异常子宫出血药物治疗进展

Progress in Medical Treatment of Abnormal Uterine Bleeding

国际妇产科联盟月经疾病组(FMDG)提出异常子宫出血(abnormal uterine bleeding,AUB)是涵盖月经紊乱的术语,应摒弃月经过多和功能失调性子宫出血(dysfunctional uferine bleading,DUB)称谓。月经量过多术语推荐用严重出血(heavy menstrual bleeding,HMB)替代月经过多。FMDG把AUB按照病因的首字母分为9个系统,即PALM-COEIN。其中COEIN为非器质性因素引起的AUB,首选为药物治疗,包括抗纤溶制剂、非甾体类抗炎药(NSAIDs)、避孕药、孕激素和左炔诺孕酮宫内缓释系统(LNG-IUS)等。LNG-IUS是最有效的治疗特发性HMB的方法之一,可以长期有效地控制月经量。去氨加压素(desmopressin,DDAVP)在治疗凝血功能障碍患者HMB时有效。二甲双胍可调节多囊卵巢综合征(PCOS)妇女月经,并对子宫内膜增生性疾病孕激素抵抗的患者有治疗作用。另外,四相口服避孕药、氨甲环酸的新制剂、丹那唑的阴道制剂和阴道避孕环等是治疗HMB的可供选择新方法。

FIGO Menstrual Disorders Group （FMDG） put forward that the abnormal uterine bleeding （AUB） was a suitable overarching term for the symptom of disturbed menstrual bleeding, and that the terms ‘menorrhagia＇ and ‘disfunctional uterine bleeding （DUB）＇ should be discarded . The heavy menstrual bleeding （HMB） should be used to replace the term of menorrhagia for the symptom of excess menstrual bleeding. FMDG classified the AUB according to the causes using the PALM-COEIN system. Medical management should be the initial treatment for AUB of COEIN causes, including multi-dose regimens of combined oral contraceptives or oral progestins, NSAIDs,tranexamic acid and the levonorgestrel-releasing intrauterine system （LNG-IUS）. LNG-IUS is the most effective medical treatment for idiopathic HMB. Desmopressin is effective in management of HMB in women with bleeding disorders. Metformin is applied to regulate the menstrual cycle in PCOS women. And Metformin has therapeutical effect on the endometrial hyperplasia combined with progestin-resistant. Moreover, there are more choices for HMB treatment, such as the new four-phasic estradiol valerate/dienogest contraceptive pills, the modified-release formulation of tranexamic acid, the combined contraceptive vaginal ring, and vaginal danazol.