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Handbook of Diagnostic Endocrinology - part 10

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mũi, thận trọng để đo lường thời gian prothrombin, thời gian kích hoạt một phần thromboplastin, và thời gian chảy máu ở những bệnh nhân với menometrorrhagia cung cấp cho một lịch sử cá nhân hoặc gia đình có xu hướng chảy máu tăng hoặc có biểu hiện xuất huyết menarcheal. | 314 Tortoriello and Hall fore prudent to measure the prothrombin time the activated partial thromboplastin time and the bleeding time in patients with menometrorrhagia who give a personal or family history of increased bleeding tendencies or who present with menarcheal hemorrhage. Hypothyroidism is also an infrequent cause of menorrhagia and a clinical and laboratory assessment of thyroid function should be performed. The most common cause of heavy or unexpected vaginal bleeding in the reproductive years is pregnancy related. A serum P-human chorionic gonada-tropin hCG should be performed to assess pregnancy status and if positive an endovaginal ultrasound should be performed in concert with the pelvic examination to help ascertain the location and viability of the pregnancy. The endometrial cavity must be assessed in nonpregnant patients with persistent abnormal bleeding. Uterine lesions such as endometrial polyps or leiomyomata with intracavitary or submucous locations frequently produce menorrhagia or menometrorrhagia. Adenomyosis often induces an enlarged globular uterus prone to excessive and painful menstruation. The mechanisms underlying these abnormal bleeding patterns require further elucidation but may involve increased endometrial surface area or a diminished ability of the distorted uterine body to contract upon itself. Intermenstrual or heavy prolonged bleeding in perimenopausal or anovulatory premenopausal women should arouse the suspicion of carcinoma. The diagnosis is frequently delayed unnecessarily because the bleeding is commonly ascribed to benign hormonal fluctuations. Indeed the mean age of presentation for cervical carcinoma is 52 the age at which most women are experiencing the menopausal transition. Squamous cell carcinoma of the cervix generally presents with light bleeding or postcoital spotting while endometrial adenocarcinoma generally presents with heavier and more irregular bleeding. Any factor that increases exposure to unopposed .