Bệnh Phụ Khoa, Tiền mãn kinh

Các bệnh phụ khoa thường gặp sau mãn kinh

benh sau man kinh

1/ HIỆN TƯỢNG RA MÁU SAU MÃN KINH 

Mãn kinh được định nghĩa là hiện tượng ngưng ra kinh suốt 12 tháng. Tuy nhiên có những trường hợp phụ nữ tuy đã đủ định nghĩa mãn kinh rồi nhưng sau đó có hiện tượng ra huyết lại tương tự huyết kinh bình thường 1 lần duy nhất rồi ngưng luôn từ đó về sau. Những trường hợp này đa số là bình thường không cần điều trị, tuy nhiên khi có hiện tượng trên các chị nên đi khám để loại trừ những bệnh lý ác tính. 

Những nguyên nhân lành tính gây ra huyết âm đạo sau mãn kinh: 

  • Nội mạc tử cung mỏng gây xuất huyết: nội mạc tử cung chịu sự tác động của estrogen sẽ dày lên sau đó dưới tác động của progesteron sẽ chế tiết và bong ra theo chu kỳ kinh. Khi phụ nữ mãn kinh nội mạc không còn chịu sự tác động của estrogen hay progesteron nên nội mạc sẽ rất mỏng gây xuất huyết. 
  • Viêm âm đạo- cổ tử cung: thường viêm cổ tử cung dễ gây ra huyết hơn viêm âm đạo dù nguyên nhân này ít gặp ở tuổi mãn kinh, ra ít huyết nâu âm đạo do viêm âm đạo tuổi mãn kinh cũng thường gặp đa phần viêm do thiếu nội tiết gây khô, ngoài ra vẫn có những trường hợp mãn kinh vẫn bị viêm âm đạo do nấm hoặc vi khuẩn. 
  • Chảy máu âm đạo do sang chấn sau quan hệ tình dục: vì niêm mạc âm đạo người phụ nữ mãn kinh rất khô, teo, mỏng nên khi quan hệ cần hết sức nhẹ nhàng và dùng thêm chất bôi trơn nếu người phụ nữ khong sử dụng liệu pháp hormon. 

Những nguyên nhân ác tính gây ra huyết âm đạo sau mãn kinh:  

  • Ung thư âm đạo-cổ tử cung: đa phần nguyên nhân do nhiễm HPV, do vậy việc tầm soát ung thư cổ tử cung rất quan trọng đối với phụ nữ mãn kinh. Việc nhiễm HPV không phải lúc nào cũng gây ung thư nhưng việc nhiễm HPV nguy cơ cao dai dẳng tồn tại nhiều năm có thể tiến triển thành ung thư cổ tử cung sau 15-20 năm, đa phần rơi vào độ tuổi trên 40. Vậy nên phụ nữ mãn kinh phải tầm soát ung thư cổ tử cung theo quy định cho đến ít nhất 65 tuổi. 
  • Ung thư nội mạc tử cung hay ung thư tử cung: là nguyên nhân hay gặp gây chảy máu sau mãn kinh, nguy cơ này gia tăng theo tuổi sau mãn kinh từ 1% ở tuổi 50 lên đến 25% ở tuổi 80, những phụ nữ có kinh sớm và mãn kinh muộn, phụ nữ chưa từng sinh con, phụ nữ bị hội chứng buồng trứng đa nang, đái tháo đường type 2, tăng huyết áp động mạch, sử dụng liệu pháp hormone thay thế không đối kháng… là đối tượng nguy cơ cao của bệnh lý này.  Chẩn đoán ung thư nội mạc tử cung bằng cách nạo sinh thiết từng phần. Đối với phụ nữ mãn kinh có xuất huyết tử cung bất thường thì tầm soát bằng siêu âm đầu dò hay siêu âm qua ngã âm đạo là cực kỳ quan trọng, nếu mội mạc từ cung >4 mm thì sinh thiết nội mạc tử cung là bắt buộc. 

2/ UNG THƯ BUỒNG TRỨNG 

Ung thư buồng trứng gặp ở mọi lứa tuổi từ tuổi dậy thì cho đến tuổi sau mãn kinh. Một nửa ung thư buồng trứng xảy ra ở phụ nữ trên 60 tuổi. Ở phụ nữ mãn kinh triệu chứng ung thư buồng trứng giai đoạn sớm không rõ ràng, đôi khi người phụ nữ chỉ cảm thấy căng tức vùng bụng dưới, sưng phù vùng bụng chậu, bụng to hơn bình thường, mệt mỏi, cảm giác ăn kém ngon, chậm tiêu, buồn nôn, có thể đi tiểu nhiều lần, tiểu gấp mà không liên quan nhiễm trùng, đi cầu nhiều lần hoặc táo bón, đây thường là dấu hiệu ung thư buồng trứng giai đoạn muộn. Việc khám định kỳ cho phụ nữ mãn kinh rất quan trọng nhằm phát hiện sớm ung thư buồng trứng. Chẩn đoán sớm ung thư buồng trứng giúp người phụ nữ có 92% cơ hội kéo dài cuộc sống sau 5 năm.  

Buồng trứng của phụ nữ chưa mãn kinh có hình dáng và kích thước như quả hạnh nhân. Sau khi mãn kinh buồng trứng teo đi nên kích thước chỉ còn bằng một nửa và nắm thấp hai bên hố chậu. Việc tầm soát ung thư buồng trứng ở phụ nữ mãn kinh nên thực hiện bằng siêu âm đầu dò, nếu phát hiện có một nang buồng trứng mới xuất hiện sau tuổi mãn kinh, cần chắc chắn rằng đó không phải là nang ác tính bằng cách theo dõi sát cùng các chỉ điểm khác hoặc phẫu thuật để có chẩn đoán giải phẫu bệnh. 

3/ UNG THƯ VÚ 

Mãn kinh tự bản thân nó không liên quan tới sự gia tăng nguy cơ ung thư vú. Tuy nhiên tỷ lệ nhiều loại ung thu bao gồm ung thư vú gia tăng cùng với tuổi tác. Hơn nữa việc sử dụng những loại thuốc để quản lý những triệu chứng mãn kinh có thể làm gia tăng hoặc giảm nguy cơ ung thư. Khoảng 95% phụ nữ được chẩn đoán ung thư vú mỗi năm đều trên 40 tuổi và 50% trong số đò trên 61 tuổi. 

Nguy cơ cao nếu như có mẹ, chị, em gái bị ung thư vú đặc biệt bị ung thư vú khi còn trẻ. Tăng sản không điển hình được chẩn đoán trên sinh thiết hoặc cắt bỏ cũng có khả năng dễ mắc ung thư vú hơn. 

Những yếu tố nguy cơ khác bao gồm: 

  • CÓ ung thư 1 bên vú (nguy cơ tái lại trên vú cũ hoặc xuất hiện ở bên còn lại ) 
  • CÓ tiền sử ung thư buồng trứng, tử cung, đại tràng. 
  • Đột biến gen BRCA1, BACR2 
  • Mãn kinh sau 55 tuổi 
  • Có kinh sớm trước 12 tuổi 
  • Có đứa con đầu lòng sau 30 tuổi 
  • Không sinh con 
  • Thừa cân, béo phì sau mãn kinh 

Tầm soát phát hiện sớm ung thư vú cải thiện đáng kể việc điều trị. Phụ nữ nên tầm soát ung thư vú bằng nhũ ảnh mỗi 1-2 năm sau tuổi 40 hoặc 50 tùy mỗi quốc gia, những đối tượng nguy cơ cao có thể được chỉ định nhũ ảnh sớm hơn từ năm 25 hoặc 30 tuổi. 

MRI có lợi trongvieejc tầm soát sớm ung thư vú cùng với chụp nhũ ảnh. 

Việc tự thăm khám vú mỗi tháng không có lợi ích rõ vì mô vú đôi khi rất khó phân biệt giữa bình thường và bất thường bằng tay nên một số nơi đã không còn khuyến khích vì gây tăng lo lắng cho phụ nữ. 

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