Dijagnostika i liječenje nenormalnih uterinih krvarenja u juvenilnom razdoblju

master's thesis

• Title (english): Diagnostics and treatment of abnormal uterine bleeding in the juvenile period
• Author: Ena Vučković
• Mentor: Marina Šprem Goldštajn (mentor)
• Committee member: Lana Škrgatić (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Marina Šprem Goldštajn (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Svrha ovog rada je pregled trenutno dostupnih spoznaja vezanih uz dijagnostiku i liječenje nenormalnih uterinih krvarenja u juvenilnom razdoblju. Nenormalna uterina krvarenja jedan su od najčešćih ginekoloških problema koji pogađa žene svih dobnih skupina, a posebno su česta u ekstremima reproduktivne dobi. Juvenilno razdoblje, koje obuhvaća osjetljive periode djetinjstva i adolescencije, zanemareno je u službenim dijagnostičkim i terapijskim smjernicama svjetskih ginekoloških društava zbog fizioloških razlika u odnosu na odraslu dob te nedostatka istraživanja provedenih na djevojčicama i adolescenticama. Unatoč tome što je prevalencija nenormalnih uterinih krvarenja u adolescentica veća u odnosu na odrasle žene, trenutno korištene metode dijagnostike i liječenja oslanjaju se većinom na iskustva stečena na odrasloj populaciji. Razlika u učestalosti pojedinih uzroka ovih krvarenja u različitim starosnim skupinama utječe na algoritam njihovog zbrinjavanja. Premenarhalna krvarenja su rijetka i najčešće ih uzrokuju strana tijela, trauma te infekcije, a postmenarhalna krvarenja, u podlozi kojih su većinom nestrukturni uzroci, relativno su česta. Tako dijagnostika nenormalnih uterinih krvarenja u juvenilnom razdoblju najvećim dijelom počiva na detaljnoj anemnezi i laboratorijskoj obradi, dok će fizikalni pregled i slikovne metode pomoći u dijagnozi nekih manje čestih uzroka. Temelj liječenja i akutnih i kroničnih krvarenja predstavljaju hormonski preparati estrogena i progestagena, od kojih prvu liniju čine kombinirani oralni kontraceptivi. Uz hormonsko liječenje, od lijekova se koriste NSAID, hemostatici i GnRH agonisti, a kirurške metode krajnja su terapijska opcija za ove dobne skupine. Ciljevi liječenja uključuju zaustavljanje krvarenja, uspostavljanje pravilnih menstrualnih ciklusa, liječenje osnovne bolesti i saniranje posljedica krvarenja, u prvom redu anemije.

Abstract (english)

The purpose of this thesis is to review the current knowledge concerning diagnostics and treatment of abnormal uterine bleeding in the juvenile period. Abnormal uterine bleeding is one of the most common gynaecological concerns affecting women of all ages, particularly common at the extremes of reproductive age. Juvenile period, encompassing vulnerable ages of childhood and adolescence, is neglected in official diagnostic and therapeutic guidelines of international gynaecological organisations due to physiological differences compared to adulthood and a lack of studies involving girls and adolescents. Although the prevalence of abnormal uterine bleeding in adolescents surpasses that in adult women, methods of diagnostics and treatment currently in use rely heavily on experiences acquired with adults. The difference in frequency of particular causes of uterine bleeding in different age groups affects the management algorithm. Premenarcheal bleeding is rare, mostly caused by foreign bodies, trauma, and infections, while postmenarcheal bleeding, caused by non-structural entities, is relatively common. Therefore, the diagnosis of abnormal uterine bleeding in the juvenile period depends largely on detailed medical history and laboratory evaluation, while physical examination and imaging methods may help with the diagnosis of some of the less common causes. The basis of treatment of both acute and chronic bleeding is hormone therapy using estrogens and progestogens, with first-line option being combined oral contraceptives. In addition to hormonal treatment, medications used involve NSAIDs, haemostatics, and GnRH agonists, while surgical procedures mark the final therapeutic option in these age groups. The aims of treatment include cessation of bleeding, establishment of regular menstural cycle, treatment of underlying disease, and management of consequences, namely anaemia.

• Keywords: nenormalna uterina krvarenja; juvenilno razdoblje; dijagnostika; liječenje
• Keywords (english): abnormal uterine bleeding; juvenile period; diagnostics; treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:280962
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-03-23 08:51:54