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Dysfunctional uterine bleeding


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Dysfunctional uterine bleeding

  2. 2. Background DUB is irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy. It reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. The bleeding is unpredictable in many ways. It may be excessively heavy or light and may be prolonged, frequent, or random. About 1-2% of women with improperly managed anovulatory bleeding eventually may develop endometrial cancer.
  3. 3. Signs and symptoms DUB should be suspected in patients with unpredictable or episodic heavy or light bleeding despite a normal pelvic examination. Typically, the usual moliminal symptoms that accompany ovulatory cycles will not precede bleeding episodes.
  4. 4. Signs and symptoms Because DUB is considered a diagnosis of exclusion, the presence or absence of signs and symptoms of other causes of anovulatory bleeding must be determined. Patients who report irregular menses since menarche may have polycystic ovarian syndrome (PCOS). PCOS is characterized by anovulation or oligo-ovulation and hyperandrogenism. These patients often present with unpredictable cycles and/or infertility, hirsutism with or without hyperinsulinemia, and obesity.
  5. 5. Signs and symptoms Thyroid enlargement or manifestations of hyperthyroidism or hypothyroidism Galactorrhea: May suggest hyperprolactinemia Visual field deficits: Raise suspicion of intracranial/pituitary lesion Ecchymosis, purpura: Signs of bleeding disorder
  6. 6. Diagnosis Laboratory studies  Human chorionic gonadotropin (HCG)  Complete blood count (CBC)  Papanicolaou test (Pap smear)  Endometrial sampling  Thyroid functions and prolactin  Liver functions  Coagulation studies/factors
  7. 7. Diagnosis Imaging studies  In obese patients with a suboptimal pelvic examination or in patients with suspected ovarian or uterine pathology, pelvic ultrasonographic evaluation may be helpful.  Ultrasonography can be used to identify uterine fibroids, as well as endometrial conditions, including hyperplasia, carcinoma, and polyps. Procedures  Rule out endometrial carcinoma in all patients at high risk for the condition  Traditionally, carcinoma was ruled out by endometrial sampling via D&C. However, endometrial sampling in the office via aspiration, curetting, or hysteroscopy has become popular and is also relatively accurate.
  8. 8. Management Pharmacologic treatment  Oral contraceptives: Suppress endometrial development, reestablish predictable bleeding patterns, decrease menstrual flow, and lower the risk of iron deficiency anemia  Estrogen: Prolonged uterine bleeding suggests the epithelial lining of the cavity has become denuded over time; estrogen administered alone will rapidly induce a return to normal endometrial growth  Progestins: Chronic management of DUB requires episodic or continuous exposure to a progestin  Desmopressin: A synthetic analogue of arginine vasopressin, desmopressin has been used as a last resort to treat abnormal uterine bleeding in patients with documented coagulation disorders
  9. 9. Management Hysterectomy may be necessary in patients who : have failed or declined hormonal therapy, have symptomatic anemia, and are experiencing a disruption in their quality of life from persistent, unscheduled bleeding. Endometrial ablation is an alternative for patients who wish to avoid hysterectomy or who are not candidates for major surgery.
  10. 10. THANK YOU