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Il ruolo dell’isteroscopia nei sanguinamenti uterini anomali in menopausa


ABSTRACT
{ITA} Il sanguinamento uterino anomalo (AUB, Abnormal Uterine Bleeding) è un fenomeno molto frequente in tutte le fasce di età. In menopausa si manifesta in media nel 10-15%delle donne e può essere correlato a diverse condizioni: atrofia endometriale, polipi endometriali, miomi sottomucosi, iperplasia endometriale, tumori endometriali e cause iatrogene correlate principalmente all’utilizzo di farmaci come il tamoxifene e la terapia ormonale sostitutiva.
L’approccio diagnostico della donna con AUB prevede in prima istanza l’esecuzione di un’ecografia transvaginale con valutazione dello spessore endometriale, della sua vascolarizzazione e della sua morfologia. Si è concordi a valutare la necessità di proseguire l’indagine diagnostica con isteroscopia e biopsia endometriale nei casi in cui all’episodio di sanguinamento uterino si associ un ispessimento endometriale maggiore di 5mm. Nei casi invece in cui le pazienti siano asintomatiche il cutoff di spessore endometriale può essere spostato a 10.5mm. Tale cutoff dovrebbe essere ulteriormente spostato a 8 mm nel caso si tatti di paziente in terapia con Tamoxifene asintomatiche. In tutti questi casi, così come quando in sede di indagine ecografia si visualizza un sospetto polipo endometriale, un sospetto mioma o un’area di sospetta iperplasia, si rende necessaria l’esecuzione di isteroscopia diagnostica. L’isteroscopia operativa con resettoscopia è utile nei casi di polipi di grandi dimensioni, miomi o biopsie allargate richiede necessariamente l’esecuzione in sala operatoria in regime di ricovero.

{ENG} Abnormal Uterine Bleeding (AUB) is very common in women during the life. In average 10-15% of women in menopause show an AUB and that can be related to different conditions: endometrial atrophy, endometrial polyps, submucosal myomas, endometrial hyperplasia, endometrial tumors and iatrogenic causes such as the use of tamoxifen and hormone replacement therapy.
First of all, the diagnostic approach of the woman with AUB needs the execution of a transvaginal ultrasound with evaluation of the endometrial thickness, its vascularization and its morphology. Studies agreed to continue the diagnostic investigation with hysteroscopy and endometrial biopsy when uterine bleeding is associated with an endometrial thickening greater than 5mm. For asymptomatic patients, the endometrial thickness cutoff can be moved to 10.5mm. This cutoff should be further moved to 8 mm for asymptomatic patient on Tamoxifen therapy. In all these cases, as well as in case of suspected endometrial polyp, or suspected myoma or suspected area of hyperplasia, diagnostic hysteroscopy is necessary. Operative hysteroscopy with resectoscopy is useful in cases of large polyps, myomas or enlarged biopsies and necessarily requires execution in the surgery room in hospitalization.


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12° Corso Strategie integrative, neuro-attive, e terapie ormonali in Ginecologia Endocrinologica
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