Dysfunctional uterine bleeding

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Dysfunctional uterine bleeding

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Dysfunctional uterine bleeding

  1. 1. DYSFUNCTIONAL UTERINE BLEEDING By, Nazni Nazar 2009 MBBS
  2. 2. ABNORMAL UTERINE BLEEDING • The menstrual bleed that is abnormally heavy or abnormal in timing • Assessment- • Causes- 1. DUB 2. Pelvic pathology 3. Pregnancy related conditions 4. Coagulation &hematological problems 5. Medical problems 6. iatrogenic
  3. 3. PALM –COEIN classification Structural causes • Polyp • Adenomyosis • Leiomyoma- submucosal and other • Malignancy & hyperplasia Non-structural causes • Coagulopathy • Ovulatory dysfunction • Endometrial • Iatrogenic • Not yet classified
  4. 4. CLINICAL TYPES 1. Menorrhagia (hypermenorrhea): prolonged (>7 days) and/or excessive (>80ml) uterine bleeding occurring at REGULAR intervals. [Fibroids,hematological problems] 2. Polymenorrhea: shortened cycles- uterine bleeding at regular intervals of <21 days.[Endometriosis, PID] 3. Oligomenorrhea: uterine bleeding at regular intervals from 6weeks to 6 months.[hormonal
  5. 5. CLINICAL TYPES…. 4. Metorrhagia: acyclical and intermenstrual uterine bleeding.[surface lesions-cervical polyps,erosions,cervical ca] 5. Menometorrhagia: uterine bleeding that is prolonged and occurs at completely irregular intervals.
  6. 6. DYSFUNCTIONAL UTERINE BLEEDING • Abnormal uterine bleeding with no demonstrable organic cause, genital or extragenital. • Diagnosis by exclusion • abnormal releasing of sex hormones 50% at near menopause 20% in adolescents  30% at reproductive age
  7. 7. pathophysiology • ANOVULATORY(80%) • OVULATORY (20%)
  8. 8. Anovulatory DUB • Irregular cycle,short cycles with scanty flow or period of amenorrhoea • Due to alteration in hypothalamic-pituitary axis corpus luteum not formed failure of the cyclical secretion of progesterone continuous unopposed production of estradiol stimulates overgrowth of the endometrium endometrium grows thick ,outgrows its blood supply necrosis and irregular bleeding
  9. 9. In adolescents and in perimenopausal women, the bleeding may be triggered by estrogen withdrawal • Threshold bleeding-low estrogen and atropic endometrium[lactation,menopause] • Metropathia hemorrhagica-periods of amenorrhoea followed by prolonged heavy bleeding[hyperestrogenism]
  10. 10. Ovulatory DUB: • Presents as menorrhagia • A less common cause of DUB • caused by a defect in local endometrial hemostasis • Absence of progesterone Alterations in prostaglandin production, with more PGE2 PGI2 [vasodilation and antiplatelet] and less PGF2[vasoconstriction] , increased fibrinolytic activity bleeding
  11. 11. • Irregular ripening-premenstrual spotting • Irregular shedding-prolonged mensus and postmenstrual spotting. • IUCD insertion • Following sterlization operation
  12. 12. Adolescent age group • Prevalance -50% • Hypothalamic-pituitary axis is still immature • Estrogen withdrawal bleeding-as it takes time to establish positive feedback and lh surge well. • An irregular period with prolonged excessive flow is suggestive of DUB
  13. 13. REPRODUCTIVE AGE GROUP • DUB less common • H/o heavy regular cyclical bleedingover several consecutive cycles. • Intermenstrual bleeding-polyp • Post coital bleeding-premalignancy
  14. 14. Perimenopausal age group • Anovulatory DUB more common • Metropathia

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