endometrial ablation by physical agents, laser electrodiathermy, and "roller ball," or surgical, resection. Hysterectomy is the treatment of last resort.
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PMID:Treatment Decisions in the Management of Menorrhagia. 974 72

There is no evidence that morphologic alterations of the ovaries cause symptoms of hormonal imbalance and a deficit in ovarian hormones in a case of micro-cystic degeneration of the ovaries. Similarly, fertility does not have to be impeded, since follicular development may be unaffected. In absence of functional disturbances, such as amenorrhea or anovulation, no therapy is needed. A different approach is, however, required when the ovaries contain larger, hormone-producing cysts which can persist for a long time. In contrast to micro-cystic ovaries the presence of persistent ovarian follicles can entail marked risks of endometrial hyperplasia, severe uterine bleeding, and anemia.
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PMID:[Persistent follicle syndrome: a forgotten clinical entity?]. 1052 72

Dysfunctional uterine bleeding is most commonly associated with chronic anovulation. Early diagnosis of anovulation is important; the induction of regular withdrawal periods using a progestin such as Provera prevents the development of endometrial hyperplasia with the subsequent inevitable occurrence of a heavy, frightening vaginal bleed. The etiology of dysfunctional uterine bleeding occurring during ovulatory cycles is unknown and all medical therapies at present are necessarily experimental. Hysterectomy is probably the treatment of choice for women who have finished their childbearing career and in whom persisting menorrhagia during ovulatory cycles results in anemia.
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PMID:Dysfunctional uterine bleeding. 2128 53

Abnormal uterine bleeding (AUB), which is defined as excessively heavy, prolonged and/or frequent bleeding of uterine origin, is a frequent cause of visits to the Emergency Department and/or health care provider. While there are many etiologies of AUB, the one most likely among otherwise healthy adolescents is dysfunctional uterine bleeding (DUB), which is characterizing any AUB when all possible underlying pathologic causes have been previously excluded. The most common cause of DUB in adolescence is anovulation, which is very frequent in the first 2-3 post-menarchal years and is associated with immaturity of the hypothalamic - pituitary - ovarian axis. Management of AUB is based on the underlying etiology and the severity of the bleeding and primary goals are prevention of complications, such as anemia and reestablishment of regular cyclical bleeding, while the management of DUB can in part be directed by the amount of flow, the degree of associated anemia, as well as patient and family comfort with different treatment modalities. Treatment options for DUB are: combined oral contraceptives (COCs), progestogens, non steroidal anti inflammatory drugs (NSAIDs), tranexamic acid (anti-fibrinolytic), GnRH analogues, Danazol and Levonorgestrel releasing intra uterine system (LNG IUS).
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PMID:Abnormal uterine bleeding and dysfunctional uterine bleeding in pediatric and adolescent gynecology. 2294 1

Few studies address alteration of sexual function in women with diabetes and chronic kidney disease (CKD). Quality of life surveys suggest that discussion of sexual function and other reproductive issues are of psychosocial assessment and that education on sexual function in the setting of chronic diseases such as diabetes and CKD is widely needed. Pharmacologic therapy with estrogen/progesterone and androgens along with glycemic control, correction of anemia, ensuring adequate dialysis delivery, and treatment of underlying depression are important. Changes in lifestyle such as smoking cessation, strength training, and aerobic exercises may decrease depression, enhance body image, and have positive impacts on sexuality. Many hormonal abnormalities which occur in women with diabetes and CKD who suffer from chronic anovulation and lack of progesterone secretion may be treated with oral progesterone at the end of each menstrual cycle to restore menstrual cycles. Hypoactive sexual desire disorder (HSDD) is the most common sexual problem reported by women with diabetes and CKD. Sexual function can be assessed in women, using the 9-item Female Sexual Function Index, questionnaire, or 19 items. It is important for nephrologists and physicians to incorporate assessment of sexual function into the routine evaluation protocols.
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PMID:Sexual dysfunction in women with diabetic kidney. 3188 58

The first menstrual bleeding, referred to as menarche, albeit an important point in a woman's life, does not yet mean her full sexual maturity. The hypothalamus-pituitary-ovary axis is fragile during this period and depends on many factors. Their mutual interplay occurs individually and gradually over the next few years, therefore menstrual irregularities of the menstrual cycle occur physiologically, and not all of them need to be regulated. However, it is one of the most frequent reasons for visiting a paediatric gynaecologists office. The average age of menarche in girls in the Czech Republic is 12 years and 6 to 9 months, the physiological limits are 10-15 years. After menarche, anovulation cycles are predominating, resulting in estrogenic activity not controlled by gestagen, which may result in dysfunctional bleeding with subsequent anaemia from blood loss. The opposite possible problem is the absence of menstruation, either primary or secondary. Correct complete gynaecological examination of adolescent girls with a purposefully thought-out next schematic of laboratory, imaging and counselling examinations leads to the correct diagnosis. This article clearly outlines and breaks down the most common disorders. The paediatric gynaecologist chooses "tailor-made" treatment with respect to the patients age, always strictly individual and justified. Keywords: sexual maturity, menarche, menstrual cycle, hormonal cytology, menstrual disorder, anovulation.
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PMID:Postmenarcheal irregularities in menstrual cycle in adolescent girls. 3065 Sep 77

Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman's physical, social, emotional, or material quality of life. If obstetrician-gynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management. Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder. Physical examination of the patient who presents with acute heavy menstrual bleeding should include assessment of hemodynamic stability, including orthostatic blood pressure and pulse measurements. The first-line approach to acute bleeding in the adolescent is medical management; surgery should be reserved for those who do not respond to medical therapy. Use of antifibrinolytics such as tranexamic acid or aminocaproic acid in oral and intravenous form may be used to stop bleeding. Nonmedical procedures should be considered when there is a lack of response to medical therapy, if the patient is clinically unstable despite initial measures, or when severe heavy bleeding warrants further investigation, such as an examination under anesthesia. After correction of acute heavy menstrual bleeding, maintenance hormonal therapy can include combined hormonal contraceptives, oral and injectable progestins, and levonorgestrel-releasing intrauterine devices. Obstetrician-gynecologists can provide important guidance to premenarchal and postmenarchal girls and their families about issues related to menses and should counsel all adolescent patients with a bleeding disorder about safe medication use and future surgical considerations.
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PMID:Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG COMMITTEE OPINION SUMMARY, Number 785. 3144 20


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