Krvarenja u perimenopauzi

Perimenopauza počinje u prosjeku 4 do 10 godina prije menopauze. Za period perimenopauze karakteristične su velike fluktuacije u razini hormona koje su teško podnošljive pacijenticama. Jedan od najučestalijih razloga njihovog posjeta liječniku su nenormalna krvarenja iz maternice. Ta krvarenja su učestalija i većeg volumena u odnosu na normalna menstrualna krvarenja i upravo zato što mnoge žene očekuju smanjenje u učestalosti i volumenu krvarenja kako se bliže menopauzi, ovo je neočekivana i neugodna promjena za njih. Vrlo je važno diferencijalno dijagnostički isključiti sve moguće organske i patološke uzroke takvih promjena krvarenja, prije nego se ona povežu sa perimenopauzom. Glavne pretrage koje se rade su transvaginalni ultrazvuk za dijagnosticiranje fibroma i polipa maternice, histeroskopija i biopsija endometrija za isključivanje raka endometrija, te kao najskuplja opcija MRI kojom se vrlo dobro može dijagnosticirati adenomioza. Kada krvarenja smetaju u svakodnevnom životu žene primjenjuje se primarno medikamentozna terapija, a zatim i kirurško liječenje. Medikamentozno liječenje dijelimo u dvije velike skupine, hormonsko i ne-hormonsko liječenje. U skupinu hormonskog liječenja ubrajamo, oralne kontraceptive, LNG-IUS, gestageni, AG GnRH, a u skupinu ne-hormonskog NSAID i antifibrinolitike. U kirurškom liječenju se koristi ablacija endometrija, kiretaža, polipektomija, miomektomija, embolizacija i histerektomija kao zadnja opcija.Perimenopause begins 4 till 10 years prior to menopause. For that period deep fluctuations in hormone levels are characheristic, which are very gravious to women. The most common reason to visit the doctor gynecologist, for them is irregular bleeding. That bleedings are charachterized by increasd freaquency as well as heavier flow. This is an unwelcome and unexpected change becouse many women, as they approach menopause, are expecting their cycles to decrease in flow and frequency. It is very important to make good diagnostic and to make sure these bleedings are connected only with the state of perimenopause and not with some pathology. Main diagnostic includes tranvaginal ultrasonography to assess for uterine polyps and fibroids, hysterioscopy and endometrial biopsy to exclude uterine cancer, MRI as most expensive diagnostic method but a very good one for evaluation of adenomyosis. If the bleeding is interfering with a woman ˈs ability to make all her regular activities, treatment is desired. Medications are first line of treatment and as a second option there is surgical options. Medications for abnormal uterine bleeding are divided into two main groups, hormonal therapy which includes oral contraceptives, LNG-IUS, gestagens , AG GnRH and non-hormonal therapy which includes NSAID and antifibrinolitics. Surgical treatment includes endometrial ablation and curettage, polypectomy, myomectomy, embolisation of arteria uterine and hysteroctomy as last option