Dysfunctional uterine bleeding

6,905 views

Published on

0 Comments
25 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
6,905
On SlideShare
0
From Embeds
0
Number of Embeds
81
Actions
Shares
0
Downloads
557
Comments
0
Likes
25
Embeds 0
No embeds

No notes for slide

Dysfunctional uterine bleeding

  1. 1. Dysfunctional Uterine Bleeding (DUB)<br />www.freelivedoctor.com<br />
  2. 2. Definition<br />an abnormal uterine bleeding without an obvious organic abnormality (neoplasma, pregnancy, inflammation, trauma, blood dyscrasia,hormoneadminstration,at el)<br />unnormal releasing of sex hormones<br />www.freelivedoctor.com<br />
  3. 3. Anovulatory functional bleeding<br />ovulatory functional bleeding<br />DUB occur in <br /> before the menopause(50%)<br /> after menarche(20%) <br /> in reproductive times(30%).<br />www.freelivedoctor.com<br />
  4. 4. Anovulatory functional bleeding<br />www.freelivedoctor.com<br />
  5. 5. Etiology of DUB:<br />1. disorders of<br />hypothalamus---pituitary ---ovary axis<br /><ul><li>immature of feedback regulation in young women
  6. 6. ovarian function failure in climacteric women</li></ul>2.other Factors:<br /><ul><li>the effects of sex hormones
  7. 7. nervous
  8. 8. circumstance
  9. 9. PCOS,TSH↑,PRL↑
  10. 10. excessive physical exercise</li></ul>www.freelivedoctor.com<br />
  11. 11. Pathology<br />Change in the endometrium<br /><ul><li>simple hyperplasia(Cystic hyperplasia , benign)
  12. 12. complex hyperplasia(Adenomatous hyperplasia ,precursor of carcinoma)
  13. 13. atypital hyperplasia(10%-25%-> carcinoma)
  14. 14. proliferative phase of endometrium (no secretive change )
  15. 15. atrophic endometrium</li></ul>www.freelivedoctor.com<br />
  16. 16. Mechanisms<br />Anovulation ----<br /><ul><li>have developing folliculi
  17. 17. no mature follicle
  18. 18. no corpus luteum
  19. 19. only have estrogen, but no progestin
  20. 20. breakthrough bleeding, spoting</li></ul>www.freelivedoctor.com<br />
  21. 21. Clinical presentation<br /><ul><li>oligomenorrhea.
  22. 22. polymenorrhea
  23. 23. hypermenorrhea
  24. 24. hypomenorrhea
  25. 25. irregular intervals and duration</li></ul>www.freelivedoctor.com<br />
  26. 26. Diagnosis<br />1.History<br /><ul><li> history of age of menarche,
  27. 27. initial regularity of cycle,
  28. 28. cycle length, amount, duration of flow,
  29. 29. parity, contraceptive pill
  30. 30. abortion, ectopic pregnancy,
  31. 31. endometriosis,
  32. 32. pelvic inflammatory disease</li></ul>www.freelivedoctor.com<br />
  33. 33. <ul><li> hemorrhagic diseases,
  34. 34. endocrinopathies,
  35. 35. traumas,
  36. 36. nutritional status</li></ul> To decide :the dysfunctional bleeding or anatomic abnormality<br />www.freelivedoctor.com<br />
  37. 37. 2.physical examination<br /> pelvic vaginal examination (PV)<br />3.laboratory diagnosis<br /><ul><li>bleed count, coagulation studies,
  38. 38. endocrine studies
  39. 39. curettage</li></ul>www.freelivedoctor.com<br />
  40. 40. Treatment<br />medicine treatment<br />1. to arrest the acute bleeding<br /><ul><li>progesterone--- secretive change,
  41. 41. high doses of estrogen---rapid hemostasis</li></ul>2.maintenance therapy<br />( restoration of normal menstruation, artificial cyclical therapy )<br /><ul><li> cyclic estrogen-progestin therapy
  42. 42. cyclic low dose oral contraceptive for 3 month ( for adolescent)
  43. 43. continue cyclic low dose oral contraceptive,( no fertility demands)</li></ul>3. induce ovulation <br />Clomiphene, HMG, FSH,GnRH)<br />www.freelivedoctor.com<br />
  44. 44. Curettage<br />for adults<br /> rarely use for teenagers unless bleeding is very severe)<br />aims<br />1.arrest an acute severe bleeding quickly and effectively<br /> 2.to prevent chronic recurrence of DUB<br /> 3.diagnosis<br />www.freelivedoctor.com<br />
  45. 45. Hysterectomy:<br /><ul><li>for older patient,
  46. 46. never been done in adolescent</li></ul>www.freelivedoctor.com<br />
  47. 47. Ovulatory functional bleeding<br /> A significant percentage of patient is women of childbearing age.<br />1.Luteal phase defect<br />Pathology :<br /><ul><li>corpus luteum is short-lived
  48. 48. luteal phase is short
  49. 49. inadequate secretion ofprogesterone</li></ul>www.freelivedoctor.com<br />
  50. 50. Clinical presentation<br /><ul><li> polymenorrhea-
  51. 51. premenstrual staining</li></ul>diagnosis<br /><ul><li> basal body temperature (BBT)—-bi-directional
  52. 52. endometrium biopsy specimen taken just before menses reveal to bad for secretive phase</li></ul>www.freelivedoctor.com<br />
  53. 53. treatment<br /><ul><li> HCG (5000-10000U 14th day)
  54. 54. progestin(15th day X 10 days)
  55. 55. ovulation induction </li></ul> (Clomiphone, HMG, FSH,<br /> mature follicle --- good corpus luteum)<br />www.freelivedoctor.com<br />
  56. 56. 2. Irregular shedding of endometrium<br />pathology<br /><ul><li>persistent corpus luteum
  57. 57. estrogen and progesterone maintain to effect the endometrium</li></ul>www.freelivedoctor.com<br />
  58. 58. Clinical presentation: <br /><ul><li> delayed onset of menses with hypermenorrhea
  59. 59. Regular cycles with hypermenorrhea</li></ul>Diagnosis:<br /> endometrium biopsy specimen taken on 5th days after the onset of bleeding, reveal a mixture of persistent secretive glands with the proliferative glands <br />www.freelivedoctor.com<br />
  60. 60. Treatment<br /><ul><li>progestin ( 5 days before next menstruation, feedback)
  61. 61. ovulation induction </li></ul>www.freelivedoctor.com<br />

×