🔻Bleeding that is outside the norm al param eters of them enstrual cycle (volum e, duration, or interval)
Abnormal Uterine Bleeding: Normal Menstrual Cycle Average menses 5 day flow (3-7 normal) Volume loss 30-80 cc (>80 cc
abnormal) Average cycle range 21-35 days
🔻 Polymenorrhea (Epimenorrhea):
Cyclic, regular, freq uent bleeding w ith cycle interval < 21 days
🔻Oligomenorrhea:
Cyclic, regular infrequent cycle interval > 35 days apart ovulatory or anovulatory
FORMS OF AUB 🔻 Menorrhagia: (Hypermenorhea)
Cyclic, but excessive heavy blood loss > 80 mL or prolonged menses > 7 days or both Hypomenorrhea
light scanty flow lasts for less than two days at regular intervals
🔻Metrorrhagia: irregular bleeding w ith variable am ount (cotact bleeding, interm enstrual bleeding)
🔻Menometrorrhagia: heavy and irregular bleeding
🔻
🔻 Pregnancy complications
Organic
-Uterine leiomyoma
-Endom etrial polyp, Cervical polyp
-Adenom yosis
-Endom etrial hyperplasia
-Malignancy (cervix, uterus)
🔻
-Atrophic E ndom etriam
🔻 Pelvic inflammatory disease PID
Contraception
🔻
-IUCD or Depo-provera or Norplant
Blood Dyscrasias
-Von Willebrand’s Disease
-Thrombocytopenia
🔻
🔻
-Leukemia
Chromosomal disorder
Excess E strogen
- Poly cystic ovary (PCO)
- Obesity
🔻
- Estrogen producing tum or
Iatrogenic
- Exogenous estrogen (HRT )
🔻
-Heparin
Systemic
-Thyroid disease
- Hyperprolactinemia
-Hepatic disease
🔻
-Renal failure
CNS suppression, low FSH and LH
🔻
(Stress, Anorexia, or Athletic)
DYSFUNCTIONAL UTERINE BLEEDING (DUB)
Anovulation
Etiology
Dysfunctional Uterine Bleeding(DUB):
🔹Diagnosis
🔹 Definition Abnormal uterine bleeding with no attributable underlying illness or pathology
of exclusion !
Must exclude all other causes of AUB ETIOLOGY OF DUB
-Polycystic ovary syndrome (PCOS )
-Obesity
-Adrenal hyperplasia
Polycystic Ovary (PCO)
-Incidence 3-5%
-Begins in teen years or early twenties
-Multifactorial inheritance associated with insulin resistance and metabolic syndrome.
-Family history of type II DM
-Associated with thyroid dysfunction.
-Increased circulating androgens arom atize to estrone (E1) Estrogen provides feedback to pituitary,
resulting in low FSH and high LH
AUB Static levels of LH trigger chronic anovulation
DIAGNOSIS ,
Oligo or anovulation with one of:
Evidence of androgen excess
Polycystic ovary by U/S
Hirsutism
treated with spironolactone and OCP ’s
by fatema okoff
🔻
🔹 History
🔹 Age of the (Reproductive, Extremes of age , Adolescent , postmenopause)
🔹-e.g.Detailed Menstrual history (LMP, volume, duration, intervals)
Associated symptoms:
dysmenorrhea, post-coital bleeding , galactorrhea, hirsutism , Weight changes
🔹
-bleeding from other sites or prolonged bleeding after m inor traum a, easly bruising
🔹 H /O S trenous physical activitis
🔹
🔹
Significant Psychological or Emotional Stress or an eating disorders
Hormonal therapy or contraception (IUD , H R T )
🔹H/O Gynecological dis.(Fibroid, PCO, Gyn. Malignancy or PID )
Medical history of (thyroid dis., Liver dis., renal dis., coaglupathies and medications
🔻 General Exam
- Anemia
-Signs of systemic diseases (thyroid enlargment , echymosis … .
🔻
-Obesity , Hirsutism
Abdominal Exam
Evaluation and Diagnosis 🔻-Abdominal mass
Pelvic Exam
-Cervical tenderness and purulent discharge in cervicitis
-Friable cevix with contact bleeding with cervical erosion or mass
-Dilated cervix with protroding tissue or polyp
-Size, shape of uterus and adexia by bimanual exam .
🔻 Laboratory
-Blood pregnancy test
-CBC with platelets
-Coagulation studies
-Thyroid studies (TSH , T4)
-Prolactin
🔻
-Serum androgens
Diagnostic Procedures
-U/S
-Transvaginal ultrasound
-Pap smear
-Endometrial biopsy (EMB)
-Hysteroscopy
-Hystero Salpingography (HSG)
Directed at treating the underlying pathology with relief of volume and duration of menses
-Rule out pregnancy, traum a, coagulopathy; replace blood products as needed
-Anatomic causes :
treat and usually bleeding controlled.
-Thyroid dysfunction:
treatment will resolve AUB once normal functions after 2 months
-Hyperprolactinemia:
treat with cabergoline or bromocriptine.
MEDICAL:
NON-HORMONAL
•Replace blood products as needed
•Antifibrinolytics Traneximic acid 2-4 gr
•NSAID’s (Mefenemic acid 500mg)(Ibuprofen 400mg)
Treat underlying dis:
•Hyperprolactinemia treat with cabergoline
•Thyroid dysfunctions
MANAGEMENT OF AUB HORMONAL
-Estrogen
Conjugated Estrogen 10 mg
-Estrogen-Progestin Comb.
OCP x 21 days
-Progestin
Medroxy progesterone 5mg
-Androgenic steroid
Danazol 200-400 mg
-Gn RH Agonist
SURGICAL
•D&C
•Endometrial ablation
•Myomectomy
– IF leiomyomata and fertility desired
•Hysterectomy
(TAH, TVH, or TLH)
•Hysteroscopic resection
– IF polyp, submucous myoma
Abnormal Uterine Bleeding: Normal Menstrual Cycle Average menses 5 day flow (3-7 normal) Volume loss 30-80 cc (>80 cc
abnormal) Average cycle range 21-35 days
🔻 Polymenorrhea (Epimenorrhea):
Cyclic, regular, freq uent bleeding w ith cycle interval < 21 days
🔻Oligomenorrhea:
Cyclic, regular infrequent cycle interval > 35 days apart ovulatory or anovulatory
FORMS OF AUB 🔻 Menorrhagia: (Hypermenorhea)
Cyclic, but excessive heavy blood loss > 80 mL or prolonged menses > 7 days or both Hypomenorrhea
light scanty flow lasts for less than two days at regular intervals
🔻Metrorrhagia: irregular bleeding w ith variable am ount (cotact bleeding, interm enstrual bleeding)
🔻Menometrorrhagia: heavy and irregular bleeding
🔻
🔻 Pregnancy complications
Organic
-Uterine leiomyoma
-Endom etrial polyp, Cervical polyp
-Adenom yosis
-Endom etrial hyperplasia
-Malignancy (cervix, uterus)
🔻
-Atrophic E ndom etriam
🔻 Pelvic inflammatory disease PID
Contraception
🔻
-IUCD or Depo-provera or Norplant
Blood Dyscrasias
-Von Willebrand’s Disease
-Thrombocytopenia
🔻
🔻
-Leukemia
Chromosomal disorder
Excess E strogen
- Poly cystic ovary (PCO)
- Obesity
🔻
- Estrogen producing tum or
Iatrogenic
- Exogenous estrogen (HRT )
🔻
-Heparin
Systemic
-Thyroid disease
- Hyperprolactinemia
-Hepatic disease
🔻
-Renal failure
CNS suppression, low FSH and LH
🔻
(Stress, Anorexia, or Athletic)
DYSFUNCTIONAL UTERINE BLEEDING (DUB)
Anovulation
Etiology
Dysfunctional Uterine Bleeding(DUB):
🔹Diagnosis
🔹 Definition Abnormal uterine bleeding with no attributable underlying illness or pathology
of exclusion !
Must exclude all other causes of AUB ETIOLOGY OF DUB
-Polycystic ovary syndrome (PCOS )
-Obesity
-Adrenal hyperplasia
Polycystic Ovary (PCO)
-Incidence 3-5%
-Begins in teen years or early twenties
-Multifactorial inheritance associated with insulin resistance and metabolic syndrome.
-Family history of type II DM
-Associated with thyroid dysfunction.
-Increased circulating androgens arom atize to estrone (E1) Estrogen provides feedback to pituitary,
resulting in low FSH and high LH
AUB Static levels of LH trigger chronic anovulation
DIAGNOSIS ,
Oligo or anovulation with one of:
Evidence of androgen excess
Polycystic ovary by U/S
Hirsutism
treated with spironolactone and OCP ’s
by fatema okoff
🔻
🔹 History
🔹 Age of the (Reproductive, Extremes of age , Adolescent , postmenopause)
🔹-e.g.Detailed Menstrual history (LMP, volume, duration, intervals)
Associated symptoms:
dysmenorrhea, post-coital bleeding , galactorrhea, hirsutism , Weight changes
🔹
-bleeding from other sites or prolonged bleeding after m inor traum a, easly bruising
🔹 H /O S trenous physical activitis
🔹
🔹
Significant Psychological or Emotional Stress or an eating disorders
Hormonal therapy or contraception (IUD , H R T )
🔹H/O Gynecological dis.(Fibroid, PCO, Gyn. Malignancy or PID )
Medical history of (thyroid dis., Liver dis., renal dis., coaglupathies and medications
🔻 General Exam
- Anemia
-Signs of systemic diseases (thyroid enlargment , echymosis … .
🔻
-Obesity , Hirsutism
Abdominal Exam
Evaluation and Diagnosis 🔻-Abdominal mass
Pelvic Exam
-Cervical tenderness and purulent discharge in cervicitis
-Friable cevix with contact bleeding with cervical erosion or mass
-Dilated cervix with protroding tissue or polyp
-Size, shape of uterus and adexia by bimanual exam .
🔻 Laboratory
-Blood pregnancy test
-CBC with platelets
-Coagulation studies
-Thyroid studies (TSH , T4)
-Prolactin
🔻
-Serum androgens
Diagnostic Procedures
-U/S
-Transvaginal ultrasound
-Pap smear
-Endometrial biopsy (EMB)
-Hysteroscopy
-Hystero Salpingography (HSG)
Directed at treating the underlying pathology with relief of volume and duration of menses
-Rule out pregnancy, traum a, coagulopathy; replace blood products as needed
-Anatomic causes :
treat and usually bleeding controlled.
-Thyroid dysfunction:
treatment will resolve AUB once normal functions after 2 months
-Hyperprolactinemia:
treat with cabergoline or bromocriptine.
MEDICAL:
NON-HORMONAL
•Replace blood products as needed
•Antifibrinolytics Traneximic acid 2-4 gr
•NSAID’s (Mefenemic acid 500mg)(Ibuprofen 400mg)
Treat underlying dis:
•Hyperprolactinemia treat with cabergoline
•Thyroid dysfunctions
MANAGEMENT OF AUB HORMONAL
-Estrogen
Conjugated Estrogen 10 mg
-Estrogen-Progestin Comb.
OCP x 21 days
-Progestin
Medroxy progesterone 5mg
-Androgenic steroid
Danazol 200-400 mg
-Gn RH Agonist
SURGICAL
•D&C
•Endometrial ablation
•Myomectomy
– IF leiomyomata and fertility desired
•Hysterectomy
(TAH, TVH, or TLH)
•Hysteroscopic resection
– IF polyp, submucous myoma
