{"id":17079,"date":"2024-05-30T14:43:09","date_gmt":"2024-05-30T14:43:09","guid":{"rendered":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/?p=17079"},"modified":"2024-05-30T14:43:15","modified_gmt":"2024-05-30T14:43:15","slug":"llr-policy-heavy-menstrual-bleeding-and-indications-for-hysterectomy","status":"publish","type":"post","link":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/ro\/llr-policy-heavy-menstrual-bleeding-and-indications-for-hysterectomy\/","title":{"rendered":"Politica LLR S\u00e2nger\u0103ri menstruale abundente \u0219i indica\u021bii pentru histerectomie"},"content":{"rendered":"

Aceast\u0103 politic\u0103 ofer\u0103 \u00eendrum\u0103ri cu privire la punerea \u00een func\u021biune a histerectomiei pentru tratamentul s\u00e2nger\u0103rilor menstruale abundente, care este nu<\/strong> cauzate de o anomalie structural\u0103 sau patologic\u0103.<\/p>\n\n\n\n

S\u00e2ngerarea menstrual\u0103 abundent\u0103 (HMB) este definit\u0103 ca pierderea excesiv\u0103 de s\u00e2nge menstrual care are loc la intervale regulate, care interfereaz\u0103 cu starea fizic\u0103, social\u0103, emo\u021bional\u0103 \u0219i\/sau material\u0103 a unei femei.<\/p>\n\n\n\n

calitatea vie\u021bii. Poate ap\u0103rea singur sau \u00een combina\u021bie cu alte simptome. Nu exist\u0103 o patologie de baz\u0103 asociat\u0103 cu s\u00e2ngerarea menstrual\u0103 abundent\u0103.<\/p>\n\n\n\n

Histerectomia trebuie luat\u0103 \u00een considerare numai atunci c\u00e2nd: alte op\u021biuni de tratament au e\u0219uat, sunt contraindicate; exist\u0103 dorin\u021ba de amenoree (f\u0103r\u0103 menstrua\u021bii); femeia (care a fost pe deplin informat\u0103) o solicit\u0103; femeia nu mai dore\u0219te s\u0103-\u0219i p\u0103streze uterul \u0219i fertilitatea.<\/p>\n\n\n\n

Ra\u021bionamentul clinic individual va continua s\u0103 fie utilizat atunci c\u00e2nd se ofer\u0103 histerectomie pentru anomalii structurale, cum ar fi prolapsul uterin, modific\u0103ri precanceroase, fibroame > 3 cm, adenomioza CIN persistent\u0103 \u0219i endometrioza ar putea fi, de asemenea, indica\u021bii pentru histerectomie la o femeie cu HMB.<\/p>\n\n\n\n

Eligibilitate<\/strong><\/p>\n\n\n\n

Criterii de prag<\/p>\n\n\n\n

Histerectomia LLR ICB pentru s\u00e2ngerare menstrual\u0103 abundent\u0103 NU ESTE FINAN\u021aAT\u0102 DE RUTIN\u0102 dec\u00e2t dac\u0103 sunt \u00eendeplinite TOATE criteriile urm\u0103toare.<\/strong>
\u00a0<\/strong>
\u00a0
\u2013 Dou\u0103 tratamente din Nice Guidance 44 (at\u00e2ta timp c\u00e2t nu au contraindica\u021bii) au fost \u00eencercate \u0219i continuate timp de cel pu\u021bin 3 luni pentru a evalua r\u0103spunsul, cu excep\u021bia cazului \u00een care efectele secundare sunt inacceptabile.

\u2013 Ar trebui f\u0103cut\u0103 o ofert\u0103 clar\u0103 de IUS, deoarece acesta este un tratament de prim\u0103 linie pentru HMB. Dac\u0103 acest lucru este refuzat sau contraindicat, acest lucru trebuie documentat \u00een mod clar. Se recomand\u0103 ca IUS s\u0103 fie p\u0103strat timp de 6 luni pentru a evalua eficacitatea conform ghidului NICE.

\u2013 V\u0103 recomand\u0103m utilizarea unui \u0219ablon de jurnal menstrual \u00een evaluarea HMB \u0219i evaluarea op\u021biunilor de tratament.

\u2013 Dup\u0103 aceea, a existat o e\u0219ec \u00een ameliorarea simptomelor (cu excep\u021bia cazului \u00een care este neadecvat din punct de vedere medical sau nu este contraindicat)
\u00a0
\u0218I
\u00a0
Urm\u0103toarele tratamente fie au e\u0219uat, fie nu sunt adecvate sau sunt contraindicate \u00een conformitate cu ghidul NG88 Heavy Menstrual Bleeding a Institutului Na\u021bional pentru S\u0103n\u0103tate \u0219i Excelen\u021b\u0103 Clinic\u0103 (NICE):

\u2022 Acid tranexamic \u0219i\/sau medicamente antiinflamatoare nesteroidiene (AINS), cum ar fi naproxenul

\u2022 Metode hormonale orale, cum ar fi contraceptivele orale combinate, progesteronul oral ciclic
\u00a0
\u0218I
\u00a0
Exist\u0103 dovezi ale impactului sever asupra calit\u0103\u021bii vie\u021bii
\u00a0
SAU
\u00a0
Dac\u0103 tratamentul nu reu\u0219e\u0219te, femeia refuz\u0103 tratamentul farmacologic sau simptomele sunt severe, lua\u021bi \u00een considerare trimiterea la \u00eengrijiri de specialitate pentru: investiga\u021bii pentru a diagnostica cauza HMB, dac\u0103 este necesar, lu\u00e2nd \u00een considerare orice investiga\u021bii pe care femeia le-a avut deja \u0219i op\u021biuni alternative de tratament, inclusiv : op\u021biuni farmacologice ne\u00eencercate deja (ca \u0219i anterior), op\u021biuni chirurgicale alternative<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Instruc\u021biuni<\/strong><\/p>\n\n\n\n

https:\/\/www.pms.org.uk\/app\/uploads\/2019\/10\/NAPS-MENSTRUAL-DIARY.docx<\/strong><\/a>
\u00a0<\/strong>
Histerectomie pentru s\u00e2ngerare menstrual\u0103 abundent\u0103 \u2013 EBI (aomrc.org.uk)<\/a>
\u00a0
Perioade grele \u2013 NHS (www.nhs.uk)
\u00a0
Histerectomie \u2013 NHS (www.nhs.uk)<\/a>
\u00a0
Menoragie (s\u00e2nger\u0103ri menstruale abundente) | Subiecte de s\u0103n\u0103tate de la A la Z | CKS | GROZAV<\/a>
\u00a0
Terapia de substitu\u021bie hormonal\u0103 (HRT) | Informa\u021bii de prescriere | Menopauza | CKS | GROZAV<\/a>
\u00a0
Managementul s\u00e2nger\u0103rilor neprogramate prin terapia de substitu\u021bie hormonal\u0103 (HRT) \u2013 British Menopause Society (thebms.org.uk)<\/a><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Informa\u021bii suplimentare<\/strong><\/p>\n\n\n\n

Ginecologie Pathway Finder<\/strong><\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Gestionarea s\u00e2nger\u0103rilor neprogramate<\/strong><\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Calea suspectat\u0103 a patologiei endometriale (SEP).<\/strong><\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n
Data revizuirii ARP 72: 2027<\/td><\/tr><\/tbody><\/table><\/figure>","protected":false},"excerpt":{"rendered":"

This policy provides guidance on the commissioning of hysterectomy for the treatment of heavy menstrual bleeding which is not caused by a structural or pathological abnormality. 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