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Peri- and Postmenopausal Abnormal Bleeding

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Book cover Comprehensive Management of Menopause

Abstract

The climacteric is a period during which women experience many new symptoms. One of the most important clinically is a modification in the pattern of menses. In this chapter, we focus on peri- and postmenopausal abnormal bleeding. Definitions are given and physiopathology, differential diagnosis, investigation, and treatment are discussed. A brief review of the potency of the different progestogens is also provided.

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Reference

  1. Christopher Nordin BE, Morris HA, Need AG, Horowitz M, Robertson WG. Relationship between plasma calcium fraction other bone related variables, and serum follicle-stimulating hormone levels in premenopausal, perimenopausal, and postmenopausal women. Am J Obst Gynecol. 1990; 163: 140–145. 15.

    Google Scholar 

  2. Tsonis CB, Messinis IE, Templeton AA, McNeilly AS, Baird DT. Conadotropic stimulation of inhibin secretion by the human ovary during the follicular and early luteal phase of the cycle. J Clin Endocrinol Metab. 1988; 66: 16. 915–921.

    Article  PubMed  CAS  Google Scholar 

  3. Koutsilieris M, Michaud J, Nikolis, A. Preferential mitogenic activity for myoblast-like cells can be extracted from uterine leiomyoma 17. tissues. Am J Obste Gynecol. 1990: 163: 1665 1670.

    Google Scholar 

  4. Azziz R. Adenomyosis: current perspectives. Obstet Gynecol Clin Am. 1990;16(1):221235.

    Google Scholar 

  5. Urabe M, Yamamoto T, Ktawaki J, Honjo H, Okada H. Estrogen biosynthesis in human 19. uterine adenomyosis. Acta Endocrin. 1989; 121 (2): 259–264.

    CAS  Google Scholar 

  6. Robbins S, Cotron RD, Kumarv. Pathologic 20. Basis of Disease. Philadelphia: WB Saunders; 1984: 1135–1136.

    Google Scholar 

  7. Corley D, et al. Post menopausal bleeding from unusual endometrial polyps in woman and chronic tamoxifen therapy. Obstet Gynecol. 1992; 79 (1): 111.

    PubMed  CAS  Google Scholar 

  8. Bemtrac MBB, Warren T, Kable MD, Gallagher JC. Histology and bleeding patterns in menopausal women treated with estrogen and continuous or cyclic progestin. J Repro Med. 1988; 33 (2): 205.

    Google Scholar 

  9. Maheux R, Lemay A. Treatment of perimenopausal women: potential long term therapy with a depot GnRh agonist combined with hormonal replacement therapy. Br J Obs Gyn. 1992; 99: 7.

    Google Scholar 

  10. Montemagno U, De Placido G, Colacurci N, et al. Endometrial effects of danazol in perimenopausal abnormal bleeding. Ann NY Acad S c i. 1991; 622: 283–290.

    Article  CAS  Google Scholar 

  11. Marion A, Van Ejikeren, Godelieve CML, et al. Effects of Mefanic acid on menstrual hemostasis in essential menorrhagia. Am J Obste Gynecol. 1992; 166 (5): 1419–1428.

    Google Scholar 

  12. Gannon M, et al. A randomized trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia. BMJ. 1991; 303: 1362–1364.

    Article  PubMed  CAS  Google Scholar 

  13. Derman S, et al. The long term effectiveness of hysteroscopic treatment of menorrhagia and leiomyomas. Obstet Gynecol. 1991; 77: 591–594.

    PubMed  CAS  Google Scholar 

  14. Jacobs I, Oram D. Prevention of ovarian cancer: a survey of the prophylactic oophorectomy by fellows and members of the Royal College of Obstetricians and Gynecologist. Br J Obstet Gynecol 1989; 96: 510.

    Article  CAS  Google Scholar 

  15. Speroff T, Dawson N, Speroff L, Haber, RJ. A risk-benefit analysis of elective bilateral oophorectomy; effect of changer in compliance with estrogen therapy on outcome. Am J Obst Gynecol. 1991; 164: 165–74.

    CAS  Google Scholar 

  16. Kerlikowke K, Brown JS, Grady DG. Should women with familial ovarian cancer undergo prophylactic oophorectomy? Am J Obstet Gynecol. 1992; 80 (4): 700–707.

    Google Scholar 

  17. Whitehead M, Godfree V. Hormone replacement therapy, your questions answered. Churchill Livingston. 1992: 172.

    Google Scholar 

  18. Hill G, et al. Comparison of late luteal phase endometrial biopsies using the Novak curette or Pipelle endometrial suction curette. Obstet Gynecol. 1989; 73: 443–445.

    PubMed  CAS  Google Scholar 

  19. Archer DF, et al. Endometrial morphology in asymptomatic postmenopausal women. Am J Obstet Gynocol. 1991; 165: 317–322.

    CAS  Google Scholar 

  20. Paganini-Hill A, et al. Endometrial cancer and patterns of use of oestrogen replacement: a cohort study Br J Cancer. 1989; 59: 445–447.

    CAS  Google Scholar 

  21. Leather AT, et al. Endometrial histology bleeding patterns after 8 years of continuous combined estrogen and progestogen therapy in postmenopausal women. Obstet Gynecol. 1991; 78: 1008–1010.

    PubMed  CAS  Google Scholar 

  22. Bunin N, et al. Endometrial adenocarcinoma in breast cancer patients receiving antiestrogens. Cancer Treat Rep. 1985; 69: 237–238.

    Google Scholar 

  23. Fornander T, et al. Adjuvant Tamakifen in early breast cancer: occurence of new primary cancers. Lancet. 1989; 117–120.

    Google Scholar 

  24. Lin M, et al. Endometrial thickness after menopause: effect of hormone replacement. Radiology. 1991; 180: 427–432.

    PubMed  CAS  Google Scholar 

  25. Granberg S, et al. Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormality. Am J Obstet Gynecol. 1991; 164: 47–52.

    PubMed  CAS  Google Scholar 

  26. Nasri MN, Coast GJ. Correlation of ultra-sound findings and endometrial histopathology in postmenauposal women. Br J Obst Gynecol 1989; 96: 1333–1338.

    Article  CAS  Google Scholar 

  27. Grunfeld L, et al. High-resolution endovaginal ultrasonography of the endometrium: a noninvasive test for endometrial adequacy. Obstet Gynecol. 1991; 78: 200–204.

    PubMed  CAS  Google Scholar 

  28. Osmers R, et al. Vaginosonograophy for early detection of endometrial carcinoma? Lancet. 1990; 335: 1569–1571.

    Article  PubMed  CAS  Google Scholar 

  29. Parlson J, Anger PMD, Thomson S, Carlson EJ. Clinical and Pathologic correlation of endometrial cavity fluid detected by ultra-sound in the postmenopausal patient. Obstet Gynecol. 1991; 77: 119.

    Google Scholar 

  30. Scoutt LM, McCarthy SM. Applications of magnetic resonance imaging to gynecology. Topics MRI. 1990; 2 (3): 37–49.

    CAS  Google Scholar 

  31. Loffer F Hysteroscopy with selective endometrial sampling compared with D & C for abnormal uterine bleeding: the value of a negative hysteroscopic view. Obstet Gynecol. 1989;73:16–20.

    PubMed  CAS  Google Scholar 

  32. Bryjalsen I, et al. The measurement of secretory endometrial protein PP14 in serum from postmenopausal women receiving unopposed estrogen or continuously combined estrogen/ progestogen. Gynecol Endocrin. 1989; 3: 143–152

    Article  Google Scholar 

  33. Bryjalsen I, et al. Sequential estrogen and progestogen therapy assessment of progestational effects on the postmenopausal endometrium. Obstet Gynecol. 1992; 79: 523–528.

    Google Scholar 

  34. Tin-Chiu L, et al. An analysis of the variation of plasma concentrations of placental protein 14 on artificial cycles. Fertil Steril, 1992; 57: 776–787.

    Google Scholar 

  35. Gambrel RD, et al. Use of the progestogen challenge test to reduce the risk of endometrial cancer. Obstet Gynecol. 1980; 55: 732–738.

    Google Scholar 

  36. Hargrove, et al. Menopausal hormone replacement therapy with continuous daily micronized estradiol and progesterone. Obstet Gynecol. 1979; 73: 606–612.

    Google Scholar 

  37. Mattsson LA, et al. Evaluation of a continuous oestrogen progestogen, regimen for climacteric complaints. Maturitas. 81; 3: 145–156.

    Article  Google Scholar 

  38. Weinstein, L. Efficacy of a continuous estrogen-progestin regimen in the menopausal patient. Obstet Gynecol. 87; 69: 929–932.

    PubMed  CAS  Google Scholar 

  39. Hargrove J, et al. Menopausal hormone replacement therapy with continuous daily and micronized estdradiol and progesterone. Obstet Gynecol. 1989; 73: 606–612.

    PubMed  CAS  Google Scholar 

  40. King R, Whitehead M. Assessment of the potency of orally administered progestins in women. Fertil Steril. 1986; 46: 1062–1066.

    PubMed  CAS  Google Scholar 

  41. Kauppila A, et al. Postmenopausal hormone replacement therapy with estrogen periodically supplemented with antiestrogen. Am J Obstet Gynecol. 1981; 140: 787–792.

    PubMed  CAS  Google Scholar 

  42. Marslew U. Bleeding pattern during continuous-combined estrogen-progesterone therapy. Am J Obstet Gyneol. 91; 164: 1163–1168.

    CAS  Google Scholar 

  43. Gordon MG, Williams SR, Frenchek B, et al. Dose-dependent effects of postmenopausal estrogen/progestin on antithrombin III and factor XII. J Lab Clin Med. 1988; 111: 52.

    PubMed  CAS  Google Scholar 

  44. Krailo MD, Pike MC. Estimation of the distribution of age of natural menopause from prevalence data. Am J Epidemiol. 1983; 117: 356.

    PubMed  CAS  Google Scholar 

  45. Melis GB, Fruzzetti F, Nicoletti I, et al. A comparative study on the effects of a monophasic pill containing desogestrel plus 20 ug ethinylestradiol, a triphasic combination containing levonorgestrel and a monophasic combination containing gestodene on coagulatory factors. Contraception. 1991; 43: 23.

    Article  PubMed  CAS  Google Scholar 

  46. Stampfer MJ, Wilett WC, Colditz GA, et al. Past use of oral contraceptives and cardiovascular disease: A meta-analysis in the context of the nurse’s health study. Am J Obstet Gynecol. 1990; 163: 285.

    PubMed  CAS  Google Scholar 

  47. Chen KTK, Schooley JL, et al. Peritoneal carcinomatosis after prophylactic oophorectomy in familial ovarian cancer syndrome. Obstet Gynecol. 1985; 665: 93–94.

    Google Scholar 

  48. Kerlikowske K, Brown JS, et al. Should women with familial ovarian cancer undergo prophylactic oophorectomy? Obstet Gynecol. 1992; 80: 700–707.

    PubMed  CAS  Google Scholar 

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© 1994 Springer-Verlag New York, Inc.

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Lorrain, J., Ravnikar, V.A., Charest, N. (1994). Peri- and Postmenopausal Abnormal Bleeding. In: Lorrain, J., Plouffe, L., Ravnikar, V.A., Speroff, L., Watts, N.B. (eds) Comprehensive Management of Menopause. Clinical Perspectives in Obstetrics and Gynecology. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-4330-4_23

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  • DOI: https://doi.org/10.1007/978-1-4612-4330-4_23

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-8737-7

  • Online ISBN: 978-1-4612-4330-4

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