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141DOI: 10.24411/2181-0443/2020-10123
ДИАГНОСТИКА, ЛЕЧЕНИЕ И ПРОФИЛАКТИКА ГИНЕКОЛОГИЧЕСКИХ
ЗАБОЛЕВАНИЙ
Соатова Наргиза Эргашалиевна Эргашева Зумрад Абдукаюмовна Назиржонов Орифхужа Хусанхужауг.ли Нугманов Озодбек ЖурабойуFли
Андижанский государственный медицинский институт
Профилактика заболеваний в гинекологии может быть улучшена за счет улучшения здоровья и лучшего понимания лечения заболеваний. Описательный анализ исследования был проведен в нескольких статьях, опубликованных в медицинских журналах и книгах. Прогнозировать и планировать, организовывать, командовать, координировать и управлять. Если мы введем следующее определение в смысле медицинской науки и применим его в медицинской практике, можно будет распознавать, управлять и решать проблемы диагностики и лечения заболеваний (в данном случае гинекологических заболеваний) в соответствии с определенными руководящими принципами и алгоритмами лечения.означает методы.
Ключевые слова: Репродуктивная, первичная профилактика, вторичная профилактика.
GINEKOLOGIK KASALLIKLARNING DIAGNOSTIKASI, DAVOLASH VA OLDINI OLISH
Ginekologiya bu ayollarning reproduktiv tizimi kasalliklarin idavolash, diagnostikava oldini olish vazifalarini bajaruvchi mutaxassislik. Ginekologiya dakasalliklarning oldini olish sog'liqni saqlashni yaxshilash va kasalliklarni boshqarishni yaxshiroq tushunish orqali yaxshilanish imumkin. Tibbiy jurnallarda va kitoblarda chop etilgan bir necht amaqolalarda ilmiy tadqiqotlar bo'yicha tavsifiy tahlil o'tkazildi. Oldindan taxmin qilish va rejalashtirish, tartibga solish, buyruq berish, muvofiqlashtirish va boshqarish. Agar biz tibbiyot ilmi ma'nosida quyidagi ta'rifni joriy etsak va un itibbiyotamaliyotidaqo'llasak, bu ma'lum ko'rsatmalar va davolash algoritmlariga muvofiq kasalliklarni (buholdaginekologikkasalliklarni) diagnostika va davolash masalalarini tanib olish, boshqarish va hal qilish usullarini anglatadi.
Kalitso'zlar: Reproduktiv, birlamchiprofilaktika, ikkilamchiprofilaktika.
DIAGNOSIS, TREATMENT AND PREVENTION OF GYNECOLOGICAL DISEASES
Gynecology is the treatment, diagnosis and prevention of diseases of the female reproductive system. Prevention of diseases in gynecology can be improved by better understanding of health promotion and management of diseases. A descriptive analysis was performed on scientific studies in several published articles in medical journals and books. Anticipate and plan, organize, command, coordinate and control. If we introduce the following definition in the sense of medical science and apply it to the medical practice that would mean way of recognizing, managing and resolving issues of diagnosis and therapy of diseases (in this case gynecology diseases) according to certain guidelines and treatment algorithms.
Keywords: Reproductive, primary prevention, secondary prevention.
Introduction: Gynecology is the medical practice dealing with the female reproduction health. The most common gynecological diseases are infectious. Infections can have a negative impact on different areas of the female reproductive system, hence the different symptoms for the same diseases. The gynaecological diseases affect the reproductive organs such as uterus, ovaries, fallopian tubes, external genitalia and breasts of a woman
and thus it may affect her body's sexual functions too. Therefore, it is important to acknowledge the symptoms and act promptly to avoid the complications. Symptoms of gynecological diseases may be vaginal discharge, genital itching, frequent urination, pain during intercourse. Also, inflammation is often a fever. As every women knows, there could be myriad gynecological conditions. A lot of the time, women tend to ignore symptoms of gynecological diseases or
any kind of infection. There are many other gynecological disorders found in women especially after marriage that need to be timely diagnosed cured to avoid major problems. Lifestyle related diseases - Auto-immune diseases like hypertension, diabetes, thyroid, obesity are very common these days that leads to the hormonal imbalance weakness inside the body which makes a female body more prone to gynecological disease. So there are a lot of gynecological diseases and in this article we will discuss them briefly.
According to a group of scientists [1]: Generally, RNAs which are transcribed from the non-coding parts of the genome can be classified into three classes: housekeeping RNAs, transfer RNAs, and regulatory RNAs. MicroRNAs (miRNAs) are a kind of small regulatory RNAs and are approximately consist of 22 nucleotides [2,3]. RNA polymerase II transcripts these single-stranded RNAs from DNA, then they get processed in the nucleus and after moving to cytoplasm, their maturation starts [4]. MiRNAs after completing the maturation process by Dicer (RNase III) [5], bind to some proteins and produce a ribonucleoprotein complex which is involved in silencing the genes and because of that it's called RNA-induced silencing complex (RISC) [3]. miRNA binds to the 3' untranslated region of the target mRNA and takes its part as a down-regulator for gene expression by inhibiting the starting of translation or by deterioration of mRNA [6]. Because of this important function of miRNAs', they are involved in some crucial processes including: maintenance of stem cells, developmental timing, metabolism, the interaction between a virus and its host, apoptosis, proliferation of the cardiac and skeletal muscular cells and expression of the genes related to neuronal system [7,8].Every month through the menstrual period, endometrium gets prepared for the implantation of embryo by the means of bearing a class of biological alterations.
Inflammatory reactions, programmed cell death, proliferation of the cells, angiogenesis, tissue formation or differentiation, and remodeling of the tissues are some examples of the engaged processes in altering the endometrium. These processes are regulated by two elements: sex steroids secreted from ovaries and products of the expression of the local genes. There are also some other regulators which their secretion can be autocrine or paracrine and include several growth factors, cytokines, chemokines, proteases, and extracellular matrix [9-12]. Because of the precise expression of this significant regulators, any disturbance can cause an improper regeneration in the endometrium tissue and this may lead to some other abnormalities such as endometriosis [9].Endometriosis is a condition known by ectopic endometrial glands and stroma which has a dependency to estrogen and is counted as an inflammatory disorder. These ectopic glands and stroma are frequently found in pelvis but there are some other locations in which they have been observed: the bowel, diaphragm, umbilicus, and pleural cavity.According to evidence, three subtypes are observed for endometriosis: superficial injuries in peritoneal area, deep penetrating wounds, and cysts or endometriomas which are consist of blood and endometrium-like tissue [13]. Dysmenorrhea, pelvic pain, urinary tract symptoms, and rectal bleeding are some symptoms by which endometriosis is diagnosed [14]. Endometriosis, by dint of hormonal induction, stimulation of neural pathways, inflammatory processes, and local bleeding, is able to cause pain but the exact mechanisms are not clear [13]. One of the most important causes of endometriosis is infertility. According to the researches, 25-50% of women with infertility are diagnosed with endometriosis and also 30-50% of women with endometriosis are estimated to be infertile [15]. It is also worth to mention that some studies declared that
some of the lesions caused by endometriosis, especially the ovarian ones, appear to be monoclonal and being monoclonal is commonly known as a hallmark for neoplasia [16]. Therefore, endometriosis, because of its unfavorable impacts on quality of life, work productivity, and fertility status, is an important disorder among the women in reproductive age [17]. In this review we gathered a great amount of evidence to inquire into the role of micro RNAs in inducing apoptosis and how this mechanism can be exerted for therapeutic purposes for endometriosis. Generally, we put the name of endometriosis on an infammatory estrogen-dependent
condition in which endometrial-like tissues are found in some places other than its real position. Till now, scientists have not come to an agreement about the mechanism by which this condition is caused. Some researchers have come up with some theories such as retrograde menstruation, coelomic metaplasia, and genetic alterations but still, further investigations are needed for clarifying the exact mechanisms. Observing the volume of blood and fragments of endometrial tissue which is refuxed during a menstrual period in women with endometriosis led to the retrograde menstruation theory. According to this theory, these retreated endometrial fragments can be implanted into some other site than uterine and then grow into an ectopic endometrial-type tissue. In another theory, the reason of this ectopic tissue's production is mainly attributed to metaplasia of the coelomic epithelium which itself is caused by environmental factors. As well, some scientists believe that the anatomical position of uterine, lymphatic or hematogenous spread of endometrial-related cells, and some other factors such as proton irradiation and dioxin might play a role in pathogenesis of endometriosis. In the immunity point of view, there is also a theory regarding the role of defcient immunity in endometriosis. Haptoglobin and
monocyte chemoattractant protein 1 are two agents that might take part in causing endometriosis. In addition, some evidence accounts the abnormal B cell, T cells, or natural killer cells as the responsible factor for this gynecological disease. Moreover, infammation caused by increased amounts of prostaglandins and cytokines is another possible reason that causes endometriosis. In addition, Arvanitis et al. showed the relationship between CYP1A1, CYP19, GSTM1, and GSTT1 polymorphisms and endometriosis [18-23].
For years, scientists thought that 98% of our DNA was junk and not useful at all [24] but discoveries about the functions of RNAs transcribed from the non-coding parts of DNA made a revolution in our therapeutic and diagnostic approaches for many diseases. miRNAs are a kind of small non-coding RNAs which are known to have many parts in cellular processes (including apoptosis, cell proliferation, and infammation) by regulating the gene expression. Hence, their contribution in pathogenesis of many diseases such as endometriosis is proven. Endometriosis is a gynecological disorder among the women in reproductive age that might lead to cancer (in a very low percentage of women) and is also an important disease for causing several health problems such as infertility. Accumulative evidence has demonstrated the role of cell proliferation, apoptosis, and invasion in the progression of these diseases. In this review, we looked into the specifc role of apoptosis and its related genes and pathways in endometriosis and tied to present an explanation of how miRNAs can afect endometriosis by their apoptotic activities. Many miRNAs are involved and they are responsible for repressing apoptosis and progression of the disease. As a result, these miRNAs have the potential to be used in diagnostic and therapeutic decisions adopted for endometriosis. In the feld of diagnosis, the current gold standard method for
endometriosis is using surgery (laparoscopy) and direct observation [25]. Hence, miRNAs have the potential to be an ideal replacement for this dangerous and high-risk approach and plus, they can act more efcient for early detection of endometriosis. Although considering the many roles and functions that miRNAs have in cellular pathways, more investigations are needed for revealing their side efects after administration. Furthermore, fnding proper delivery systems which are able to increase the stability of miRNAs, protect them against degradation inside the body, and deliver them to the specifc site of the disease are needed.
Venous thromboembolism (VTE) refers to the formation of blood clots (thrombus) in the veins, most commonly in the deep veins of the lower extremities or pelvis, namely, deep vein thrombosis (DVT); when the thrombus is dislodged and travels to the pulmonary artery, pulmonary embolism (PE) occurs. The main adverse consequences of VTE are PE and post-thrombotic syndrome (PTS), which may significantly affect the quality of life of patients and even lead to death. VTE has become a public health threat worldwide. Studies have shown that the annual incidence of VTE is more than 10 million people globally, and it is the third most common cardiovascular disease after myocardial infarction and stroke. VTE is also a potentially fatal perioperative complication of major pelvic or abdominal surgery. Meanwhile, studies have shown VTE is one of the most frequent complications in patients with gynecological cancer, with an incidence ranging from 3% to 25%. The incidence of VTE is even higher in patients undergoing surgery for gynecological malignancy. Studies reported that the incidence of postoperative DVT in patients with gynecological malignancies was 12% to 33% and that of perioperative DVT was 19.6% to 38%. The risk factors for VTE may include primary and secondary
factors according to the well-known "triad" theory of venous thrombosis proposed by the German medical scientist Rudolf Virchow, i.e., blood stagnation, hypercoagulability, and vascular endothelial injury. Consequently, it is critical to identify relevant risk factors, especially reversible or modifiable risk factors, which may guide the development of prevention and treatment strategies for VTE. Caprini, refined and popularized by Caprini and colleagues, is the most widely used VTE risk assessment tool in surgery patients. However, the Caprini score was not developed in a gynecologic oncology patient population, and its validity in this population is unknown. A study has shown that Caprini is limited in its ability to discriminate the relative VTE risk among gynecologic oncology patients. Meanwhile, studies have reported that in clinical practice, VTE can still occur in patients with Caprini scores of 3 or higher despite the use of postoperative thromboprophylaxis, such as low molecular weight heparin (LMWH) injection and other mechanical prevention measures. To date, standard evaluations of postoperative VTE in patients with gynecological malignant tumors and research on appropriate monitoring methods are scarce. Therefore, it is imperative to develop targeted and effective prevention strategies based on the risk factors for VTE. Although there are many studies on the risk factors related to the occurrence of perioperative VTE in patients with gynecological malignancies, the findings of existing studies are diverse or even contradictory. For the risk factors for perioperative VTE in patients with gynecological malignancy, no formal systematic review or meta-analysis has been performed so far [26].So, after research, this group of scientists came to the following conclusion: The risk factors for perioperative VTE in patients with gynecological malignancy may include advanced age, BMI > 26 kg/m2 , increased
platelet count, elevated D-dimer level, long duration of surgery, long time in bed after surgery, long-term hospital stay, large amount of intraoperative blood loss, tumor differentiation (GREAD3), tumor staging (stage IV), and operative approach (laparotomy). For perioperative patients with gynecological malignancy, it is important to individualize the assessment regimen, taking into account the characteristics of each patient and their malignancy, and then to develop targeted prophylactic strategies to minimize the risk of VTE during the perioperative period [26].
A specific intrauterine mass, formed from residues of placental tissues after a miscarriage, abortion, or childbirth, is a placental polyp of the endometrium. On the remaining tissues of the placenta, which is tightly attached to the uterus, blood clots settle, which form the growth of a benign character. According to medical statistics, about 10% of women face this problem.The main cause of placental growth is the retention of chorionic tissue in the uterine cavity. There are also a number of factors that increase the risk of developing this pathology: Death of the fetus in the womb; Medical or classic abortion, miscarriage with incomplete removal of the attachment site of the ovum; Incomplete removal of the placenta after cesarean section; Improper maintenance of the postpartum period.In some cases, the placental neoplasm occurs during pregnancy, but is not dangerous for the mother and fetus. It is formed from the tissue of the placenta or fetal membranes and excreted from the body during labor [27].The diagnosis is usually established with a colonoscopy. Irrigoscopy, especially double contrasting, is informative, but colonoscopy is preferable because of the possibility of removing polyps during the study. Since the polyps of the rectum are often multiple and can be combined with cancer, complete colonoscopy to the caecum is necessary, even if the lesion of
the distal intestine is detected by a flexible sigmoidoscope. The polyp of the intestine should be completely removed by means of a loop or electrosurgical biopsy forceps during a total colonoscopy; complete removal is especially important for large villous adenomas, which have a high malignancy potential. If the colonoscopic removal of the polyp is impossible, laparotomy is indicated. The subsequent treatment of the intestinal olive depends on the histological evaluation of the neoplasm. If the dysplastic epithelium does not penetrate the muscular layer, the line of resection along the polyp stalk is clearly visible, the formation is clearly differentiated, then an endoscopic removal is performed, which is quite sufficient. With a deeper germination of the epithelium, fuzzy line of resection or poor differentiation of the lesion, segmental resection of the large intestine is necessary. Since the invasion of the epithelium through the muscular layer provides access to the lymphatic vessels and increases the potential for metastasis to the lymph nodes, such patients need to undergo further examination (as in colon cancer, see below).The definition of subsequent studies after polypectomy is controversial. Most authors recommend conducting a total colonoscopy every year for 2 years (or irrigoscopy, if total colonoscopy is not possible) with the removal of newly discovered formations. If two annual studies do not reveal new formations, a colonoscopy is recommended 1 time in 2-3 years [28]. The diagnosis is made in the study using mirrors. However, if the symptoms persist after treatment, it is necessary to take swabs for atypical cells from the cervical canal and perform an endometrial biopsy to exclude the corresponding cancer. Polyps of the cervical canal are excised outpatiently without anesthesia. Bleeding after removal is rare, and it can be stopped by chemical cauterization [29].
The peculiarity of the female reproductive system is that its organs are mostly inside the body and are hidden from the eyes of even the woman herself. If pathological processes begin in the ovaries, vagina, uterus or fallopian tubes, they do not necessarily immediately manifest themselves. The penetration of a bacterial or viral infection and inflammatory processes in the internal genital organs can make their debut with pains and unusual secretions, and may also proceed secretly. But the attachment of papillomavirus infection in most cases complicates the course of the disease no less than the presence of chlamydia, mycoplasma and other pathogens that support the inflammatory process. It must be said that the likelihood of contracting the papilloma virus in people of reproductive age of the same sex is the same. But the consequences of such infection in women and men are different [30]. The fact that female reproductive organs are located inside the body and their surface is covered with a tender mucous membrane, the penetration of which in depth does not represent complexity for virions, leads to the fact that the virus does more harm to the weaker sex. Plus, hygiene procedures on internal organs are hampered, and natural cleansing of the uterus and vagina is not able to completely remove the virus that enters the cells. In viral pathology, women are more likely to get bacterial infections, which further weaken the body, because for them the warm and moist environment of the vagina is truly an idyll for life and reproduction, if only the immune system allowed such living. For example, cervical erosion, as one of the most frequently diagnosed pathologies during a gynecological examination, may not give specific symptoms. In 90% of cases a woman learns about her diagnosis after another gynecological examination on the chair, because only so the doctor can assess the condition of the organs of the reproductive system of a woman. In some
women with the appearance of an erosive-inflammatory focus, natural physiological excretions increase. But if they do not have an unpleasant smell and a suspicious yellowish-greenish color indicating the presence of pus, the lady may not particularly worry about them, writing off everything for hypothermia and lowering immunity [31]. Much less likely to have damage to the mucous uterus at the entrance to the cervical canal can speak discomfort during intercourse, a feeling of heaviness in the lower abdomen, the appearance of bloody veins in the physiological discharge from the vagina outside the menstrual period. If there are pain in the lower abdomen, the menstrual cycle is broken, whites with an unpleasant smell appear, then it is not so much about the erosion itself as about the inflammatory process provoked by the activation of opportunistic microorganisms in the lesion. But it is possible that inside the female womb penetrated and pathogens (the same chlamydia or viruses). In women with chronic erosion, in most cases, analysis shows the presence of HPV virions. It does not have to be highly oncogenic types of the virus. Usually a mixed microflora is detected: conditionally pathogenic microorganisms, mycoplasma, ureaplasma, chlamydia, papilloma viruses (usually from one to four varieties), herpes viruses. To determine the contribution of each pathogen in the maintenance and development of the inflammatory process in the affected area is not easy, but it must be said that their presence always complicates the situation and contributes to increasing erosion in size. A long-term erosive process at some point may change its nature and, in addition to inflammation in the affected area, the doctor should notice the proliferation of mucosal tissues (cervical dysplasia). It must be said that one of the main factors provoking this process is considered to be papillomavirus infection. Erosive foci are the most vulnerable places on the mucous membrane of the
uterus and the vagina, so it is much easier for the virus to penetrate into the tissues of the organs, then into the cells. If high-oncogenic types of papilloma virus ( HPV 18 and 16) are detected in smears, in addition to dysplastic processes, which are benign tumors, one can expect the degeneration of individual tumor cells into malignant ones. After all, the change in the properties of the host cell is embedded in the genome of highly ionic virions, and the behavior of such mutated cells is no longer controlled by the immune system. It is difficult to say whether the papilloma virus itself can cause erosion of the cervix (if this happens, it will not be soon). But to provoke dysplastic processes it is quite capable even in the absence of an erosive process, having penetrated into microdamages on the mucous membrane of the uterus and the vagina, which can arise after abortions, active sexual intercourse, be the result of frequent and erratic sexual contacts. In this case dysplasia will proceed without any symptoms for a very long time. Symptoms will only give concomitant diseases (erosive-inflammatory processes, which often develop against the background of papillomavirus infection). If the cause of dysplasia are viruses of 16 and 18 types, then in half the cases after 10 or more years the disease passes into cervical cancer. Doctors presuppose such an outcome, therefore, they must prescribe a special analysis that allows to identify the virus in the smear (the usual cytology of the smear in this plan is not very informative) and determine its type. Foci of erosion and dysplasia should be removed regardless of whether a highly coenotic type of papilloma virus is detected in them. But when it is revealed, it is mandatory not only to perform a surgical operation to excise pathological tissues, but regular follow-up monitoring of the uterine mucosa. Another pathology, the development of which is associated with the papillomatous virus, is the ovarian cyst. The cyst is considered a
benign neoplasm. In appearance it resembles a pouch with a liquid that can even exceed the size of the organ itself, squeezing it and preventing the release of the egg [32-33].The formation of cysts doctors associate with surgical operations on the genitals, erosive-inflammatory diseases of the uterus, hormonal disorders (half the cases), early menstruation, cycle disorders, etc. Ideally, the neoplasm (luteal cyst, formed from the yellow body, and the follicular cyst, which is formed in the case of the absence of the egg) must resolve itself. The hemorrhagic and endometriotic cysts are amenable to therapeutic treatment. The greatest danger is represented by the mucinous cyst, which is found in women over 50 and consists of several rapidly growing chambers, and paraovarian, which is formed not on the ovary, but on the priests and also prone to rapid growth. It is difficult to say whether papillomavirus has anything to do with the formation of such cysts, but if the body has HPV or other high-ionic virions, there is a big risk of a benign tumor degenerating into a malignant one. If a woman has cervical erosion, an ovarian cyst, dysplastic processes in the uterus and HPV 16 or 18, doctors start to sound an alarm. It can not be said that a virus of high oncogeneity necessarily provokes cancer of the cervix or ovaries, but its presence in the body increases the risk of developing a deadly disease several times [34].
The American College of Obstetricians and Gynecologists (ACOG) recommends that, for adolescents, an evaluation of the menstrual cycle should be included as a vital sign because it can improve the early identification of potential health problems. Using this same rationale, evaluation of the menstrual cycles and symptoms associated with it, referred to within this article as menstrual health, are essential components of wellwoman care for adult women. Menstrual health assessment facilitates identification of a pathologic
condition (eg, abnormal uterine bleeding [AUB], endometriosis), offers the opportunity to educate women on what menstrual symptoms may be normal or abnormal, and provides the opportunity to initiate treatment of women who are suffering because of problems with their menstrual bleeding or associated symptoms [36-38]. In the scientific vision statement for the Gynecologic Health and Disease Research branch of the National Institute of Child Health and Human Development, Tingen and colleagues stated that lack of education and stigma result in barriers to care for gynecologic health disorders, and that women often suffer in silence because they have a difficult time expressing their symptoms to their physicians or they think their symptoms are an inevitable outcome of menstruation. Because some women, unprompted, may not disclose symptoms related to their menstrual cycle that could represent an underlying problem, including heavy menstrual bleeding, pain, or mood disorders, either because of embarrassment or because they think their suffering is normal, health care
providers need to be familiar with menstrual health disorders and take a thorough history to assist women in discussing their menstrual health experiences. This article describes menstrual health, first in terms of the physiologic process of menstruation and the normal parameters of menstrual bleeding. Next, it covers the diagnosis and evaluation of AUB and a brief description of other nonbleedingmenstrual health disorders, including dysmenorrhea, endometriosis, and premenstrual syndrome (PMS). To address problems with inconsistent and poorly defined terminologies, the Menstrual Disorders Committee (MDC) of the International Federation of Gynecologists and Obstetricians (FIGO) published recommendations for standardized terminologies related to menstrual bleeding and AUB. [39-41] For use in both clinical and research settings, the FIGO MDC recommends describing bleeding symptoms in terms of 4 menstrual dimensions: frequency, regularity, duration, and volume
Table 1.
Table 1 The International Federation of Gynecologists and Obstetricians Menstrual Disorders Committee uterine bleeding classification system (system 1)
Frequency Frequent Normal Infrequent Absent Less than every 24 d Every 24-38 d Every 38 d No periods or bleeding: amenorrhea
Regularity Regular Irregular Variation (shortest to longest) <9 d Variation (shortest to longest) >10
Duration Prolonged Normal >8 d <8 d
Volume Heavy Normal Light Determined by the patient Heavy menstrual bleeding defined as bleeding sufficient to cause interference with quality of life
These definitions of normal menstrual bleeding were adopted by ACOG through the reVITALize Gynecology Data Definitions Initiative, a process started in 2013 to standardize the
definitions of common reproductive health terminologies for use in documentation, research, coding, and databases. The terminologies and definitions developed as part of this
process are outlined in Table 2. Understanding the normal range of these dimensions is a critical first step in diagnosing and treating menstrual health disorders. These definitions may continue to evolve as more data, potentially from more diverse populations, become available to contribute to the definition of population norms for menstrual bleeding. The definition of 1 parameter of bleeding, volume, has evolved considerably over the past decade to move away from strictly defining it objectively as greater than 80 mL of menstrual blood loss per cycle, which was not relevant to clinical care or feasible to measure in clinical practice, to defining it in a more patient-centered way that focuses on the impact of the bleeding on the woman's quality of life (see Tables 1 and 2). Asking questions to categorize a woman's bleeding relative to these 4 dimensions will facilitate consistent description of bleeding patterns between clinical providers and the ability to identify a
woman who is experiencing AUB. However, AUB is not the only menstrual health disorder and, as such, an evaluation of these 4 dimensions alone is too superficial to determine whether or not a woman is experiencing other associated symptoms related to her menses and whether or not her bleeding is having a negative impact on her quality of life. Multiple validated questionnaires have been developed to evaluate both menstrual bleeding and related menstrual symptoms with regard to quality of life. [42,43] Additionally, asking questions about associated symptoms, such as pain and mood changes, as part of a comprehensive evaluation of menstrual health may facilitate the diagnosis of endometriosis, dysmenorrhea, PMS, or major premenstrual dysphoric disorder (PMDD). See later discussion of these disorders and their assessment in the context of preventive health.
Table 2 The American College of Obstetricians and Gynecologists reVITALize data definitions gynecology related to bleeding
Normal uterine bleeding
AU В
Heavy menstrual bleeding (formerly menorrhagia)
Irregularand heavy uterine bleeding (formerly menometrorrhagia)
Intermenstrual bleeding
Cyclic bleeding that occurs from the uterine corpus between menarche and menopause The bleeding generally lasts up to 8 d and occurs every 24-38 d The cycle should occur at regular predictable intervals and the difference between the longest and shortest cycle over a 1-year period should be no more than 20 da Normal volume may be defined quantitatively as up to 80 mL per cycle and/or qualitatively as volume that does not excessively interfere with a woman's physical, social, emotional, and/or material quality of life
Bleeding from the uterus that differs in frequency, regularity, duration, or volume from normal uterine bleeding, in the absence of pregnancy AUB as a symptom should be further classified etiologically as follows: PALM-COEIN: polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not otherwise classified
A type of AUB characterized by excessive cyclic blood loss, which differs from normal uterine bleeding and interferes with a woman's physical, social, emotional, and/or material quality of life
A type of AUB that represents the symptom of excessive uterine blood loss (in terms of volume or duration) which occurs unpredictably and interferes with a woman's physical, social, emotional, and/or material quality of life
A type of AUB characterized by bleeding episodes between regular episodes of cyclic uterine bleeding
Postmenopausal bleeding Bleeding from female genital organs D 12 mo after the final menstrual period.
Conclusion: In summary, there are many types of gynecological diseases, the main part of which are infectious diseases. Gynecological cancers are also
common. We also discussed the research and opinions of several scientists on the
prevention, treatment, and diagnosis of disease. We hope that this article will be these diseases among women. And we can main to more in-depth research in the say that the best option is to prevent this field of gynecology.
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