Managing menstruel disorders in primary care
Abnormal uterine bleeding (AUB) is one of the most common gynecological complaints in clinical practice, effecting 30% of women throughout life. Approximately 2/3 of AUB occurs because of organic reasons. The remaining 1/3 are classified as dysfunctional uterine bleeding (DUB) and are common reasons for uterine bleeding after menarche. When left untreated, DUB can cause serious problems such as deep anemia and heart failure. The role of the family physician is important in the follow-up and treatment of bleeding pathologies which may be the first symptom of genital cancer. DUB is diagnosed when organic pathologies are excluded. 90% of DUB are anovulatory; 90% can be treated with medical treatment. Ovulatory DUB usually heal spontaneously and are resistant to medical treatment. The most commonly used agents in DUB are progestins. Most can be treated with combined oral contraceptives (COCs), hormonal therapy and nonsteroid antinflammatory drugs (NSAIDs). The family physician should be aware that AUB can be encountered at least a few times in the life of women from menarche to menopause, be able to make differential diagnosis and administer first-line treatments, to offer the patient different treatment choices and treatment plans, to protect the patient from prolonged bleeding, to prevent recurrence and, if necessary refer the patient to a specialist in secondary –tertiary care centres.
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