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Abstract

Bleeding disorders in pre-, peri- and postmenopause

Bleeding disorders in pre-, peri- and postmenopausal patients are often clinical problems. An invasive diagnostic can be avoided by an exact anamnesis, clinical examination and vaginalsonography in combination with a progestin test in many cases. Organic causes should be excluded before a hormonal treatment starts. The exclusion of an endometrial cancer is very important in patients with postmenopausal bleedings. Premenopausal breakthrough bleedings can be effective treated by hormonal treatment. Some medical treatment options are available for therapy of heavy menstrual bleedings. The use of LNG-IUS or endometrial ablation are effective organ retaining procedures. A hysterectomy is in the most of situations not necessary. In the perimenopause we should have a special attention to the diagnostics of metrorrhagia, because a prevention of endometrial cancer by an adequate treatment is possible. Vaginalsonography is very important in postmenopause. In patients with a first episode of postmenopausal bleed-ing and sonographical thin endometrium an expectative management is possible. In risk situation and reccurent postmenopausal bleedings an invasive diagnostic is necessary to exclude an endometrial cancer. Patients suffering from bleeding disorders need a specific individualized diagnostic and treatment.

Keywords
Blutungsstörungen, Korpuskarzinom, Hormontherapie, Hysteroskopie, Endometriumablation

Thomas Römer
Evangelisches Krankenhaus Köln-Weyertal, Köln
Reviewer: Matthias David, Berlin,
und Stephan Heß, Hamburg

Römer T. Blutungsstörungen ... Gynakol Geburtsmed Gynakol Endokrinol 2018; 14(1): 86–99 publiziert 31.3.2018 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2018 ISSN 1614-8533