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Abnormal Uterine Bleeding.pptxAbnormal Uterine Bleeding.pptx
- 1. Abnormal Uterine Bleeding Presenter: Muhammad Eimaduddin bin Sapiee @ Muhammad Syafiei Iffah Supervisor : Dr Nazihah Dr Sumayyah
- 2. Menstrual Cycle ●Definition :cyclic uterine bleeding caused by shedding of secretory endometrium ●Characteristics ●Menarche : the first menstrual period of female(10-16 years old) ●Duration : 2-7 days ●Amount : 20-80ml ●Length : 3-5 weeks ●Cycle : 21-35 days
- 4. Abnormal Bleeding fromGenital Tract ●Duration ●Menorrhagia - prolonged or excessive uterine bleeding ●Hypomenorrhea - short or scanty uterine bleeding ●Length of cycle ●Polymenorrhea - menstrual cycles < 21 days ●Oligomenorrhea - menstrual cycles > 35 days
- 7. AUB Classification byFIGO(PALM- COEIN) ●Polyp ●Adenomyosis ●Leiomyoma ●Malignancy and hyperplasia ●Coagulopathy ●Ovulatory dysfunction ●Endometrial ●Iatrogenic ●Not yet classified
- 11. Endometrial polyps ●Localized overgrowthtissue, containing glands, stroma, and blood vessels, covered with epithelium ●Stimulated by estrogen ●Diagnosed by visualization and removal by hysteroscopy ●Send for HPE to exclude malignancy
- 14. Adenomyosis ●Extension of endometrialglands and stroma in the uterine myometrium ●Common in patient with multipara and history of LSCS, D&C, and spontaneuous abortion ●Patient came with menorrhagia, secondary dysmenorrhea and pressure symptoms ●Enlarged asymmetrical uterus on TAS ●Definite treatment by surgical intervention ie : total abdominal hysterectomy
- 16. Leiomyoma (Fibroids) ●Benign tumorsof the uterine myometrium ●Estrogen dependent ●Common in child bearing age, black, and nulliparous ●Classified according to site : submucous, intramural and subserous fibroids ●Can cause bleeding by increased vascularity of uterus(red degeneration in pregnancy), endometrial hyperplasia, ovarian congestion or malignant changes
- 20. ●Most of fibroidsare asymptomatic that need no intervention ●Intervention needed if give rise to symptoms like bleeding, pain, infertility, and huge size that lead to compressive symptoms ●Investigation by ultrasonography, HSG, hysteroscopy and CT/MRI ●Definitine treatment are surgical intervention ●Myomectomy -want to keep uterus ●Hysterectomy -when myomectomy contraindicated
- 21. Malignancy ●Most common cancersin woman are cervical and endometrial cancers ●Usually presented with painless PV bleed(coital bleed or intermenstrual bleeding) ●Risk factors : prolonged exposure to hyperestrogenic state ●Chronic anovulation ●PCOS ●Obesity ●Nulliparity ●Iatrogenic (on HRT)
- 22. ●Opportunistic screening bypap smear and endometrial sampling in risky groups ●In highly suspicion of malignancy, for tumor markers and imaging investigations ●Definite diagnosis by HPE ●Treatment by surgical, radiotherapy or chemotherapy
- 28. Coagulopathy ●Presence of bloodcoagulation disorder in patients that lead to heavy menses ●Examples like von Willebrand disease, prothrombin deficiency, leukemia, idiopathy thrombocytopenic purpura, and hypersplenism ●May presented with epistaxis, bleeding gum or ecchymosis ●Treat according to symptoms and causes ●Referral to hematologists
- 29. Ovulatory dysfunction ●Alteration inneuroendocrine function ●Continuous estradiol production without corpus luteum formation and progesterone production thus causing excessive proliferation of endometrium lead to necrosis ●Anovulatory bleeding commons in early years after menarche due to immaturity of HPO axis and perimenopausal woman due to lack of synchronization of HPO
- 31. ●Anovulation causes by ●Extremesof reproductive life ●PCOS ●Hypothalamic dysfunction ●Abnormalities of other hormones(thyroid, prolactin, and cortisol)
- 33. Iatrogenic ●Abnormal uterine bleedingfrom medication ●Hyperprolactinemia from CNS dopamine antagonism of drugs like risperidone ●COC and POP can cause breakthrough bleeding ●Common meds like ●Selective estrogen receptor modulators(Tamoxifen) ●Gonadotropin releasing hormone agonists and antagonists
- 34. Endometrial ●Previously known asdysfunctional uterine bleeding (DUB) ●Abnormal uterine bleeding not attributable to any systemic cause or organic lesion in genital tract ●Diagnosis of exclusion ●Classified into cyclic and acyclic ●Dysfunctional polymenorrhea due to short proliferative or secretory phase ●Dysfunctional menorrhagia due to irregular ripening or regular shedding
- 35. Not Otherwise Specified ●Abnormalbleeding not in other classification ●Examples like foreign bodies or trauma ●Treatments are according to causes
- 36. History ●Menstrual history likefrequency, duration and amount of bleeding ●Pattern of menstruation ●Menstrual calendar to properly characterize type of bleeding ●Ask about menarche, cycle length, menstrual product, first day of LMP, contraceptives and dysmenorrhea ●Inquire the bleeding of other systems like epistaxis and gum bleeding
- 38. Physical Examination ●General ●Pallor ●Obesity, acne,hirsutism ●Petechiae or bruises ●Vital sign(tachycardia,hypotension) ●Auscultate for murmur ●Local ●Palpation of abdomen ●Speculum and bimanual exams
- 39. Laboratory ●UPT ●FBC – hblevel and platelet ●Iron studies ●Coagulation profile ●Thyroid function test ●Specific test ●For blood diseases (von Willebrand studies, factor antigen)
- 40. ●FSH and LH ●Totaland free testosterone levels ●Prolactin levels ●HPE ●Pap smear and endometrial sampling ●Tumor markers ●CA 125, CEA, AFP, BHCG
- 44.
- 48. Management ●General management byABCD ●Correct anemia either by medication or blood transfusion ●Maintain hemodynamic stability ●Correct the menstruation ●Prevent recurrence ●Prevent long term damage in anovulation ●Anemia, infertility, cancer
- 49. Medical therapy ●High doseestrogen(temporary measure to stop bleeding) ●Androgen(Danazol) ●Mirena(levonorgestrel intrauterine system) ●Progestin therapy ●Tranexamic acid ●NSAIDs ●COCP
- 50. Reference ●Abnormal Uterine Bleedingin Comprehensive Gynecology, 7th edition ●Zagazig Textbook of Gynecology ●Obstetrics and Gynecology Malaysian Protocol
- 51.