Your SlideShare is downloading. ×
dysfunctional uterine bleeding
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

dysfunctional uterine bleeding

2,334
views

Published on


0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,334
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
225
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Dysfunctional Uterine Bleeding Semyatov S., M.D., Ph.d Department of Obstetrics and Gynecology PFUR
  • 2. Definition: Dysfunctional Uterine Bleeding (DUB) - abnormal bleeding caused by hormonal abnormalities in the absence of pregnancy, tumor, infection, coagulopathy. It is often associated with anovulation, continuos ovarian estrogen production and a nonsecretory endometrium.
  • 3. Aetiology: DUB may result from disorders of: •The central nervous system; •Pituitary; •Ovary; •From the effects of exogenous or endogenous steroids; •Systemic metabolic disorders (hyper,- hypotheroidism, hepatic dysfunction and various chronic diseases).
  • 4. Signs and Symptoms: •Amenorrhoea. •Continuous uterine bleeding (may last for many weeks). •Secondary anaemia. •Infertility.
  • 5. Diagnosis  History  A full general examination  Pelvic Exam  Papanicolaou smear test  US exam (endometrium, ovaries)  A diagnostic curettage  Hystero-salpingography  Hysteroscopy  Hematologic studies
  • 6. Differential Diagnosis: 1. Complications of pregnancy (abortion, ectopic gestation, bleeding corpus luteum, hydatidiform mole, choriocarcinoma) 2. Organic lesions of: - the corpus: myoma, carcinoma, polyps, hyperplasia of endometrium; - cervix: chronic cervicitis, carcinoma, polyps; - ovary: functional ovarian cysts and functioning neoplasms; - oviducts: carcinoma; - vagina: carcinoma.
  • 7. Differential Diagnosis: Extragenital causes: • blood dyscrasias; • thrombocytopenia; •deficient clotting factors; •endocrinopathies; •hypertension; •bleeding from urinary tract and rectum.
  • 8. Treatment: Overall Approach  Recognize Goals: – Haemostasis – Restoration of Menstrual Cycle and Fertility – Regularize and control menstrual bleeding – Prevention of DUB
  • 9. Treatment: Depends on: 1. The age of the patient, her fertility and her desire for children. 2. The degree of anaemia. 3. The response to curettage, which is performed primarily as an aid to diagnosis, may be therapeutically beneficial.
  • 10. Continuous OCPs  “Pseudopregnancy” (Kistner)  ? Minimizes Retrograde Menstruation  Lower Fertility Rates than Other Medical Treatments  Choose OCPs with Least Estrogenic Effects, Maximal Androgenic / Progestin Effects
  • 11. Progestins  May be as Effective as GnRH-a for Pain Control  MPA 10 mg/day, DP 150 mg Semi-Monthly  May be Taken Long-Term  Relatively Inexpensive  Side-Effects: AUB, Mood Swings, Weight Gain, Amenorrhoea
  • 12. Danazol  Weak Androgen  Suppresses LH / FSH  200 mg daily for 4-6 months  Causes Endometrial Regression, Atrophy  Expensive  Not recommended in young women  Side-Effects: Weight Gain, Masculinization, Occ. Permanent Vocal Changes….
  • 13. Oestrogen  Suppresses LH / FSH  Causes Endometrial Regression, Atrophy
  • 14. Clomiphen  Induce ovulation.  50-150 mg daily from 5 to 9 day of menstrual cycle.  Complications: multiple pregnancy, hyperstimulation of ovaries.
  • 15. Ethamsylate  Reduces the capillary fragility.  Reduces menorragia by 50%.  500 mg 4 times a day started from 5 day prior to the anticipated start of the period to 10 days after.
  • 16. Nonsteroidal anti-inflammatory drugs (NSAID)  Mefenamic acid 500 mg for 5-6 days controls menorrhagia in 70% cases of ovulatory cycles.  Side effects: nausea, vomiting, dyspepsia, diarrhoea, headache, auto-haemolytic anaemia.
  • 17. Combined oral contraceptive pills  More effective than oestrogen and progesteron alone.  Reduces blood loss by 50% and eliminates dysmenorrhoea.  Not expensive
  • 18. Antifibrinolytic agents  Tranexamic acid, epsilon-amino-caproic acid, 1-2 g 4 times a day for 6-7 days during menstruation - with 50% success.  Side effects: nausea, vomiting, diarrhoea, headache, visual disturbances, intracranial thrombosis  Not expensive
  • 19. GnRH  is used as a last drug when others fail.  Depot injection 3.6 mg monthly for 4-6 month - nearly 100% successful.  Expensive.  Side effects: anti-oestrogenic effect for more than 6 monhts can cause menopausal symptoms and osteoporosis.
  • 20. Surgical Treatment 1. D&C - removal of endometrium’s hyperplasia  D&C will be required in young women, if hormonal therapy failed.  30-40% may be cured by curettage alone. 2. Hysterectomy - in older women with severe menorrhagia; recurrent irregular uterine bleeding that is unresponsive to progestin therapy.  The ovaries should be conserved in women below the age of 50 yrs.
  • 21. Surgical Treatment 3. Hysteroscopic endometrial ablation by  Nd:YAG laser  electro-cautery  resection (TCRE)  roller-ball electrocoagulation  radio-frequency induced ablation (RITEA) - thermal destruction of endometrium at 66°C. 85% get cured.  balloon therapy - hot fluid is used which causes superficial burn.