This document provides guidelines for the management of abnormal uterine bleeding (AUB). It discusses the various classifications of AUB according to etiology, including structural causes like fibroids and adenomyosis, and non-structural causes such as ovulatory dysfunction. Evaluation involves establishing a diagnosis through medical history, physical exam, imaging like ultrasound, and lab tests. Treatment depends on the classification and includes medical options, surgical interventions, and hormonal therapies tailored to patient symptoms, desires around fertility, and clinical findings. The goal is to establish normal menstrual patterns, correct anemia, and prevent long term consequences.
Infertility is typically defined as the inability to achieve pregnancy after
one year of unprotected intercourse. If you have been trying to conceive
for a year or more, you should consider an infertility evaluation.
AUB in ADOLESCENTS Dr. Jyoti Bhaskar Dr. Sharda Jain Dr. Jyoti AgarwalLifecare Centre
PREVALENCE
A population based study of 1000 adolescents:
Incidence of AUB is 40%
Out of those who have AUB
20% have bleeding disorders
Von Willebrand disease, 5%-36%;
Platelet function defects, 2%-44%;
Thrombocytopenia, 13%- 20%
Clotting factor deficiencies, 8%-9%.
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
Infertility is typically defined as the inability to achieve pregnancy after
one year of unprotected intercourse. If you have been trying to conceive
for a year or more, you should consider an infertility evaluation.
AUB in ADOLESCENTS Dr. Jyoti Bhaskar Dr. Sharda Jain Dr. Jyoti AgarwalLifecare Centre
PREVALENCE
A population based study of 1000 adolescents:
Incidence of AUB is 40%
Out of those who have AUB
20% have bleeding disorders
Von Willebrand disease, 5%-36%;
Platelet function defects, 2%-44%;
Thrombocytopenia, 13%- 20%
Clotting factor deficiencies, 8%-9%.
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
The focus of our discussion is "Menopausal Health," a crucial topic that warrants our attention due to its significant impact on women's well-being. We'll delve into various aspects including genitourinary symptoms, screening for cancers, HRT, postmenopausal bleeding, health tips etc
It’s common to feel discomfort around your abdomen, lower back, and thighs when you’re menstruating.
During your period, the muscles of your womb contract and relax to help shed built-up lining. Sometimes you’ll experience cramps, which are your muscles at work. Some women and girls may experience nausea, vomiting, headaches, or diarrhea as well.
A woman’s emotional wellbeing is as important as her physical health during pregnancy. Pregnancy can also bring up other emotionally charged issues, such as difficult family relationships, insecurities and unrealistic expectations, which may have previously been suppressed or ignored.
Is painless delivery safe? Is painless delivery really painless? Can labour be painless? Is epidural birth same as natural birth?
If you are one among those women, who plan to have a c-section only because of the fear of labor pains or
if you have a question “how to get normal delivery without pain?”; you have another option to bring your baby into this world without pain, known as “Painless delivery” or “Epidural delivery”.
Almost everyone knows the severity of the pain a woman has during natural birth. The pain a woman experiences during the process of childbirth is considered to be the most severe form of pain. And the survival after delivery is considered as the rebirth of the woman.
If you're older than age 35 and hoping to get pregnant, then this is for you. Many women are delaying pregnancy well into their 30s and beyond — and delivering healthy babies. Taking special care can help give your baby the best start.
Dental health (also called oral health) is the health of your mouth, teeth and gums. It’s an important part of your overall health. And if you’re pregnant, it’s an important part of your prenatal care. Being pregnant can increase your risk for oral health problems, and these problems can affect your pregnancy.
Hormones change quite a bit during pregnancy, causing fatigue, mood changes, and even changes in oral health. If you experience sensitivity or bleeding, swollen gums during pregnancy, you could be experiencing what’s called, “pregnancy gingivitis.” A rapid increase in hormones estrogen and progesterone can increase the flow of blood to your gum tissue. Hormonal changes also have the ability to impact the way the body fights infection, too. Because of this, it’s crucial to maintain good daily oral health habits and dental visits during your pregnancy.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
3. Burden of HMB in India
• 15% of all Gynae visits &
• 25% of all Gynae surgeries
4. Impact of AUB on Daily Life
Anxiety,
pscychological
Decreased QOL
Negative impact
on relationship
with partners
Pain &
Discomfort
Dec Work
Productivity
Iron Deficiency
Anemia
6. Abnormal Uterine Bleeding
ACOG1 NICE2
Bleeding from uterine
corpus that is abnormal in
a) regularity,
b) volume,
c) frequency, or
d) duration and
e) occurs in the absence of
pregnancy
When a woman
experiences a change in
a) her menstrual loss, or
b) the degree of loss or
c) vaginal bleeding pattern
differs from that
experienced by the age-
matched general female
population
NICE Guidance 2007ACOG: Obstet Gynecol 2013; 121(4):891-6
7. Acute and Chronic AUB
• Acute uterine bleeding unrelated to pregnancy was defined in
as “that which is sufficient in volume as to, in the opinion of
the treating clinician, require urgent or emergent intervention.”
(FIGO definition)
• Chronic: AUB present for most of the previous 6 months
ACOG Obstet Gynecol 2013
Munro Am J Obstet Gynecol 2012
9. Menstrual History
• Age at menarche
• Cycle length
• Duration of bleeding
• Perception of flow: light, medium or heavy
• First day of LMP
• Dysmenorrhoea
11. Blood Loss Assessment Tools
• Diagnostic tool
• Outcome (follow up tool)
1. Alkaline Haematin Method
2. Pictoral Blood Loss Assessment Chart
12. Pictoral Blood Loss Assessment Chart
A PBAC score of >150 points is most often used as an inclusion criterion in
HMB studies
13. Medical History
• Social History – social stressors, substance abuse,
exercise patterns or athlete
• Family History – bleeding or menstrual disorders,
diabetes & thyroid
• Past Medical History – systemic illness (hematologic or
renal disease), PCOD
• Drug History (current or recent medications, medical
abortion pill or ipill, drug induced hyperprolactinemia)
14. Medical History
Sexual History
• Contraceptive & condom use
• Number of partners
• H/o STIs (vaginal discharge, pelvic pain)
• Previous pregnancy loss or abortion
• H/o sexual abuse or assault
17. IMAGING
TVS
Doppler Ultrasonography (suspected AVM or malignancy)
3D USG (fibroid mapping)
Hysteroscopy/SIS (intracavitary lesion & type of myoma)
MRI (differentiate b/w fibroid & adenomyoma, fibroid mapping
pre surgery or prior to UFE)
18. Imaging: Transvaginal Ultrasound
• Evaluate uterus: Assessment of
myometrium, cervix, endometrial polyp,
adenomyosis, leiomyoma, uterine
anomalies & endometrial thickness
• Adnexa: any mass or cyst
19. Endometrial Histopathology
• In women > 40 years
• In women < 40 years with risk of cancer endometrium
(irregular bleeding, obesity associated with hypertension,
PCOD, diabetes, endometrial hyperplasia >12mm, family history
of cancer ovary, breast, endometrium or colon, use of tamoxifen
for HRT or breast cancer, late menopause or HNPCC (hereditary
non polyposis colon cancer syndrome)
Endometrial Aspiration (Not D&C)
20. Hysteroscopy
• To rule out endometrial polyps
• To look for submucus myoma
• Suspicious for malignancy: Polypoid
proliferations, ulceration & necrosis, friable
mass with irregular vessels
• Retained fetal bones following abortion (2nd
trimester)
21. Goals of Treatment
• Establish/maintain haemodynamic stability
• Correct acute or chronic anemia
• Return to a pattern of normal menstrual cycle
• Prevent recurrence
• Prevent long-term consequences (anemia, infertility,
endometrial cancer)
22. Waves of Change
2009 – FIGO Menstrual Disorders Group
2011 – PALM-COEIN classification system created
2012 – PALM-COEIN system endorsed by ACOG
FOGSI GUIDELINES SEP 2015
29. AUB-P (POLYPS)
• Symptoms – prolonged uncontrolled
bleeding or intermenstrual bleeding,
pallor or infertility
• Signs – Normal size uterus, cervical os
patulous if protruding fibroid polyp
• Imaging – Thickened endometrium
30. AUB-P (POLYPS)
• Single Polyp - Hysteroscopic polypectomy in women desirous
of fertility
• Multiple polyps – Hysteroscopic polypectomy f/b LNG IUS
insertion in women not desirous of fertility
HISTOPATHOLOGY if malignant, manage as AUB-M
31. AUB-A (ADENOMYOSIS)
• Symptoms – heavy bleeding, marked dysmenorrhoea
• Signs – uterus 12 weeks, uniformly enlarged & globular with or
without tenderness
• Imaging – Enlarged uterus not due to myoma, asymmetric
thickening of uterine wall, obscuring of endomyometrial
junction, heterogenous endometrium
32. AUB-A (ADENOMYOSIS)
• Depends on age and symptomatology
• Women desirous of preserving fertility
- First Line: LNG-IUS
- Second Line: GnRH agonist with add back therapy
• Women with infertility: adenomyomectomy
• Failure of medical management: Vaginal H/TLH
• Earlier: COCs, Danazol, NSAIDs or progesterone
34. AUB-L (LEIOMYOMA)
• Individualised – age, parity, symptoms, fertility desire
• Symptomatic subserous/intramural myomas(2-6)
- Desirous of fertility (Tranexa, NSAIDs, COCs)
- Not desirous of fertility for 1 year – LNG IUS if medical
treatment fails
• Myomectomy if medical treatment fails or interfering with
fertility
• Hysterectomy if age >40 years & family complete
• GnRH agonists for short-term management
35. AUB-L (LEIOMYOMA)
• For long-term management, LNG-IUS except in type 0 &1
• Newer promising options:
- Mifepristone 5 to 10mg
- Ulipristal acetate 5mg
36. AUB-M (MALIGNANCY
• Symptoms – postmenopausal bleeding,
irregular perimenopausal bleeding
• Signs – normal to mildly enlarged, restricted
mobility
• Imaging – thickened endometrium on USG,
irregular endometrial lining, loss of
endomyometrial junction
37. AUB-M (MALIGNANCY &
ENDOMETRIAL HYPERPLASIA)
• Ca endometrium: standard protocol
• Endometrial hyperplasia with atypia: Hysterectomy
• Endometrial hyperplasia without atypia: LNG-IUS or oral
progestins
38. AUB- C (Coagulopathy)
• Heavy menstrual bleeding since menarche
• One of the following:
- Postpartum haemorrhage (PPH)
- Surgical site bleeding
- Bleeding associated with dental work
• Two or more of the following:
- Bruising/epistaxis 1 to 2 times per month
- Frequent gum bleeding
- family history of bleeding symptoms
39. AUB- C (Coagulopathy)
• Symptoms – puberty menorrhagia, heavy bleeding at
menarche, H/o bleeding diathesis, family history
• Signs – uterus normal size, pallor, easy bruisability,
petechiae
• Imaging – thickened endometrium on USG, irregular
endometrial lining, loss of endomyometrial junction
40. AUB-C (Coagulopathy)
AUB due to
coagulopathy
Secondary
Option
(Hormonal
treatment)
COCs/LNG-
IUS
Tranexemic
acid
Primary
option (Non
Hormonal
treatment)
After consultation with Haematologists
Specific Factor Replacement CI – NSAIDS & IM prep
41. AUB-O (Ovulatory Dysfunction)
• Symptoms – of PCOD, irregular cycles, insulin
resistance
• Signs – uterus normal size
• Imaging – PCOD on ultrasound, thickened
endometrium
43. AUB-O
• Not planning conception: COCs for 6-12 months (Grade A Level 1)
• Cyclical luteal phase progesterone (x 10-14 days) (Grade A, Level 1)
• In acute episode of bleeding - Norethisterone cyclically for 21
days for 3 months (Grade B, Level 4)
44. AUB-O
• Surgical intervention: if persistent AUB or failure of medical
treatment
• LNG-IUS, if patient is unwilling for COCs or they are
contraindicated
46. AUB-E (Endometrial)
• Primary disorder of the endometrium
• Secondary to endometrial inflammation or infection
• Abnormalities in local inflammatory response
• Abnormalities in endometrial vasculogenesis
- Deficiency of vasoconstrictors (PGF2alpha & Endothelin 1)
- Increased production of vasodilators (PG E2 & PGI2)
- Increased production of plasminogen activators
Management similar
to AUB-O
47. AUB –I (Iatrogenic)
• Symptoms – H/o use of CuT
• Signs – No abnormality
• Imaging – Uterus normal, CuT in
situ
48. AUB –I (Iatrogenic)
• Unscheduled endometrial bleeding or
Breakthrough bleeding (BTB)
– Using OCs, P, E, androgens
– Use of GnRH agonists, SERMs, heparin or
anticoagulants
– IUD or implant related bleeding
• Cigarette smoking
Recommendation:
LNG IUS
49. AUB –N (Not Yet Classified)
• Symptoms – heavy menstrual bleeding
• Imaging – ultrasound, doppler USG to rule out AVM
50. AUB –N (Not Yet Classified)
• Disorders that would be identified only by biochemical or
molecular biology assays
• AVM (Arteriovenous malformation)
• Myometrial hypertrophy
51. AUB –N (Not Yet Classified)
• Women who desire effective contraception: LNG-IUS or
COCs
• Women with predictable or cyclical bleeding: Tranexa
or NSAIDs
Editor's Notes
References:
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891-6.
NICE quality standards. Heavy menstrual bleeding. Available at: http://www.nice.org.uk/guidance/QS47 (Last accessed: 11.09.2015).