abnormal uterine bleeding
DESCRIPTION
Abnormal uterine bleeding. Dr.Srwa Jamal Murad MBChB,FICOG. Abnormal uterine bleeding. Menorrhagia (heavy periods’) is blood loss of greater than 80ml per period. Metrorrhagia flow at irregular intervals. Menometrorrhagia frequent, excessive flow. - PowerPoint PPT PresentationTRANSCRIPT
ABNORMAL UTERINE BLEEDING
Dr.Srwa Jamal MuradMBChB,FICOG
Abnormal uterine bleeding
• Menorrhagia(heavy periods’) is blood loss of greater than 80ml per period.
• Metrorrhagia flow at irregular intervals.• Menometrorrhagia frequent, excessive flow.• Polymenorrhea bleeding at interval <21 days• Dysfunctional uterine bleeding :abnormal
uterine bleeding without any obvious structural or systemic abnormality.
Menorrhagia is extremely commonIs the single leading cause of referral to gynecology clinic.Normal menstrual cycle:Occur each 28days(21-35days)Duration 2-8 daysAverage 20-80 ml.
Causes 1.Organic2.Non organicOrganic a. Localb. Systemicc. Pregnancy related Non organica. Ovulatoryb. Non ovulatory (DUB)
Organic causes:Local causes:FibroidIUCDPIDMalignancyEndometrial CaCervical CaEndometrial hyperplasiaUterine abnormality
Organic causesSystemic causes;Endocrine causes.hypo&hyper thyriod.DM.prolactin abnormality.advanced liver disease.drugs (heparin, asprine,warfarin,tamoxfine)Hematological.VWBD.ITP
Organic causesPregnancy related.ectopic.miscarriage.trophoblastic diseaseOther causes.urinary tract.GIT
Non organic causeNon organic cause or DUB • Ovulatory • Non ovulatory
Presentation & assesment1.History :how long have period been heavy, last& how often do they occur.Is there flooding or passage of clotsAny intermenstrual bleeding or PCBPelvic pain & dyspareuniaWhat contraception is being used & PAP smear
examinationGeneral exam: for anaemia, thyroid BMIPelvic exam Cervical smear
investigation• Influence by age, reproductive
status, pattern &severity of symptoms
• 1.haematological & biochemistry
• PT,FBC if clinically indicated• Thyroid function test if
clinically indicated
imaging2.TV/US is usually the 1st invx . measure endometrial thickness (10-12mm in follicular phase is cut off).3.Endometrial sample: is to exclude endometrial hyperplasia &Ca.
Endometrial sampleis recommended in• female with >40 yr old• Those with increase risk of malignancy
include obesity ,DM, HTN, chronic anovulation, nulliparity, hx of infertility ,fhx of endometrial& colon Ca. , tamoxifin & HRT therapy.
• In younger female if no response to clinical Mx.
Commone method of endometrial sample
• Aspiration curettage (pipelle ,vabra).
• Dilatation & curettage( D&C).
• Hysteroscopy.
Management
Management
Thank you