abnormal uterine bleeding , definition cause and investigation required and its treatment

1. ABNORMAL UTERINE BLEEDING
Pinky Antony

2. OBJECTIVE
 IMPORTANCE OF LEARNING AUB
 DEFINITION
 TYPES OF AUB
 PREVALENCE
 AGE GROUP
 CAUSES OF AUB
 FIGO CLASSIFICATION FOR MENSTRUAL DISORDERS
 DIAGNOSIS
 INVESTIGATIONS
 TREATMENT

3. IMPORTANCE OF LEARNING AUB
 1-2% UNTREATED AUB MAY DEVELOP ENDOMETERIAL CANCER
 UNNECESSARY CURETTAGES
 UNNECESSARY HYSTERECTOMIES
 PROPER WORK UP AND MEDICAL MANAGEMENT IS MOST APPROPRIATE
IN MAJORITY AUB

4. DEFINITION
 Menstrual Bleeding That Is Unpredictable, abnormally Heavy Or Abnormal In
Timing
 Any Deviation From Normal Frequency (21 To 30 Days), Amount Of
Bleeding, Duration 3-7 Days In Woman Of Reproductive Age.

5. TYPES OF AUB
 ACUTE EMERGENT : Bleeding is characterized by a significant loss that result
in hypovolemia or shock
 CHRONIC : Menstrual abnormality that occurs slowly over a period of six
months

6. PREVALENCE
 10-20% of OPD Patients
 Affect 1/3 of women at some stage in their life.

7. AGE GROUP
 ADOLESCENTS – 20%
 AGE BETWEEN 40–50 YEARS – 50%
 REPRODUCTIVE AGE – 30%

8. CAUSES OF AUB
 PELVIC PATHOLOGY – PCOS (Poly Cystic Ovary Syndrome)
 PREGNANCY RELATED CONDITION – Abortions, Ectopic, Gestational
trophoblastic diseases
 COAGULATION AND HAEMATOLOGICAL PROBLEMS
 MEDICAL PROBLEMS – Thyroid, Liver, Hepatic
 IATROGENIC
 DYSFUNCTIONAL UTERINE BLEEDING

9. FIGO CLASSIFICATION FOR
MENSTRUAL DISORDERS
 PALM-COEIN CLASSIFICATION
 P – Polyp
 A – Adenomyosis
 L – Leiomyoma
 M – Malignancy
 C – Coagulopathy
 O – Ovulatory disfunction
 E – Endometrium
 I – Iatrogenic
 N – Not yet classified
(International federation of gynaecology and obstetric 2011 published by Elsevier Ireland
Ltd)

10. DIAGNOSIS
 DETAILED HISTORY
 GENERAL EXAMINATION : Anemia, Goiter
 PER SPECULAM EXAMINATION : Polyps, Growths
 BIMANUAL PELVIC EXAMINATION : To exclude any palpable pelvic pathology
 RECTAL EXAMINATION : To exclude any palpable pelvic pathology
 HYSTEROSCOPY : The gold standard in the assessment of AUB

11. INVESTIGATIONS
 CBC
 PAP SMEAR
 ULTRASONOGRAPHY – Pelvis
 HYSTEROSCOPY
 SALINE INFUSION SONOGRAPHY
 ENDOMETRIAL BIOSCOPY
 PREGNANCY TEST
 HORMONAL TESTS – TSH, Serum Prolactin
 COAGULATION PROFILE
 LFT

12. TREATMENT
 DEPENDS ON :
AGE, FERTILITY DESIRE, COEXISTING MORBID CONDITIONS.
 GENERAL TREATMENT :
Explanation and reassurance
Maintaining menstrual calendar,
weight reduction
Treatment of anemia
Lifestyle modification

13.  ACUTE AUB :
Admission
IV fluids
Blood transfusion,
Inj Premarin
Oral conjugate estrogens 1.25 or 2.5 mg cyclically with progesterone 10mg
supplementation for later 12 days.
Hysteroscopy
 CHRONIC AUB : Medical management (it can be hormonal or non hormonal)

14. SURGICAL MANAGEMENT
 CONSERVATIVE SURGICAL : Endometrial ablation techniques
 RADICAL TREATMENT : Myomectomy, hysterectomy

15. THANK YOU