関: dysfunctional uterine bleeding、intermenstrual bleeding、metrorrhagia、spotting

WordNet

bleeding from the uterus that is not due to menstruation; usually indicative of disease (as cervical cancer)
a penetration of a barrier such as an enemys defense
making an important discovery
the flow of blood from a ruptured blood vessel (同)hemorrhage, haemorrhage

PrepTutorEJDIC

敵陣突破[作戦];(ある事態・線の)突破 / (科学などの)新機軸,新発見,成功,大躍進
出血する / 出血;放血

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/14 19:10:58」(JST)

wiki en

Breakthrough bleeding (BTB) is any of various forms of vaginal bleeding,^[1] usually referring to mid-cycle bleeding in users of combined oral contraceptives,^[1] as attributed to insufficient estrogens.^[1] It may also occur with other hormonal contraceptives. Sometimes, breakthrough bleeding is classified as abnormal and thereby as a form of metrorrhagia,^[2] and sometimes it is classified as not abnormal.^[1]

Presentation

The bleeding is usually light, often referred to as "spotting," though a few women may experience heavier bleeding.

Many women find that the breakthrough bleeding ceases after one or two cycles.

Mechanism

Breakthrough bleeding is most commonly caused by an excessively thick endometrium (uterine lining). This is not a dangerous condition, though the unpredictable and often lengthy periods of bleeding are unpleasant. Breakthrough bleeding may also be caused by hormonal effects of ovulation. Breakthrough bleeding may also itself be a symptom of pregnancy.

Breakthrough bleeding is most common when a woman first begins taking oral contraceptives, or changes from one particular oral contraceptive to another, though it is possible for breakthrough bleeding to happen at any time. Smokers are especially prone to breakthrough bleeding while taking oral contraceptives; though many users experience breakthrough bleeding in the first three cycles of taking the pill, non-smokers tend to see the bleeding dissipate more quickly than smokers.

Breakthrough bleeding is likely due to hormonal fluctuations. The body is programmed to make certain estrogen levels each day and the estrogen (and some additional hormones, such as FSH, LH, and Progesterone) are responsible for regulating endometrium shedding. Therefore, when new levels of hormones enter the body through oral contraceptives, the body is provided with two ways to receive estrogen. These excess estrogen levels can cause pre-period bleeding (bleeding through). This should be regulated in several months.

According to Lange Gynecology and Obstetrics, 8th edition, the most common side effect associated with OC use is breakthrough bleeding. It usually occurs during the first one or two cycles and resolves itself spontaneously. Another common problem is amenorrhea. Persistent break through bleeding and amenorrhea commonly reflect an atrophic endometrium, which means a thin and not developed endometrium.

Use of combined estrogen and progesterone eliminates the normal endogenous hormonal cycling and gradually produces atrophy of the endometrial glands. This is because the dosage of estrogen in the OCs pills is much lower than the quantity produced naturally by the ovaries. Higher quantities produced by the ovaries induce proliferation, but low levels supplied by the pills produce atrophy but are sufficient to inhibit the endogenous secretion of the gonadotropins.

The exact chain of events that lead from an atrophic endometrium to the spotting between menses is not explained by the text. This condition may be corrected by using a pill with a higher estrogen (which will stimulate further proliferation of the endometrium) or lower progestin content (which will reduce its stability).^[3]

Treatment

Breakthrough bleeding that does not resolve on its own is a common reason for women to switch to different pill formulations, or to switch to a non-hormonal method of birth control.

References

^ ^a ^b ^c ^d Farlex Medical Dictionary > Breakthrough Bleeding, in turn citing:
- Segen's Medical Dictionary. Copyright 2012
- McGraw-Hill Concise Dictionary of Modern Medicine. Copyright 2002
^ Merriam-Webster's Medical Dictionary > Breakthrough bleeding Retrieved on Feb 28, 2010
^ Lange Q&A, obstetrics and gynecology 8th edition, chapter 27, Practice test, question 51

UpToDate Contents

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1. 避妊している女性におけるホルモン剤内服中の出血のマネージメント management of unscheduled bleeding in women using contraception
2. 妊娠していない生殖可能年齢の女性における不正子宮出血に対するアプローチ approach to abnormal uterine bleeding in nonpregnant reproductive age women
3. 思春期における異常子宮出血：鑑別診断およびアプローチ abnormal uterine bleeding in adolescents differential diagnosis and approach
4. 女性における生殖器出血の鑑別診断 differential diagnosis of genital tract bleeding in women
5. 子宮内避妊：副作用および合併症のマネージメント intrauterine contraception management of side effects and complications

English Journal

Bleeding profile of a flexible extended regimen of ethinylestradiol/drospirenone in US women: an open-label, three-arm, active-controlled, multicenter study.

Jensen JT, Garie SG, Trummer D, Elliesen J.SourceDepartment of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 97239-2941, USA.
Contraception.Contraception.2012 Aug;86(2):110-8. Epub 2012 Jan 26.
BACKGROUND: Unscheduled bleeding may affect satisfaction and compliance with extended oral contraceptive (OC) regimens. The bleeding patterns of two variants of a flexible dosing regimen designed to manage intracyclic bleeding problems during extended cycles were compared with that of a conventional
PMID 22281416

Does this woman have adnexal torsion?

Huchon C, Panel P, Kayem G, Schmitz T, Nguyen T, Fauconnier A.SourceDepartment of Gynecology and Obstetrics, CHI Poissy Saint-Germain en Laye, Poissy, France University Versailles- Saint Quentin en Yvelines, Versailles, France.
Human reproduction (Oxford, England).Hum Reprod.2012 Aug;27(8):2359-64. Epub 2012 Jun 6.
BACKGROUND No questionnaire is currently available for the presurgical diagnosis of adnexal torsion (AT). Our objective was to develop a predictive model for AT, based on the Self Assessment Questionnaire for Gynecologic Emergencies (SAQ-GE) designed for triaging women with acute pelvic pain. METHO
PMID 22674200

Japanese Journal

止血機序とその破綻

柏木浩和
日本内科学会雑誌 98(7), 1554-1561, 2009-07-10
止血機構は，血管内皮細胞，血小板，凝固/凝固制御系および線溶系が相互に密接に作用しながら，血流の恒常性を維持する極めて精緻かつ巧妙なメカニズムである．出血性疾患を正しく診断し，治療および予防を行うためには，この生理的な止血機序を理解することが必要である
NAID 10025192869

Breakthrough disseminated zygomycosis induced massive gastrointestinal bleeding in a patient with acute myeloid leukemia receiving micafungin

SUZUKI Kei,SUGAWARA Yumiko,SEKINE Takao,NAKASE Kazunori,KATAYAMA Naoyuki
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 15(1), 42-45, 2009-02-01
NAID 10025128210

脳梗膜動静脈瘻の外科的治療 : 特に上矢状静脈洞および横-S字状静脈洞周辺部病変について

榊寿右,森本哲也,星田徹,川口正一郎,中瀬裕之,浦西龍之介,奥野修三
脳神経外科ジャーナル 10(1), 47-55, 2001-01-20
上矢状静脈洞ならびに横-S字状静脈洞周辺部に発生した硬膜動静脈瘻の治療は, 主として血管内塞栓による治療法と外科的に摘出する治療が行われている.この病変の治療を行うにあたって最も大切なことは, 瘻の完全な消失を得ることである.さもなくば必ず再増大して出血の危険性が生じてくる.血管内治療は侵襲性が少ないことより最近よく行われているが, 必ずしも安全な手段ではない.経動脈的に行われば瘻の消失を得ること …
NAID 110003812292