This document summarizes the management of abnormal uterine bleeding in perimenopausal women. It discusses how perimenopause causes irregular menstrual periods due to declining estrogen levels. It describes anovulatory bleeding that can occur when the corpus luteum is not produced. The document introduces the new FIGO classification system for abnormal uterine bleeding and lists common causes like polyps, fibroids, and disorders like adenomyosis. It provides details on diagnostic tests and treatments including medications, intrauterine devices, endometrial ablation, and hormone therapy options. Surgical treatments for heavy menstrual bleeding or postmenopausal bleeding are also summarized.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Menstrual cycle irregularities can have many different causes. For some women, use of birth control pills can help regulate menstrual cycles. However, some menstrual irregularities can't be prevented. Regular pelvic exams can help ensure that problems affecting your reproductive organs are diagnosed as soon as possible.
A case study interactive presentation illustrating the importance of identifying the cause of irregular bleeding in the reproductive age, the new FIGO classification and the role of progestogen supplementation in the treatment of irregular bleeding. The contents were modified from a presentation given online by Professor Peter HM van de Weijer, MD, PhD
University of Auckland- Waitemata District Health Board- Auckland, New Zealand and ccessible at peervoice.com
Abnormal uterine bleeding can occur when a woman experiences a change in menstrual loss, or the degree of loss or vaginal bleeding pattern differs from that experienced by the age-matched general female population
AUB is not restricted to menstrual bleeding that is abnormally heavy, but includes bleeding that is abnormal in TIMING
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Menstrual cycle irregularities can have many different causes. For some women, use of birth control pills can help regulate menstrual cycles. However, some menstrual irregularities can't be prevented. Regular pelvic exams can help ensure that problems affecting your reproductive organs are diagnosed as soon as possible.
A case study interactive presentation illustrating the importance of identifying the cause of irregular bleeding in the reproductive age, the new FIGO classification and the role of progestogen supplementation in the treatment of irregular bleeding. The contents were modified from a presentation given online by Professor Peter HM van de Weijer, MD, PhD
University of Auckland- Waitemata District Health Board- Auckland, New Zealand and ccessible at peervoice.com
Abnormal uterine bleeding can occur when a woman experiences a change in menstrual loss, or the degree of loss or vaginal bleeding pattern differs from that experienced by the age-matched general female population
AUB is not restricted to menstrual bleeding that is abnormally heavy, but includes bleeding that is abnormal in TIMING
Insight AUB Management Guidelines on AUB in Reproductive PeriodLifecare Centre
DISCLAIMER
Use of these slides is permitted only for the purpose of scientific and educational presentations.
While every reasonable effort has been made to ensure accuracy of content, it is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. DGF shall not be responsible or in any way liable for the continued accuracy &/or veracity of the information or for any errors, omissions or inaccuracies or for any injury and/or damage to persons or property arising from relying on the information contained in the presentation or otherwise.
D.G.F. CME CASE STUDY DISCUSSIONAbnormal Uterine BleedingLifecare Centre
D.G.F. CME CASE STUDY DISCUSSIONAbnormal Uterine Bleeding
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Miscarriage is pregnancy loss before 22 weeks’ gestation based on the LMP or if gestation age is unknown, it is the loss of an embryo or a fetus of less than 500g.
HYPEREMESIS GRAVIDARUM (intractable nausea and vomiting during pregnancy typi...ambreenabatool110
It is really important to know about such conditions these conditions help us out to differentiate hyperemesis gravidarum form other diseases. Better way to manage its symptoms. Knowledge can built a better environment.
The term metrorrhagia is often used for irregular menstruation that occurs between the expected menstrual periods. Oligomenorrhea is the medical term for infrequent, often light menstrual periods (intervals exceeding 35 days). Amenorrhea is the absence of a menstrual period in a woman of reproductive age.
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.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
Evaluation of antidepressant activity of clitoris ternatea in animals
Abnormal Uterine Bleeding in Perimenopausal Women
1. Management of
Abnormal Uterine Bleeding
in Perimenopausal Women
Dr.Fariha Farooq
Assoc.Prof.Obs & Gynae
Akhtar Saeed Medical & Dental College
2.
3. Perimenopause
• Perimenopause (around menopause) is a
transition phase, begins several years
before menopause.
• Estrogen levels gradually decline.
• Irregular menstrual periods, hot flashes,
vaginal dryness, sleep disturbances, and
mood swings are common, normal signs of
perimenopause.
6. Anovulatory Bleeding
• Corpus luteum is not produced
– Ovary fails to secrete progesterone
– Continuous, unopposed E stimulation of
endometrium:
• Endometrial proliferation without P-induced
differentiation / stabilization
– Endometrium becomes excessively
vascular without stromal support
fragility and irregular endometrial
bleeding
9. Abnormal Uterine Bleeding
New Terminology by FIGO
Term HMB (Heavy mentrual bleeding)
has replaced the term Menorrhagia:
Bleeding that occurs at regular intervals,
loss of ≥ 80 mL blood per
DUB has been replaced by
BEO(Bleeding of Endometrial origin)
26. Anovulatory Bleeding:
Later Reproductive Age (40-Menopause)
• Incidence of anovulatory bleeding
increases due to declining ovarian
function.
• Incidence of endometrial CA in women
40-49 years: 36.2/100,000
• All women >40 yrs who present with
suspected anovulatory bleeding merit
endometrial bipsy.
29. Diagnosis of Abnormal uterine
bleeding
• Medical history
• Physical examination
• Laboratory tests
• Imaging tests
30. • Age of onset of menses
• Frequency/duration of menses
• Quantity of flow,number of pads,passage of
clots and flooding
• Intermenstrual bleeding
• Postcoital bleeding
• Dyspyerunia
• Use of contraceptives/medication
• Family history of menarche,
menopause,malignancy
AUB-History
31. AUB-History
• Pelvic Pain
• Postcoital pain
• Vaginal Discharge
• Excessive bruising/bleeding from other
sites
• History of post partum haemorrhage
• Family history of bleeding problems
• Urinary symptoms
• Weight change ,heat or cold intolerance
• Stress
33. Examination
• GPE
Assess for obesity, hirsutism, stigmata of
thyroid disease (hypothyroidism associated
with anovulation), signs of
hyperprolactinemia (visual field testing,
galactorrhea)
• ABDOMINAL EXAMINATION
Abdominal masses
34. • CBC,Coagulation screen
– Assays for thyroid hormone
• HVS,endocervical swab,Pap smear
• Pelvic ultrasound
– Abdominal/Transvaginal Ultrasonography (TVS)
– Sonohysterography,saline infusion
• Endometrial biopsy
– Endometrial sampling by Pipelle
– Hysteroscopy
– Dilation and Curettage (D&C)
Biopsy should be performed as first line test(ACOG)
• Aged >45 years
• Irregular or intermenstrual bleeding
CT scan and MRI(special circumstances))
Laboratory and Imaging Tests
43. Composition
•Composed of estradiol-17 valerate and cyproterone
acetate
* Presented in calendar packs of 21 tablets each
* First 11 tablets contain estrogen only; the other 10
contain
both hormones
Climen
44. Contraindications of HRT
• PREVIOUS THROMBOEMBOLIC
DISEASE
• IMPAIRED LFT/ LIVER DISEASE
• CARCINOMA BREAST
• CARCINOMA ENDOMETRIUM
• FIBROIDS &ENDOMETRIOSIS(relative)
HYPERTENTION,DIABETES,CARDIO
-VASCULAR DISEASE ARE NOT C/I
47. What is Mirena®
used for?
Indications:
–Contraception
–Treatment of heavy menstrual
bleeding (idiopathic menorrhagia)
–Protection from endometrial
hyperplasia during oestrogen
replacement therapy
48. Endometrial effects with Mirena®
Before Mirena®
Endometrial changes
Ovulation
Menstruation
Reduced
menstruation
After Mirena®
Ovulation
52. • Defintion:
Post menopausual bleeding is defined as:
vaginal bleeding after the menopause in
women who are not taking HRT.
• Aetiology:
• Atrophic vaginitis
• Endometerial polyp
• Endometerial hyperplasia
• Endometerial carcinoma
• Cervical carcinoma
Post menopausal bleeding
53. MANAGEMENT OF PMB
Diagnosis Management
Atrophic vaginitis Topical oestrogen cream, oestrogen pessaries or
estringTM
oestrogen ring pessary.
Cervical polyp Remove via speculum examination using polyp forceps
Endometrial polyp Remove under direct visualization at hysteroscopy
Simple
hyperplasia
Progestogens: oral preparation or LNG-IUS (Mirena)
Complex
hyperplasia
Progestogens: oral preparation or LNG-IUS (Mirena)
Atypical
hyperplasia
Total abdominal hysterectomy as significant risk of
progression to malignancy.
Endometrial
cancer
Total abdominal hysterectomy + BSO + Washings ±
adjuvant therapy.
There are three indications for Mirena®:
Contraception
Treatment of heavy menstrual bleeding (idiopathic menorrhagia)
Endometrial protection during oestrogen replacement therapy.
This presentation will focus on the use of Mirena® for the treatment of
heavy menstrual bleeding.
Currently, Mirena® is marketed in 113 countries and has market authorisation in a further 15 countries. As of December 2012, there have been 28.4 million cumulative Mirena® placements since launch, corresponding to 83.4 million cumulative women-years of experience.
This figure shows the endometrial changes that occur with Mirena use, compared with the ‘normal’ cyclical changes observed without Mirena® use.
Mirena® induces profound morphological and biochemical changes in the endometrium, mainly as a result of the high endometrial levonorgestrel concentration. This downregulates endometrial oestrogen and progesterone receptors, making the endometrium insensitive to circulating oestradiol (thereby suppressing endometrial growth).1,2
After only a couple of months of Mirena® use, the glands of the endometrium atrophy, the stroma becomes swollen and decidual, the mucosa thins and the epithelium becomes inactive. Vascular changes include a thickening of arterial walls, suppression of the spiral arterioles and capillary thrombosis.3 An inflammatory reaction characterised by an increase in neutrophils, lymphocytes,
plasma cells and macrophages is described3,4 and focal stromal necrosis may also occur.2,4
The endometrium becomes uniformly atrophic and suppressed within 3 menstrual cycles after Mirena® placement,3 and persists in this thin, inactive state with no further histological development taking place over the long-term.2
The initial changes in the endometrium caused by Mirena® may be associated with irregular bleeding or spotting, particularly in the first few months of treatment. With Mirena® use, once the endometrial effects are established, bleeding becomes less in quantity than usual, or may cease altogether.
Following Mirena® removal, the morphological changes in the endometrium revert to ‘normal’, and menstruation has been reported from as early as the first month afterwards.5
References
Pakarinen PI, et al. Hum Reprod 1998; 13: 1846–53.
Silverberg SG, et al. Int J Gynecol Pathol 1986; 5: 235–41.
Zhu PD, et al. Contraception 1989; 40: 425–38.
Phillips V, et al. J Clin Pathol 2003; 56: 305–7.
Nilsson CG & Lahteenmaki P. Contraception 1977; 15: 389–400.