Materiały źródłowe

• #1 Heavy Menstrual Bleeding (Chapter 7) – The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology

  https://www.cambridge.org/core/books/ebcog-postgraduate-textbook-of-obstetrics-gynaecology/heavy-menstrual-bleeding/E6F6A1A104B8073EDD023BC24870AB4B

  Heavy menstrual bleeding (HMB) is a common condition that affects 2030% of women during their reproductive lifetime and has a major impact on womens quality of life. […] It is usually defined as, excessive menstrual blood loss which interferes with a womans physical, emotional, social wellbeing and/or material quality of life, which can occur alone or in combination with other symptoms. […] Hapangama, DK, Bulmer, JN. Pathophysiology of heavy menstrual bleeding. Women Health (Lond) 2016;12:313.

• #1 Managing Menorrhagia

  https://www.uspharmacist.com/article/managing-menorrhagia

  Menorrhagia is heavy cyclical bleeding that occurs when menstrual blood loss exceeds 80 mL per cycle, and it is the most common gynecologic complaint. […] Anything that causes thickening of the endometrium, and hence increases its vascularization, can cause menorrhagia. Menorrhagia may be idiopathic or as a result of underlying disorders such as tumors and endocrine or hormonal disorders. […] The normal menstrual cycle is the result of the interaction of estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). At different times of the cycle, one or more of these hormones result in proliferation, differentiation, and necrosis of the endometrium, resulting in menstrual bleeding. […] FSH and LH released by the anterior pituitary stimulate the development of follicles and production of estradiolthe follicular phase. The elevated estrogen levels induce the proliferation of the endometrial lining through a negative feedback mechanism on FSH production.

• #1 Pathophysiology of Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779569/

  Heavy menstrual bleeding (HMB) is a common gynecological complaint with multiple etiologies and diverse pathophysiological origins. […] Our present understanding of the mechanisms of menstrual bleeding as well as many of the pathological aberrations of HMB is incomplete. […] Further research into the pathophysiology of HMB is urgently needed, as clear knowledge of the mechanisms of this disorder will provide new therapeutic targets to formulate more effective treatments. […] Any process that interferes with the normal endocrine, paracrine or hemostatic functions of the endometrium as well as possibly any interference with myometrial contractility may cause HMB. […] The pathophysiology of HMB may be discussed in the context of both ovulatory and anovulatory cycles. […] The mechanisms by which EH induces HMB are not fully understood.

• #1 Heavy menstrual bleeding diagnosis and medical management | Contraception and Reproductive Medicine | Full Text

  https://contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-017-0047-4

  Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a womans quality of life and the activities of daily living. […] As there is no single pathway that is associated with HMB, there are several therapeutic interventions involving different molecular pathways to reduce HMB. […] The mechanism(s) whereby myomas increase menstrual blood loss is unclear, but abnormal bleeding due to leiomyomas may be related to uterine vasculature abnormalities or impaired or dysregulated endometrial hemostasis. […] Several different pathways that result or cause hemostatic dysfunctions have been implicated in increased menstrual blood loss. […] No single pathway explains the cause of HMB. This has resulted in several therapeutic interventions specifically altering different pathways resulting in reduced blood loss with menstruation.

• #1 Menorrhagia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255540-overview

  Knowledge of normal menstrual function is imperative in understanding the etiologies of menorrhagia. Four phases constitute the menstrual cycle: follicular, luteal, implantation (in the case of pregnancy), and menstrual (in the case of unfertilized ovum and no pregnancy). In response to pulsatile gonadotropin-releasing hormone (GnRH) from the hypothalamus, the pituitary gland synthesizes follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which induce the ovaries to produce estrogen and progesterone. During the follicular phase, estrogen stimulation results in hypertrophy of endometrial tissue causing an increase in endometrial thickness in preparation for implantation. This also is known as the proliferative phase. The luteal phase is intricately involved in the process of ovulation. During this phase, also known as the secretory phase, progesterone causes endometrial maturation. An LH surge is the harbinger of ovulation and release of an ovum from the ovary. If fertilization occurs, beta-HCG will stimulate the corpus luteum to continue to make progesterone and ultimately maintain the implantation phase and continued decidualization of the endometrium. Without fertilization, estrogen and progesterone withdrawal results in menstruation. The endometrium consists of two discrete zones, the basalis layer and the functionalis layer. The basalis layer allows for regeneration of the functionalis layer following menses and is positioned between the myometrium and functionalis layer. The functionalis layer is the most superficial layer, covering the entire uterine cavity and sloughs off with menstruation. Blood supply to the uterus is primarily through the uterine and ovarian arteries. These arteries anastomose and branch into arcuate arteries that supply the myometrium, which branch further into radial arteries to supply the two layers of the endometrium. The fall in progesterone at the end of the menstrual cycle leads to enzymatic breakdown of the functionalis layer, ultimately leading to sloughing of the endometrium and blood loss, also known as the menstrual phase. Hemostasis relies on sufficient vasoconstriction and a functioning coagulation system, and a disruption in either element can affect menstruation. Hemostasis of the endometrium is directly related to the functions of platelets and fibrin. Deficiencies in either of these components results in menorrhagia for patients with von Willebrand disease or thrombocytopenia. Thrombi are seen in the functional layers but are limited to the shedding surface of the tissue. These thrombi are known as „plugs” because blood can only partially flow past them. Fibrinolysis limits the fibrin deposits in the unshed layer. Following thrombin plug formation, vasoconstriction occurs and contributes to hemostasis. Many cases of AUB are secondary to anovulation. Without ovulation, the corpus luteum fails to form, resulting in no progesterone secretion. Unopposed estrogen allows the endometrium to proliferate and thicken. The endometrium finally outgrows its blood supply and degenerates. The result is asynchronous breakdown of the endometrial lining at different levels. This also is why anovulatory bleeding is heavier than normal menstrual flow. Unlike menorrhagia, anovulatory cycles are often described as irregular in timing as well as flow volume. Anatomic defects or growths (most typically polyps or fibroids but also malignancy) within the uterus can alter either of the aforementioned pathways (endocrinologic/hemostatic), causing significant uterine bleeding. The clinical presentation is dependent on the location and size of the gynecologic lesion. Organic diseases also contribute to menorrhagia in the female patient. For example, in patients with renal failure, gonadal resistance to hormones, and hypothalamic-pituitary axis disturbances result in menstrual irregularities. Most women in this renal state are amenorrheic, but others also develop menorrhagia. If uremic coagulopathy ensues, it usually is due to platelet dysfunction and abnormal factor VIII function. Due to the overwhelming factors that can contribute to the dysfunction of either the endocrine or hematologic pathways, in-depth knowledge of an existing organic disease is just as imperative as understanding the menstrual cycle itself.

• #1 Uterine bleeding: how understanding endometrial physiology underpins menstrual health | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-021-00629-4

  Menstruation (that is, endometrial shedding) is a fine balance between proliferation, decidualization, inflammation, hypoxia, apoptosis, haemostasis, vasoconstriction and, finally, repair and regeneration. […] An imbalance in any one of these processes can lead to the abnormal endometrial phenotype of AUB. […] The endometrium is a dynamic, multicellular tissue highly responsive to sex steroids; subtle variances in the endometrial environment and, therefore, functioning, can lead to abnormal uterine bleeding (AUB). […] Comprehensive knowledge of menstrual cycle physiology is crucial for understanding and progressing endometrial physiology research. […] The terminology and definitions for diagnosing causes of AUB are now standardized in the International Federation of Gynecology and Obstetrics Systems 1 and 2, and should be followed for ease of clinical and research synchrony.

• #1 Managing Menorrhagia

  https://www.uspharmacist.com/article/managing-menorrhagia

  Anything that causes thickening of the endometrium, and hence increases its vascularization, can cause menorrhagia. […] The endometrium of women who experience menorrhagia has been shown to have higher levels of plasminogen activators than that of women with normal flow. […] Tranexamic acid is a synthetic lysine derivative that exerts its effect by blocking lysine binding sites on plasminogen, thus preventing fibrin degradation. […] Danazol works by suppressing the pituitary-ovarian axis and inhibiting the pituitary output of gonadotropins, hormones that increase in the endometrium. […] GnRH analogues are competitive agonists at GnRH receptors in the pituitary. GnRH-releasing cells are eventually desensitized, resulting in a hypogonadotropic state, which causes hypoestrogenism, endometrial atrophy, and amenorrhea.

• #1 Abnormal Uterine Bleeding – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/abnormal-uterine-bleeding

  Abnormal uterine bleeding (AUB) in patients of reproductive age is a bleeding pattern that is not consistent with normal menstrual cycle parameters (frequency, regularity, duration, and volume). […] Ovulatory dysfunction (anovulation or oligo-ovulation) is the most common cause of AUB in women of reproductive age and occurs most often in women 45 years old (50% of cases) and in adolescents (20% of cases). […] During an anovulatory cycle, estrogen is produced, but the corpus luteum does not form. Thus, the normal cyclical secretion of progesterone does not occur, and estrogen stimulates the endometrium unopposed. Without opposition by progesterone, the endometrium continues to proliferate, eventually outgrowing its blood supply; it then sloughs incompletely and bleeds irregularly and sometimes profusely or for many days. When this abnormal process occurs repeatedly, the endometrium can become hyperplastic, sometimes with atypical or cancerous cells.

• #1 Heavy Menstrual Bleeding in Adolescents | Article | GLOWM

  https://www.glowm.com/article/heading/vol-2–adolescent-gynecology–heavy-menstrual-bleeding-in-adolescents/id/418313

  Heavy menstrual bleeding (HMB) is excessive menstrual blood loss, regardless of duration, which interferes with well-being and quality of life as reported by the menstruator. HMB is defined as more than 80 mL of menstrual blood loss in one menstrual cycle. […] Ovulatory dysfunction is the most common cause of AUB in adolescents. […] Heavy menstrual bleeding (HMB) may be the first presentation of an underlying bleeding disorder in adolescents. […] AUB is the most common cause of iron deficiency in adolescents.

• #1 Dysfunctional Uterine Bleeding | GLOWM

  https://www.glowm.com/section-view/heading/Dysfunctional%20Uterine%20Bleeding/item/293

  Most cases of anovulatory bleeding are the result of estrogen withdrawal or estrogen breakthrough bleeding. […] When there is unopposed estrogen stimulation to the endometrium and no periodic desquamation, the endometrium reaches abnormal heights and lacks structural support. […] The resulting tissue consists of increased vascularity, back-to-back glandularity, but without an intervening stromal support system. […] Because of tissue fragility, spontaneous superficial breakage and bleeding occur. […] The disorderly, abrupt breakdown of tissue along with opening of the multiple vascular channels coupled with the large amount of tissue available for breakdown results in prolonged and excessive flow. […] Stasis is not induced because of the lack of vasoconstrictive rhythmicity, no tight coiling of the spiral vessels, and their disorderly collapse. […] Local bleeding can rely only on the healing effects of endogenous estrogen to halt flow. […] This healing is only temporary in that as soon as one site heals, another fragile tissue site breaks down and the bleeding ensues again.

• #1 Sudden heavy period: Causes and what to do

  https://www.medicalnewstoday.com/articles/sudden-heavy-period

  High estrogen levels can cause heavy periods. […] A person may experience a sudden heavy period as a result of using an intrauterine device (IUD), for example. […] If a heavy period occurs, a person can take steps at home to manage it, such as wearing darker clothing, using heat therapy, and using more than one sanitary product.

• #1 Natural Treatment of Heavy Periods — Walnut Creek Naturopathic

  https://www.walnutcreeknaturopathic.com/blog/natural-treatment-of-heavy-periods

  Research has shown that a deficiency in vitamin A impairs hormone production and enzyme activity in the ovaries of animals. Although the mechanism of action of vitamin A on blood loss during menstruation is unclear, studies have shown it to have a complex interaction with estrogen. […] Studies have shown that a deficiency in B vitamins causes the liver to lose its ability to inactivate estrogen, which could theoretically result in an estrogen excess. Since some forms of menorrhagia are caused by an estrogen excess, supplementation with B vitamins may restore the liver’s ability to properly metabolize estrogen, thereby reducing the flow of the period. […] Hypothyroidism is a common cause of menorrhagia. This is included under treatment for DUB because studies have shown reduction in menstrual blood loss in women treated for hypothyroid who had normal thyroid results but showed clinical evidence of the condition.

• #1 Heavy menstrual bleeding – Wikipedia

  https://en.wikipedia.org/wiki/Heavy_menstrual_bleeding

  Heavy menstrual bleeding (HMB) is associated with increased omega-6 AA in uterine tissues. The endometrium of people with HMB have higher levels of prostaglandin (E2, F2alpha and others) when compared with women with normal menses. It is thought that prostaglandins are a by product of omega 6 build up. Furthermore, prostaglandins have been found to trigger abnormal, painful uterine contractions, making it a source for targeted therapy.

• #1 Treatments for cramps don’t cut it. Why aren’t there better options?

  https://www.statnews.com/2023/02/17/cramps-menstrual-period-pain-treatment/

  The problem starts, experts said, with how unclear the science still is on the various causes of cramps. The prevailing theory behind cramps is a group of compounds called prostaglandins. At the beginning of menstruation, levels of the hormones progesterone and estradiol drop, leading to an increased production of prostaglandins. The compounds cause the uterus to contract to help it expel tissue, but may also cause painful cramps. […] In short, there are probably many mechanisms responsible for menstrual pain, said Kevin Hellman, a menstrual pain researcher at the University of Chicago. Uterine contractions are a likely cause, and abdominal muscle soreness, inflamed tissue, pelvic floor muscle fatigue, and a number of other factors could also be at play, he said. […] Having a better understanding of whats causing the pain could help researchers develop more effective treatments. It could also help doctors know how to better treat those who dont find relief from NSAIDs.

• #1 Meftal Spas – Uses, Side Effects, Composition, Dosage & Price PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact Num

  https://www.pacehospital.com/meftal-spas-uses-side-effects-composition-dosage-price

  Mefenamic acid’s anti-inflammatory properties are low when compared with other pain relievers, especially during abnormal bleeding during periods. […] Meftal spas is widely indicated in the: Treatment of mild and moderate abdominal pain […] Primary dysmenorrhea (heavy menstrual bleeding associated with pain). There is meagre evidence to suggest that mefenamic acid is better than other NSAIDs in dealing with menorrhagia (abnormally heavy bleeding, menstrual cramps) […] Meftal spas demonstrates analgesic properties (pain reliever) but no anti-coagulant properties (blood clotting). Despite that, studies have shown that non-steroidal anti-inflammatory drugs reduce menstrual bleeding and cramps in menorrhagia patients, and based on this evidence, physicians at times prescribe meftal spas to reduce bleeding.

• #1 Pathophysiology of Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779569/

  The plausible explanations include lack of the usual reduction in progesterone to initiate shedding of the thick and excessive endometrial tissues; ongoing proliferative activity in the endometrium even at the time of shedding and possibly generous blood flow that is established to support the enhanced endometrial growth; all of which may cause prolonged, heavy bleeding as well as incomplete cessation of bleeding. […] Despite advances in understanding of the molecular changes in leiomyomas and associated myometrium and endometrium, it remains unclear why clinical symptoms are so varied. […] HMB is seen in some women with leiomyomas but it does not correlate clearly with the size or location of fibroids or with the expression of angiogenic growth factors or blood flow. […] The cause of HMB in adenomyosis is unknown.

• #1

  https://www.fibroids.net/pubfart4.html

  Leiomyomas are an important cause of menorrhagia and other forms of abnormal uterine bleeding. The pathogenesis of this process is largely unknown, however. A classic theory, first suggested by Sampson’s work in 1912, states that local dysregulation of the vascular structures in the uterus is responsible for this abnormal bleeding. Recent work demonstrates dysregulation of a number of growth factors in the myomatous uterus. As many of these factors regulate the process of angiogenesis or have other effects on vascular structures, we hypothesize that this dysregulation of growth factors or their receptors provides the molecular mechanism underlying these vascular abnormalities. In turn, these abnormal vessels lead women with leiomyomas to experience menorrhagia. Factors that may prove to be important in this process include basic fibroblast growth factor, vascular endothelial growth factor, heparin-binding epidermal growth factor, platelet derived growth factor, transforming growth factor-b, parathyroid hormone-related protein and prolactin.

• #1

  https://www.fibroids.net/pubfart4.html

  Growth factors or their receptors that are differentially regulated in the leiomyomas or the endometrium of leiomyomatous uteri are potential mediators of leiomyoma-related complications. These differentially regulated factors, which are known to act on vascular tissue by increasing proliferation or changing vessel caliber, are potential causes of leiomyoma-related menorrhagia. The factors that meet these criteria include bFGF, vascular endothelial growth factor (VEGF), heparin-binding epidermal growth factor (HBEGF), platelet derived growth factor (PDGF), TGF-b, PTHrP and prolactin. […] The targeting of angiogenic molecules is clinically desirable since angiogenesis is usually a pathologic process, except in the female reproductive system. Thus, many of the agents might be administered with minimal adverse systemic effects.

• #1

  https://www.fibroids.net/pubfart4.html

  The theory that best explains leiomyoma-related abnormal bleeding states that the primary event is a change in venous structures in the endometrium and myometrium resulting in venule ectasia. […] Current evidence suggests that it is not physical compression but the local action of vasoactive growth factors which have altered synthesis, expression or sequestration in leiomyomas, that account for these vascular abnormalities. With ectatic venules, the hemostatic actions of the platelet and fibrin plug may be overwhelmed by the increased diameter of the vessels which causes the „flooding” clinically seen in women with menorrhagia. […] Thus, multiple somatic mutations can result in the same phenotypic changes. This paradigm of dysregulation of growth factor function that results in disruption of normal vascular function appears relevant for non-uterine bleeding disorders.

• #1 Why do fibroids in the uterus cause severe bleeding?

  https://chennaigynecologist.com/why-do-fibroids-in-the-uterus-cause-severe-bleeding/

  Physical mechanism can make fibroids cause severe bleeding – Fibroids may cause heavy bleeding through an increase in endometrial surface due to underlying fibroid growth. […] Angiogenesis in fibroids can cause severe bleeding – There is no other tissue in the human body that undergoes angiogenesis to the degree and frequency as the endometrium. […] Pseudocapsule in fibroids could explain severe bleeding – The fibroid mass is poorly vascularised but it can be surrounded by a pseudocapsule which is a highly vascularised tissue that develops only in intramural fibroids. […] Venous lakes in fibroids can be responsible for increased bleeding – Severe bleeding connected to uterine fibroids suggests physiological formation of venous lakes which are large sinusoidal structures within the uterine vasculature from arteriovenous anastomoses. […] Aberrant architecture of fibroid can cause severe bleeding – The vasculature developing around uterine fibroids could show structural defects that could be highly irregular, with high tortuosity, shunting of vessels and non-patent ends.

• #1 Abnormal uterine bleeding – Wikipedia

  https://en.wikipedia.org/wiki/Abnormal_uterine_bleeding

  The causes of abnormal uterine bleeding are divided into nine categories (PALM COEIN) under the FIGO System 2 which is the second part of the classification system developed by the International Federation of Gynecology and Obstetrics. More than one category of causes may apply in an individual case. […] The mechanisms, or reasons, that each of the PALM COEIN abnormalities cause uterine bleeding is not well understood, but the table below includes some scientific hypothesis and observations that give a strong indication of what may be happening. […] Polyps Condensed tissue overgrowths along the endometrial lining. Possibly due to stromal cell congestion that blocks normal blood flow leading to expulsion of excess blood through the uterus. […] Adenomyosis Endometrial tissue invades the uterine muscle causing enlargement. Possibly due to reduction of hormone signaling in response to fibrotic lesions that invade the uterine muscle and cell wall lining meet. Increased angiogenesis and immunological oxidative stress have also been implicated.

• #1 Pathophysiology of Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779569/

  In common with leiomyoma, adenomyosis can affect normal myometrial contractility and this may contribute to the HMB. […] The pathogenesis of adenomyosis is uncertain and various explanations have been suggested. […] The most popular hypothesis is that endometrium invaginates into myometrium from the stratum basalis during periods of regeneration and healing. […] An alternative suggestion is that adenomyosis develops within the myometrium from Mullerian remnants. […] The presence of leiomyomas may also affect the composition of the overlying endometrium. […] Abnormal or incomplete angiogenesis, resulting in abnormal blood vessels with fragile vessel walls may cause HMB and several studies have suggested that abnormal endometrial vessel number, structure or function may play a role in HMB.

• #1 Abnormal uterine bleeding – Wikipedia

  https://en.wikipedia.org/wiki/Abnormal_uterine_bleeding

  Leiomyoma (Fibroids) Non-cancerous smooth muscle cell tumors. Possibly due to increased vasculature (blood vessels) and surface area of uterine lining. Impaired angiogenesis and uterine blood clotting abilities may also contribute. […] Malignancy (Cancer) Uterine cancer Endometrial hyperplasia. Most likely due to long-term exposure to estrogen without simultaneous exposure to progesterone. […] Coagulopathies (Clotting Disorders) Bleeding disorders impairing the body’s blood clotting function. Improper platelet function and blood clotting factor deficiencies impair uterine ability to create blood clots that prevent excess bleeding. […] Ovulatory Disorders Conditions impairing the female body’s ability to produce gametes (reproductive eggs). Possibly due to abnormal increases or decreases of reproductive hormones interrupt the ovulation cycle and prevent appropriate shedding and regeneration of the uterine lining.

• #1 Heavy Menstrual Bleeding – Causes – Management – TeachMeObGyn

  https://teachmeobgyn.com/gynaecology/menstrual/heavy-bleeding/

  The main features of heavy menstrual bleeding are: Bleeding during menstruation deemed to be excessive for the individual woman. […] There are numerous differential diagnoses for heavy menstrual bleeding. […] Von Willebrands disease is the most common coagulopathy to cause heavy menstrual bleeding. […] The only definitive treatment for HMB is hysterectomy. It offers amenorrhoea and an end to fertility. […] Heavy menstrual bleeding is defined by the woman presenting with the problem. […] Multiple structural and non-structural causes, however 40-60% of cases not attributed to any of these. […] Three tiered pharmacological approach to treatment is the first line. […] Surgical options for treatment include ablation and hysterectomy.

• #1 Menorrhagia(Archived) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK536910/

  Another important consideration and a significant cause of AUB are the patients medications. An intact coagulation pathway is essential for menstrual regulation and medications that interact with platelets and coagulation factors can lead to Acute AUB. The following is a list of some medications that can lead to AUB: Warfarin, aspirin, clopidogrel, and other anticoagulants; Conceptive medications and devices; Tamoxifen; Tricyclic antidepressants; Antipsychotics; Corticosteroids.

• #1 Heavy Menstrual Bleeding (Menorrhagia): Symptoms and More

  https://www.verywellhealth.com/top-causes-of-heavy-menstrual-bleeding-3522223

  Certain medications may cause heavier menstrual bleeding. Some examples include anticoagulants (blood thinners), antidepressants, antipsychotics, corticosteroids, and certain medicinal herbs. […] Heavy menstrual bleeding can have a number of possible causes, including problems with the ovaries, uterine fibroids, pelvic inflammatory disease, and others. Certain medications may also cause you to bleed more heavily than usual.

• #1 Is Your Anemia Due to Menorrhagia (Heavy Menstrual Bleeding) – Dr. Jolene Brighten

  https://drbrighten.com/anemia-menorrhagia-heavy-menstrual-bleeding-making-anemic/

  One of the most common causes of iron deficiency anemia in menstruating women is due to heavy periods. […] It is well understood the copper IUD can lead to heavy and painful periods. If you’ve had a copper IUD placed this may be the root cause of your increased menstruation and can lead to anemia. […] Fibroids and uterine polyps can lead to increased blood flow during menses. […] Endometriosis can also be a cause of heavy periods with significant pain. […] Inadequate thyroid hormone can lead to long and irregular periods. […] Women on blood thinners, like aspirin or warfarin, may also have increased bleeding during their periods.

• #1 Transforming growth factor-β superfamily signalling and its role in the pathogenesis of heavy menstrual bleeding | SFEBES2014 | Society for Endocrinology BES 2014 | Endocrine Abstracts

  https://www.endocrine-abstracts.org/ea/0034/ea0034p330

  Transforming growth factor- superfamily signalling and its role in the pathogenesis of heavy menstrual bleeding […] Aberrations in endometrial repair may lead to pathology such as heavy menstrual bleeding (HMB). […] The prolonged bleeding identified in women with HMB is consistent with defective endometrial repair. The presence of active SMAD2/3 protein at menstruation and decreased SMAD3 expression at this time in women with HMB implicates TGF- signalling in the pathogenesis of this common disorder.

• #1 Abnormal Uterine Bleeding – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/abnormal-uterine-bleeding

  When abnormal uterine bleeding occurs in patients with ovulatory cycles, progesterone secretion is prolonged; irregular shedding of the endometrium results, probably because estrogen levels remain low, near the threshold for bleeding (as occurs during menses). In women with obesity, ovulatory AUB can occur if estrogen levels are high, resulting in amenorrhea alternating with irregular or prolonged bleeding. […] Chronic heavy or prolonged uterine bleeding may cause iron deficiency anemia. […] If AUB is due to ovulatory dysfunction, infertility may also be present. […] AUB due to ovulatory dysfunction (AUB-O) is the most common type of nonstructural AUB and the most common cause overall. AUB-O can result from any disorder or condition that causes anovulation or oligo-ovulation. Causes of ovulatory dysfunction include Polycystic ovary syndrome, Hyperprolactinemia, Hypothyroidism, Perimenarche or perimenopause, Primary ovarian insufficiency, and Idiopathic (sometimes occurring when gonadotropin levels are normal).

• #1 Uterine bleeding: how understanding endometrial physiology underpins menstrual health | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-021-00629-4

  Treatments for AUB are not specific and a third of patients resort to a hysterectomy for resolution of symptoms, highlighting a clinically unmet need for more targeted and personalized treatments. […] AUB is a debilitating symptom that affects up to one third of reproductive-aged women. […] There is a high prevalence of iron deficiency and iron deficiency anaemia in those with AUB, on a global scale, and this is often under-recognized and under-reported.

• #1 Is Your Anemia Due to Menorrhagia (Heavy Menstrual Bleeding) – Dr. Jolene Brighten

  https://drbrighten.com/anemia-menorrhagia-heavy-menstrual-bleeding-making-anemic/

  Heavy menstrual bleeding can cause a significant loss of iron-rich blood, resulting in iron deficiency anemia. […] Anemia due to menorrhagia (heavy periods) is one of the most common cases of iron deficiency anemia. […] If you have heavy periods, you may be losing more iron-rich blood than your body can keep up with, which is making you anemic. […] Heavy menstrual bleeding, otherwise called menorrhagia, is one of the most prevalent causes of anemia. This is because you’re losing iron-rich blood. Every. Single. Month. If you’re not offsetting blood loss with an appropriate intake of iron, your body will start to run through its iron stores, leading to an iron deficiency. […] Yes, iron deficiency can cause heavy periods and heavy periods can cause iron deficiency. This can make it tricky to understand which came first.

• #1 Natural Treatment of Heavy Periods — Walnut Creek Naturopathic

  https://www.walnutcreeknaturopathic.com/blog/natural-treatment-of-heavy-periods

  A common finding with menorrhagia is the passing of blood clots. There are varying medical perspectives as to the cause of menstrual clots. One view is that the clots form if blood accumulates faster than the body’s ability to transfer it out of the uterus through the cervix. As it pools in the uterus, clots form. Another theory is that the body releases anticoagulants during a woman’s period that are designed to keep the blood from clotting. If the flow is heavy, the blood may be expelled too rapidly for the anticoagulants to work, resulting in the formation of clots. […] Although it is well known that heavy menstrual bleeding can lead to iron-deficiency anemia, it is not as well recognized that iron-deficiency anemia can actually cause or worsen menorrhagia. Iron deficiency may cause the muscles of the uterus to weaken, thereby reducing the ability of these muscles to clamp down on blood vessels, which is necessary to decrease or stop bleeding. Heavy bleeding may then worsen iron deficiency, which then worsens the bleeding, thus creating a vicious cycle.

• #1 The Link Between Uterine Fibroids and Heavy Menstrual Bleeding

  https://www.everydayhealth.com/womens-health/uterine-fibroids-heavy-menstrual-bleeding/

  Heavy menstrual bleeding is typically defined as a period that lasts more than seven days and requires frequent changing of sanitary products. […] While there’s no one reason uterine fibroids cause heavy, prolonged periods, there are a few theories. […] Uterine fibroids may press against the uterine lining, causing more bleeding than usual. […] The uterus may not contract properly, which means it can’t stop the bleeding. […] Fibroids may stimulate the growth of blood vessels, which contributes to heavier or irregular periods and spotting between periods. […] Elevated levels of hormones called prostaglandins may also contribute to heavy bleeding. […] Heavy menstrual bleeding related to uterine fibroids is typically based on the location of the fibroids, contractility of the uterus, the presence of ancillary prostaglandins, and any distortion to the lining of the uterus, explains Bradley.

• #1 Pathophysiology of Heavy Menstrual Bleeding

  https://www.periodicos.capes.gov.br/index.php/acervo/buscador.html?task=detalhes&id=W2221310712

  Heavy menstrual bleeding (HMB) is a common gynecological complaint with multiple etiologies and diverse pathophysiological origins. […] Our present understanding of the mechanisms of menstrual bleeding as well as many of the pathological aberrations of HMB is incomplete. […] Further research into the pathophysiology of HMB is urgently needed, as clear knowledge of the mechanisms of this disorder will provide new therapeutic targets to formulate more effective treatments.

• #1 Accelerating Innovations to Address Heavy Menstrual Bleeding

  https://gcgh.grandchallenges.org/challenge/accelerating-innovations-address-heavy-menstrual-bleeding-women-low-resource-settings

  Heavy menstrual bleeding (HMB) affects millions of women globally. Clinically, HMB is defined as excessive menstrual blood loss that negatively affects a woman’s physical, emotional, and social well-being. […] The underlying biological mechanisms, particularly related to endometrial dysfunction-related HMB also remain poorly understood. […] Research priorities in HMB include understanding the underlying biological mechanisms, particularly related to endometrial dysfunction-related HMB, developing and introducing cost-effective and easy to scale-up diagnostics to identify causes of HMB and guide treatment, and identifying ways to increase acceptability and access to treatments such as the hormonal intrauterine device for women in low-resource settings. […] Biological Mechanisms Advancing understanding of the fundamental biology of HMB to identify targets for innovative diagnostics and treatments.

• #1

  https://www.fibroids.net/pubfart4.html

  Current treatment regimens for women with leiomyoma-related bleeding depend on the manipulation of the steroid hormone environment. By better understanding the pathogenesis of this disease process, therapies directed against growth factor abnormalities may result in better treatment with less harmful side-effects. […] Leiomyoma-related menorrhagia is a significant medical and social problem for many women. Effective treatment strategies are limited by a narrow understanding of the pathogenesis of this disease. Classic studies suggest that there is a fundamental alteration in the vascular structures of the myomatous uterus. Recent progress in defining the molecular mechanisms of angiogenesis in the uterus lends support to this theory by demonstrating local dysregulation of vasoactive growth factors or growth factor receptors in leiomyomas or leiomyomatous myometrium. Thus, the molecular mechanisms underlying the process of leiomyoma-related menorrhagia are delineated.

• #2 Uterine bleeding: how understanding endometrial physiology underpins menstrual health | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-021-00629-4

  Treatments for AUB are not specific and a third of patients resort to a hysterectomy for resolution of symptoms, highlighting a clinically unmet need for more targeted and personalized treatments. […] AUB is a debilitating symptom that affects up to one third of reproductive-aged women. […] There is a high prevalence of iron deficiency and iron deficiency anaemia in those with AUB, on a global scale, and this is often under-recognized and under-reported.

• #2 Managing Menorrhagia

  https://www.uspharmacist.com/article/managing-menorrhagia

  Anything that causes thickening of the endometrium, and hence increases its vascularization, can cause menorrhagia. […] The endometrium of women who experience menorrhagia has been shown to have higher levels of plasminogen activators than that of women with normal flow. […] Tranexamic acid is a synthetic lysine derivative that exerts its effect by blocking lysine binding sites on plasminogen, thus preventing fibrin degradation. […] Danazol works by suppressing the pituitary-ovarian axis and inhibiting the pituitary output of gonadotropins, hormones that increase in the endometrium. […] GnRH analogues are competitive agonists at GnRH receptors in the pituitary. GnRH-releasing cells are eventually desensitized, resulting in a hypogonadotropic state, which causes hypoestrogenism, endometrial atrophy, and amenorrhea.

Zobacz więcej