围绝经期异常子宫出血诊断和治疗专家共识

Expert Consensus on the Diagnosis and Treatment of Perimenopausal Abnormal Uterine Bleeding

围绝经期异常子宫出血(abnormal uterine bleeding,AUB)主要与卵巢功能衰退有关。卵巢衰退后常处于无排卵状态,可能引起月经异常,同时也是子宫内膜良、恶性病变的诱发因素。多数AUB会使患者不适,并对其生活质量产生重大影响,需要及时干预。随着诊断手段的不断丰富和规范化,越来越多的AUB在门诊即得到了快速诊断。围绝经期异常子宫出血需针对病因进行规范化、个体化治疗。AUB的病因包括结构性改变和无结构性改变。无结构性改变者常需进行药物干预,如孕激素、口服避孕药(尤其是短效口服避孕药)、放置左炔诺孕酮宫内缓释系统以及抗纤维蛋白溶解药物,还可辅以微创治疗如宫腔镜手术和子宫内膜消融术等,这使得很多AUB患者避免或推迟了子宫切除手术。

The main cause of perimenopausal abnormal uterine bleeding（ AUB） is the decline of ovarian function resulting in anovulatory status,which may lead to menstrual abnormalities and act as a predisposing factor for benign and malignant endometrial lesions. In most cases,AUB is disquieting and significantly affecting the quality of life. With abundant and standardized diagnostic methods,more and more AUB could be rapidly diagnosed in clinics. It is of vital importance to perform a standardized and individualized diagnosis and treatment procedure. Structural and nonstructural changes are two categories of perimenopausal AUB,which need completely different methods of treatment. Nonstructural diseases commonly require non-surgical interventions,for instance,cyclic progestogens,oral contraceptives（ especially short-acting oral contraceptives）,the levonorgestrel intrauterine system,antifibrinolytic medicines,and minimally invasive treatments such as hysteroscopy and endometrial ablation,which may avoid or delay hysterectomy.