Advertisement

Vaginaal bloedverlies, abnormaal

  • H. de Vries
  • N. Brendel
  • P. J. E. Bindels
  • A. H. Blankenstein
  • R. Barentsen
Chapter

In de fertiele levensfase behoren de menstruaties bij de vrouw met een zekere regelmaat te komen: eens per 21-40 dagen. De normale duur is meestal niet langer dan zeven dagen. Abnormaal vaginaal bloedverlies is bloedverlies dat afwijkt van de normale menstruatie door veranderingen in duur en/of hevigheid en/of tijdstip van de bloeding.1 Daarbij gaat het om verschillende typen: overvloedig, tussentijds of onregelmatig vaginaal bloedverlies, contactbloedingen en postmenopauzaal bloedverlies (zie definities).

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatuur

  1. 1.
    Heineman MJ, Bleker OP, Evers JLH, et al, editors. Obstetrie en gynaecologie: De voortplanting van de mens. Maarssen: Elsevier/Bunge; 2004.Google Scholar
  2. 2.
    Polderman JA, Wee PM ter, Goor H van, et al. Postmenopauzale bloedingen: epidemiologische aspecten en histologische diagnosen. Ned Tijdschr Geneesk 1985; 129: 500–504Google Scholar
  3. 3.
    Nagele F, O’Connor H, Davies A, et al. 2500 Outpatient diagnostic hysteroscopies. Obstet Gynecol 1996; 88: 87–92PubMedCrossRefGoogle Scholar
  4. 4.
    NVOG richtlijn Abnormaal vaginaal bloedverlies in de postmenopauze. NVOG-richtlijn nr. 04. Utrecht: Nederlandse Vereniging voor Obstetrie en Gynaecologie; 1997.Google Scholar
  5. 5.
    Okkes IM, Oskam SK, Lamberts H. Van klacht naar diagnose. Episodegegevens uit de huisartspraktijk. Bussum: Coutinho; 1998.Google Scholar
  6. 6.
    Eijkeren MA van, Christiaens GCML, Haspels AA, et al. Measured menstrual blood loss in women with a bleeding disorder. Am J Obstet Gynecol 1990; 162: 1261–1263PubMedGoogle Scholar
  7. 7.
    Denekens J, Aertsens WA. Abnormaal vaginaal bloedverlies. In: Damme J van, Essed GGM, editors. Gynaecologie. Houten/Diegem: Bohn Stafleu Van Loghum; 1999.Google Scholar
  8. 8.
    Gould D. Menorrhagia: care and treatment. Nurs Stand 1995; 9: 36–39PubMedGoogle Scholar
  9. 9.
    Janssen CA, Scholten PC, Heintz AP. A simple visual assessment technique to distinguish between menorrhagia and normal menstrual blood loss. Obstet Gynecol 1995; 85: 977–982PubMedCrossRefGoogle Scholar
  10. 10.
    Meijer LJ, Zwart S, Wemekamp H, et al. NHG-Standaard Vaginaal bloedverlies. Huisarts Wet 2001; 44: 260–266Google Scholar
  11. 11.
    Hallberg L, Högdall A, Nisson L, et al. Menstrual blood loss – a population study. Variation at different ages and attempts to define normality. Acta Obstet Gynec Scandinav 1966; 45: 320–351Google Scholar
  12. 12.
    Wilansky DL, Greisman B. Early hypothyroidism in patients with menorrhagia. Am J Obstet Gynecol 1989; 160: 673–677PubMedGoogle Scholar
  13. 13.
    Krassas GE, Pontikides N, Kaltas T, et al. Disturbances of menstruation in hypothyroidism, Clin Endocrinol 1999; 50: 655–659CrossRefGoogle Scholar
  14. 14.
    Dekker JH, Veehof LJG, Heeres PH, et al. NHG-Standaard Pelvic inflammatory disease. In: Thomas S, Geijer RMM, Laan JR van der, Wiersma Tj, editors. NHG-Standaarden voor de huisarts deel II. Utrecht: Bunge; 1996: 230–236Google Scholar
  15. 15.
    Lamberts H. In het huis van de huisarts. Verslag van het Transitieproject. Lelystad: Meditekst; 1994.Google Scholar
  16. 16.
    Warner P, Critchley HOD, Lumsden MA, et al. Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management. BMJ 2001; 323: 24–28PubMedCrossRefGoogle Scholar
  17. 17.
    Gredmark T, Kvint S, Havel G, et al. Histopathological findings in women with postmenopausal bleeding. Brit J Obstet Gynaecol 1995; 102: 133–136Google Scholar
  18. 18.
    Emanuel MH, Verdel MJ, Wamsteker K, et al. An audit of true prevalence of intrauterine pathology: The hysteroscopic findings, controlled for patient selection in 1202 patients with abnormal uterine bleeding. Gynaecol Endosc 1995; 4: 237–241Google Scholar
  19. 19.
    Akkad AA, Habiba MA, Ismail N, et al. Abnormal uterine bleeding on hormone replacement: the importance of intrauterine structural abnormalities. Obstet Gynecol 1995; 86: 330–334PubMedCrossRefGoogle Scholar
  20. 20.
    Clevenger-Hoeft M, Syrop CH, Stovall DW, et al. Sonohysterography in premenopausal women with and without abnormal bleeding. Obstet Gynecol 1999; 94: 516–520PubMedCrossRefGoogle Scholar
  21. 21.
    Edlund M, Blomback M, von Schoultz B, et al. On the value of menorrhagia as a predictor for coagulation disorders. Am J Hematol 1996; 53: 234–238PubMedCrossRefGoogle Scholar
  22. 22.
    Kadir RA, Economides DL, Sabin CA, et al. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet 1998; 351: 485–489PubMedCrossRefGoogle Scholar
  23. 23.
    Dilley A, Drews C, Miller C, et al. Von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia. Obstet Gynecol 2001; 97: 630–636PubMedCrossRefGoogle Scholar
  24. 24.
    Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol 1996; 175: 766–769PubMedCrossRefGoogle Scholar
  25. 25.
    Chimbira TH, Anderson ABM, Turnbull AC. Relation between measured menstrual blood loss and patient’s subjective assessment of loss, duration of bleeding, number of sanitary towels used, uterine weight and endometrial surface area. Br J Obstet Gynecol 1980; 87: 603–609Google Scholar
  26. 26.
    Chapple, May C, Ling M. Is objective testing for menorrhagia in general practice practical? Results from a qualitative study. Eur J Gen Pract 2001; 7: 13–17CrossRefGoogle Scholar
  27. 27.
    Peterson HB, Xia Z, Wilcox LS, et al. Pregnancy after tubal sterilisation with bipolar elektrocoagulation. U.S. Collaborative Review of Sterilization Working Group. Obst Gynecol 1999; 94: 163–167CrossRefGoogle Scholar
  28. 28.
    Ramoska EA, Sachetti AD, Nepp M. Reliability of patient history in determining the possibility of pregnancy. Ann Emerg Med 1998; 18: 48–50CrossRefGoogle Scholar
  29. 29.
    Shaw RW, Allen I, Harper MA, et al. RCOG Evidence-based clinical guidelines. The initial management of menorrhagia. Royal College of Obstetricians and Gynaecologists; 1998.Google Scholar
  30. 30.
    Prentice A. Fortnightly review, Medical management of menorrhagia. BMJ 1999; 319: 1343–1345PubMedGoogle Scholar
  31. 31.
    Long CA. Evaluation of patients with abnormal uterine bleeding. Am J Obstet Gynecol 1996; 175: 784–786CrossRefGoogle Scholar
  32. 32.
    Sramek A, Eikenboom JCJ, Briet E, et al. Usefulness of patient interview in bleeding disorders. Arch Intern Med 1995; 155: 1409–1415CrossRefGoogle Scholar
  33. 33.
    Essed GGM, Phaff Ch, Spronken-Verschuren ThMThE, et al. Het gynaecologisch onderzoek. 2nd ed. Utrecht: Bunge; 1996.Google Scholar
  34. 34.
    Essed GGM, Nieuwenhuizen Kruseman-Smit NJM. Fysische diagnostiek – het vaginaal toucher. Ned Tijdschr Geneesk 2001; 145: 2115–2120Google Scholar
  35. 35.
    Reuss ML, Kolton S, Tharakan T. Transvaginal ultrasonography in gynecologic office practice: assessment in 633 premenopausal women. Am J Obstet Gynecol 1996; 175: 1189–1194PubMedCrossRefGoogle Scholar
  36. 36.
    Oriel KA, Schrager S. Abnormal uterine bleeding. Am Fam Physician 1999; 60: 1371–1382PubMedGoogle Scholar
  37. 37.
    Leusden H van. Diagnostisch Kompas 2003. Amstelveen: CVZ; 2003.Google Scholar
  38. 38.
    Mitchell H, Medley G, Giles G. Cervical cancers diagnosed after negative results on cervical cytology: Perspective in the 1980s. BMJ 1990; 300: 1622–1626PubMedCrossRefGoogle Scholar
  39. 39.
    Leebeek FWG, Lotgering FK. Een erfelijke hemostaseafwijking als oorzaak van menorragie. Ned Tijdschr Geneesk 2002; 146: 545–548Google Scholar
  40. 40.
    Robinson K, Giangrande P. Menorrhagia. Underlying bleeding disorders need to be ruled out. BMJ 2001; 322: 732.PubMedCrossRefGoogle Scholar
  41. 41.
    Bronz L, Suter T, Rusca T. The value of transvaginal sonography with and without saline instillation in the diagnosis of uterine pathology in pre- and postmenopausal women with abnormal bleeding or suspect sonographic findings. Ultrasound Obstet Gynecol 1997; 9: 53–58PubMedCrossRefGoogle Scholar
  42. 42.
    NVOG-richtlijn Gynaecologische echoscopie. NVOG-richtlijn nr. 27. Utrecht: Nederlandse Vereniging voor Obstetrie en Gynaecologie; 1999.Google Scholar
  43. 43.
    Flikweert S, Emanuel MH, Boukes FS, et al. Landelijke Transmurale Afspraak Vaginaal bloedverlies in de postmenopauze. Huisarts Wet 2002; 45: 129–132Google Scholar
  44. 44.
    Dijkhuizen FP, Brolmann HA, Potters AE, et al. The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities. Obstet Gynecol 1996; 87: 345–349PubMedCrossRefGoogle Scholar
  45. 45.
    Vries LD de, Dijkhuizen FP, Mol BW, et al. Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding. J Clin Ultrasound 2000; 28: 217–223PubMedCrossRefGoogle Scholar
  46. 46.
    Dijkhuizen FP, Vries LD de, Mol BW, et al. Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women. Ultrasound Obstet Gynecol 2000; 15: 372–376PubMedCrossRefGoogle Scholar
  47. 47.
    Smith P, Bakos O, Heimer G, et al. Transvaginal ultrasound for identifying endometrial abnormality. Acta Obstet Gynecol Scand 1991; 70: 591–594PubMedCrossRefGoogle Scholar
  48. 48.
    Karlsson B, Granberg S, Wikland M, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding – a Nordic multicentered study. Am J Obstet Gynecol 1995; 172; 1488–1494PubMedCrossRefGoogle Scholar
  49. 49.
    Gaucherand P, Piacenza B, Salle B, et al. Sonohysterography of the uterine cavity: Preliminary investigations. J Clin Ultrasound 1995; 23: 339–348PubMedCrossRefGoogle Scholar
  50. 50.
    Mortakis A, Mavrelos K. Transvaginal ultrasonography and hysteroscopy in the diagnosis of endometrial abnormalities. J Am Assoc Gynecol Laparosc 1997; 449–52Google Scholar
  51. 51.
    Emanuel MH, Wamsteker K, Lammes FB. Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding? Acta Obstet Gynecol Scand 1997; 76: 65–68PubMedCrossRefGoogle Scholar
  52. 52.
    Pal L, Lapensee L, Toth TL, et al. Comparison of office hysteroscopy, transvaginal ultrasonography and endometrial biopsy in evaluation of abnormal uterine bleeding. JSLS 1997; 1: 125–130PubMedGoogle Scholar

Copyright information

© Bohn Stafleu van Loghum 2007

Authors and Affiliations

  • H. de Vries
    • 1
  • N. Brendel
  • P. J. E. Bindels
    • 2
  • A. H. Blankenstein
    • 3
  • R. Barentsen
    • 4
  1. 1.afdeling Huisartsgeneeskunde en EMGO-InstituutVrije Universiteit AmsterdamAmsterdam
  2. 2.afdeling Huisartsgeneeskunde, divisie Public HealthAcademisch Medisch CentrumAmsterdam
  3. 3.afdeling Huisartsgeneeskunde en EMGO-InstituutVrije Universiteit Medisch CentrumAmsterdam
  4. 4.afdeling Gynaecologie en VerloskundeVrije universiteit Medisch CentrumAmsterdam

Personalised recommendations