AUB : Definition, Epidemology and Causes

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AUB : Definition, Epidemology and Causes

  1. 1. AUB Definitions Significance. Classifications Bethelhem Berhanu
  2. 2. Definition • Any deviation in normal frequency, duration amount of menstruation Normal?? 28 7 1-8 (3-5) 10-80ml (30-50) Can also include vaginal bleeding before menarche and after menopause
  3. 3. Definitions contd • Menorrhagia: Excessive (>80 ml) & / or prolonged menstruation(>7), at regular intervals • Metrorrhagia - Irregular, frequent bleeding of varying amounts but not excessive • Menometrorrhagia Prolonged or excessive bleeding at irregular intervals • Polymenorrhea Regular bleeding at intervals of less than 21 days • Oligomenorrhea Bleeding at intervals greater than 35 days – may be irregular • Intermenstrual Uterine bleeding between regular cycles
  4. 4. Others… • Hypermenorrhea – similar to menorrhagia but usually refers to heavy mensus (in terms of amount) • Hypomenorrhea (cryptomenorrhea) – regular scanty bleeding – Could be due to anatomic or hormonal abnormalities • Anatomic – imperforated hymen, incomplete transverse vaginal septum, cervical or vaginal stenosis, asherman’s syndrome. • Hormonal – hypothyroidism, hyperprolactinemia, hyperinsulinemia
  5. 5. • Contact bleeding – post coital or post examination bleeding. 2/3 – unknown causes Cervicitis or vaginitis – e.g. – Chlamydia, trichomonas Cervical ca cervical Cervical polyps cancer unless Cervical eversion R/O Atrophic vaginitis • METROTAXIS: continuous uterine bleeding without interruption • Amenorrhea – no mensus for 6 months
  6. 6. Novak’s gynaecology 14th edition
  7. 7. Why do we have to know about AUB?? • Abnormal uterine bleeding affects 10 to 30 percent of reproductive-aged women and up to 50 percent of perimenopausal women • It is a common reason for gynecologic consultation. • Responsible for over one third of hysterectomies.
  8. 8. Classification of AUB Childhood • Mostly vaginal – vulvovaginitis, trauma, neoplasms, precosious puberty Adolescence • DUB – anovulation mostly…., sexual abuse, STDs Child bearing age – r/o pregnancy • Pregnancy related, STDs, myomas. Etc. Peri menopausal • DUB Post menopausal - r/o malignancies • Tumors, atrophy
  9. 9. Classification of causes
  10. 10. Classifications contd. Systemic NonObstetric Nongynaecologic Endocrinopathies Coagulopathies Hepatic and renal failure DUB Gynaecologic AUB Obstetric Lieomyoma Adenomyosis Polyps Tumors Infections Trauma Abortion Ectopic pregnancy GTD Implantation bleeding Local Urethral bleeding Rectal bleeding
  11. 11. Gynecologic causes - uterus • Uterine fibroids – especially submucous type. – – – – Higher surface area Venous congestion Dysregulation of local vasoactive growth factors Interfere with myometrial contractility • Adenomyosis – also called ‘endometriosis interna’, refers to ectopic endometrial tissue within the myometrium – possibly results from increased and abnormal vascularization of the endometrial lining – Is also associated with dysmenorrhea
  12. 12. Gyn. Contd. • Endometrial polyps – are also associated with AUB possibly due to asynchronous shedding to that of the normal endometrium – Thus usually associated with intermenustrial bleeding. • Endometrial hyperplasia and cancer – Endometrial cancer should be suspected in any woman in menopausal transition with abnormal uterine bleeding Two thirds of women with endometrial cancer present with postmenopausal bleeding Only about 5% of endometrial ca occurs in patients younger than 40 yrs
  13. 13. Gyn. Contd. • Other uterine lesions include: – Atrophic endometrium – Infections – STD, TB – Mechanical causes – e.g. - IUD – Arteriovenous malformation
  14. 14. Non uterine gyn, causes • • • • Ovary - ??? Fallopian tube – salphingitis, Cancer Cervix – Cancer, polyps, Infections Vagina – Cancer, infections, atrophic vaginitis, foreinbody, Trauma
  15. 15. Systemic causes… • Endocrinopathies – Hypo or hyperthyroidism, hyperprolactinemia, adrenal disorders, DM • Coagulopathies – Factor deficiency – von willebrand’s disease, hemophilia – Palate disorders – ITP, leukemia, aplastic anemia etc. • Hepatic and renal failure – deficiency due to decreased synthesis and increased loss respectively
  16. 16. What is the most common cause of AUB??? DUB (50%)
  17. 17. References • • • • • • • Williams Gynecology Berek & Novak's Gynecology, 14th Edition Danforth's Obstetrics and Gynecology, 9th Ed Wikipedia www.figo.com www.acog.com www.slideshare.com

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