menstrual abnormalities

1. Dysfunctional Uterine Bleeding

2. DEFINITION
DUB is defined as ABNORMAL uterine bleeding in
the absence of any clinically detectable cause. It is
usually with hormonal disturbances due to
hypothalamic-pituitary-ovarian axis (HPOA) dysregulation.

3. Normal Menstrual Cycle

4. Pathophysiology
 Two types: anovulatory and ovulatory
 Anovulatory: Most women with DUB do not ovulate (70-
80%).
• In theses women, there is continuous prostaglandin
production without corpus luteum formation and
progesterone production.
• Adolescent: 20%
• Perimenopausal years: 50%
 Ovulatory DUB occurs most commonly at the reproductive
age.
• 20-30% of DUB
• Incidence in these patients may be as high as 10%

5. Anovulatory DUB
Etiology
 Psychological stress
 Body weight (obesity, anorexia, or a rapid change)
 Endocrine:
In perimenopausal women, the mean length of the cycle
is shorter compared to younger women.
 Shortened follicular phase
 Diminished capacity of follicles to secrete
Estradiol
 Neoplasm,
 Drugs
 It may be otherwise idiopathic.
 Endometrial Hyperplasia

6. Ovulatory DUB
Luteal phase insufficiency
Irregular shedding of endometrium
• 5-6th day during menses of the
menstrual cycle, the secretory phase
endometrium was still seen

7. Clinical features
 Polymenorrhea (frequent menses)
Occurs following the child birth and abortion,
during adolescence and premenopausal
period
 Oligomenorrhea: light or infrequent menses
(adolescence and pre menopausal period)
 Menorrhagia: excessive and prolonged
mensus

8. Evaluation
 History
• Onset, frequency, duration, cyclic vs. acyclic,
severity
• Pain, change from menstrual pattern (calendar)
• Age, parity, marital status, sexual history,
contraception
• medications, pregnancies
• symptoms of pregnancy and reproductive tract
disease
 Physical Exam
• pelvic exam
• endometrial biopsy(endometrial cancer)

10. Treatment Goals of DUB
Adolescent
• Control bleeding
• Regulate menstrual cycle
• Induce ovulation
Reproductive age
• Stimulate follicle development
• Promote corpus luteum function
• Induce ovulation
Perimenopausal
• Control bleeding, reduce volume
• Regulate menstrual cycle
• Prevent endometrial cancer

11. Treatment of DUB-general
 Rest
 correction of anemia- diet ,hematenics and
blood transfusion

12. Treatment of DUB-Medical
management
 Hormones :Estrogens, progestins, or both
a. Norethisterone acetate
b. Medroxy progesterone acetate
c. Equine conjugated estrogen
d. Combined estrogen and progesterone pills
(OCP`S)

13. Treatment of DUB-Medical
management
 Antifibrinolytic agents-tranexamic acid
 Danazol for recurrent symptoms and waiting for
hysterectomy
 GnRH agonists: for infertile women who wants to
become pregnant.(reduces blood loss and produces
hypoestrogenic features)
 Hormonal IUD`s-levonorgestrel IUD effective for 5
years
 NSAID`s to reduce amount of menstrual bleeding
 Anti progesterones: mifepristone inhibit
ovulation,induce amenorrhea,and reduce myoma
size

14. Treatment of DUB
 Surgical Treatment
1.Dilation and Curettage
 quickest way to stop bleeding in patients who
are hypovolemic
 follow with medroxyprogesterone acetate or
OCP’s to prevent recurrence

15. Surgery treatment of DUB
 2.Endometrial ablation


Endometrial laser ablation
Electrosurgical endometrial ablation
Roller-ball endometrial ablation


 Radio-frequency-induced thermal endometrial
ablation
Microwave endometrial ablation
Uterine balloon therapy
 3.Hysterectomy