Abnormal uterine bleeding (AUB) refers to any deviation from normal menstruation in terms of frequency, duration, or amount of bleeding. The document discusses various types of AUB and their potential causes, both organic and systemic. It also outlines the diagnostic approach, including medical history, physical examination, laboratory tests, ultrasound, and other imaging procedures. Treatment depends on the individual's age and may involve general measures, medical options like hormones or antifibrinolytics, or surgical interventions.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
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
Classification & conservative surgeries for prolapseIndraneel Jadhav
Stage 0
no prolapse
- Aa,Ba,Ap,Bp are all at -3
- C or D between tvl and < tvl -2
Stage I
most distal portion > 1cm above level of hymen
Stage II
<1cm proximal to or distal to the plane of hymen
Stage III
>1cm below the plane of the hymen
Stage IV
complete eversion, distal portion at least (tvl -2 cm)
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
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
Classification & conservative surgeries for prolapseIndraneel Jadhav
Stage 0
no prolapse
- Aa,Ba,Ap,Bp are all at -3
- C or D between tvl and < tvl -2
Stage I
most distal portion > 1cm above level of hymen
Stage II
<1cm proximal to or distal to the plane of hymen
Stage III
>1cm below the plane of the hymen
Stage IV
complete eversion, distal portion at least (tvl -2 cm)
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time. Bleeding may be heavier or lighter than usual and occur often or randomly. AUB can occur: As spotting or bleeding between your periods.
Gestational trophoblastic disease (GTD) is a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception. In gestational trophoblastic disease (GTD), a tumor develops inside the uterus from tissue that forms after conception (the joining of sperm and egg).
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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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
- 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
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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
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Surgical Site Infections, pathophysiology, and prevention.pptx
AUB for 4th year med.students
1. Associate Clinical Prof. Dr Aisha EL-Bareg, MD, PhD
Senior Consultant in (Obs & Gyn/Reproductive Medicine)
Faculty of Medicine, Misurata University, LIBYA
2. Abnormal uterine bleeding (AUB)
Any deviation from normal frequency, duration
or amount of menstruation in women of
Reproductive age.
NORMAL MENSES
•Frequency: 21-35 d
•Duration: 3-7 d
•Volume: 30-80 ml
3. AUB- Clinical types
•Polymenorrhoea: frequent (<21 d) menstruation, at
regular intervals
•Menorrhagia: Excessive (>80 ml) & / or prolonged
menstruation, at regular intervals
•Metrorrhagia: Mensturation at irregular intervals.
10. •Definition:
Abnormal uterine bleeding in absence of
obvious pelvic organ disease or a systemic
disorder
•Incidence:
• 60 % of AUB
Dysfunctional uterine bleeding (DUB)
11.
12.
13. Mechanism of hemostasis during menstruation
2. Hemostatic plug formation
in the functional endometrium
1. Vasoconstriction in the
basal layer
Vascular occlusion is not complete, for short time
Until endometrial regeneration is completed
15. • Estrogen withdrawal bleeding
– Frequently occurs in peri-menopause.
– Short proliferative phase because of abnormal
follicular developments.
– E levels will vary with the quality and state of follicular
recruitment and growth.
– Bleeding might be light or heavy depending on the
individual response.
DUB- Pathophysiology
16. • Estrogen breakthrough bleeding
– Anovularoty cycles have no CL formation
– Progesterone is not produced
– The endometrial continues to proliferate under the
influence of unopposed E.
– Out-of-phase endometrium is shed in an irregular
manner that might be prolonged and heavy.
– Occur in absence of E decline.
DUB- Pathophysiology
17. Endocrine abnormality
Insufficient C. luteum leading
to short luteal phase
Persistent C luteum leading
to long luteal phase
Endometrial changes
Irregular or deficient
Secretory changes
Irregular shedding
A. Hormonal disturbances
DUB- Pathophysiology
18. B. Local endometrial defect
– Increase PGE2/PGF2α- VD
– Decreased Thromboxane A2/Prostacyclin ratio
– Increased activity of the fibrinolytic system locally in
the uterus
Why these changes occur and their exact
causal relation with menorrhagia have not
yet been determined.
19. AUB- Complications
• Iron deficiency anemia
• Endometrial adenocarcinoma: 1-2% of women with
anovulatory bleeding might develop Ca.
• Infertility: as with chronic anovulation, with or without
androgen production : PCOS, obesity, chr HTN, DM
are at risk.
• Complications of the etiology if present .
20. Aim:
1. Nature & severity of bleeding
2. Exclusion of organic causes
3. Ovulatory or anovulatory
Diagnosis
21. I. History
1. Personal: Age
2. Present H: onset of the problem, amount of
bleeding, duration, frequency, relation to
sexual intercourse, associated symptoms (pain,
abdominal mass).
3. Menstrual H.
4. Sexual activity: infection.
Diagnosis
22. 5. Obstetric and gynecological H
6. Contraceptive H.
7. Past medical & surgical H.
8. Family history
9. Current medication
Diagnosis
I. History
23. II. Examination:
1. General examination
Obesity (BMI)
Signs of androgen excess (hirsutism, acne)
Signs of hypo or hyperthyroidism
Galactorrhea
Visual field defect (pituitary lesion)
Ecchymosis, purpura
Signs of anemia
Diagnosis
24. 2. Abdominal examination
– liver, spleen, pelvi-abdominal mass
3. Local examination
• External genital lesions
• Speculum ex: assess the bleeding, vaginal discharge,
vaginal & cervix lesions
• Bimanual ex: uterine size, shape, countour, adnexa
for ovarian mass.
Diagnosis
26. III.Investigations
Local
1. Pap smear, cervical swap for infection
2. USS, saline-infusion-sonography
3. Endometrial biopsy, D & C biopsy
4. Fractional curettage
5. Hysteroscopy
Diagnosis
27. 1. TAS: can exclude pelvic masses, pregnancy
complications.
2. TVS:
• More informative than TAS.
• Measurement of the endometrial thickness.
• Endometrial carcinoma in postmenopausal is suspected if
endometrial thickness > 3.5 mm.
Ultrasonography
28. 3. Saline infusion sonography:
Infusion of saline into the uterine cavity.
Ultrasonography
29. TVS is recommended
1. Weight >90 Kg
2. Age > 40
3. Other risk factors for endometrial hyperplasia or
carcinoma e.g. infertility, nulliparity, family history of
colon or endometrial cancer, exposure to unopposed
estrogen.
Ultrasonography
30. Indications:
• Between 20 & 40 yrs.
• If endometrial thickness on TVS is >10mm,
endometrial sample should be taken to exclude
endometrial hyperplasia.
Aim
• Diagnosis of the type of the bleeding
• Exclude local pathology
Endometrial biopsy
31. Methods:
•As an outpatient procedure.
1.Pipelle curette
2.Sharman curette
3.Accrette
4.vabra aspirator
Advantages: An adequate & acceptable screening
procedure in females under 40 yrs
Endometrial biopsy
32. Indications
1. Mandatory after 4o yrs.
2. Persistent or recurrent bleeding after medical tt in
patient between 20 & 40 yrs.
Aim
1. Diagnosis of organic disease e.g. endometritis,
polyp, carcinoma, TB.
2. Diagnosis of the type of the endometrium,
hyperplastic, proliferative, secretory, atrophic.
Dilatation & Curettage (D & C)
33. 3. Arrest of the bleeding, if the bleeding is severe or
persistent, particularly hyperplastic endometrium.
Curettage is essentially a diagnostic & not a
therapeutic procedure.
Disadvantages
1.Small lesions can be missed.
2.The sensitivity of detecting intrauterine pathology is
only 65% .
Dilatation & Curettage (D & C)
35. • It is an endoscopic
visualization of endometrial
cavity.
Hysteroscopy
•Using a telescope, camera and light source.
• Use distensile media
CO2, normal saline, Glycin 1.5%
36. Hysteroscopy
1) To locate submucous myoma.
2) To diagnose uterine septum.
3) To locate & remove lost I.U.C.D.
4) To locate Endometrial polyp.
5) To locate uterine synechae.
6) To detect endometrial cancer.
• Indications
43. AUB- Treatment
• Principle of management
– Control of the bleeding followed by regulation
of menses.
– Induction of ovulation in patients with
infertility.
45. 1. General measures
• Treatment of iron deficiency anemia
• Treatment of systemic diseases
• Treatment of endocrinological diseases
Treatment
46. Treatment < 20 yrs 20-40 yrs > 40 yrs
Medical always
First resort after
endometrial biopsy
Temporary & if
surgery is refused
or imminent
menopause
Surgical
never
Seldom, only if
medical treatment
fail
First resort if
bleeding
is recurrent
Strategy of treatment
47. I. Non –hormonal
1. Antifibrinolytics
2. Prostaglandin synthetase inhibitors (PSI)
3.Ethamsylate
II. Hormonal
1. Progestagen 4. Danazol
2. Oestrogen 5. GnRh agonist
3. COCP 6. Levo-nova (Merina)
Medical therapy
48. 1. Antifibrinolytics
Tranexamic acid (tranex)
Mechanism of action:
The endometrium possess an active fibrinolytic system,
& the fibrinolytic activity is higher in menorrhagia.
Effect:
• ↓ menstrual bleeding > other therapies (PSI, oral
luteal phase progestagen & etamsylate)
• Is effective in treating menorrhagia associated with
IUCD.
49. Side effects
•Is dose related.
•GIT upset, dizziness.
•Rarely: - Transient color vision disturbance
- Intracranial thrombosis.
1. Antifibrinolytics
50. 2. Prostaglandin synthetase inhibitors (PSI)
Mefanemic acid
Mechanism of action: Antiprostaglandins
Effects:
• Decrease MBL by 24%
• The beneficial effect on other symptoms e.g.
dysmenorrhea, headache, nausea, diarrhea &
depression persists for several months.
51. Side effects
• GIT upset, dizziness.
• Rarely: hemolytic anemia, thrombocytopenia.
•The degree of reduction of MBL is not as great as
it is with tranxamic acid but PSI have a lower side
effect profile.
2. Prostaglandin synthetase inhibitors (PSI)
52. Mechanism of action: (Hemostatic)
Maintain capillary integrity, anti-hyalurunidase activity
& inhibitory effect on PGE2
Effect:
• Starting 5 days before anticipated onset of the
cycle & continued for 10 days
• 20% reduction in MBL.
Side effects
headache, rash, nausea
3. Etamsylate (Dicynone)
53. •Norethisteron
•medroxyprogesterone acetate
•Effect:
Effective if given at higher dose for 3 w out of 4 w (5 mg
tds from D5 to 26)
•Side effects:
weight gain, nausea, bloating, edema, headache, acne,
depression, exacerbation of epilepsy & migraine, loss of
libido
Systemic progestagens
55. Effect
1. Decrease MBL by 80%-90%
2. Cost effective (used for 5 yrs)
2. May be an alternative to hysterectomy in some
patients
Special indications
1. Intractable bleeding associated with chronic
illness
2. Ovulatory heavy bleeding
Intrauterine progestagens
56. Side effects
1. Breakthrough bleeding in the first 3-4 cycles
2. 20% develop amenorrhea within 1 yr
Intrauterine progestagens
57. Mechanism of action:
Ovulation suppression
Effect
Reduce MBL by 50%
Side effects
headache, migraine, weight gain, breast tenderness,
nausea, cholestatic jaundice, hypertension,
thrombotic episodes
The combined contraceptive pill
COCP
58. synthetic androgen with antioestrogenic &
antiprogestagenic activity
Mechanism of action
Inhibits the release of pituitary Gn & has direct
suppressive effect on the endometrium
Effect
Reduction in MBL , amenorhea at doses >400 mg/d
Danazol
59. Side effects
headache, weight gain, acne, rashes, hirsuitism,
mood & voice changes, flushes, muscle spasm,
reduced HDL, diminished breast size. Rarely:
cholestatic jaundice.
It is effective in reducing blood loss but side effects
limit it to a second choice therapy or short term use
only
60. Injectable : SC, Monthly for 3-6 months
Side effects
hot flushes, sweats, headache, irritability,
loss of libido, vaginal dryness, lethargy,
reduced bone density.
GnRH analog
61. Surgical treatment
1. Endometrial ablation
Destruction of the basal layer of the endometrium
So little or no remaining endometrium can
regenerate
63. Indications
1. Failure or contraindication of medical treatment
2. Family is completed
3. Uterine cavity <10 cm
4. Submucos fibroid <5 cm
5. Endometrium is normal or low risk hyperplasia.
1. Endometrial ablation
64. 2. Hysterectomy
Indications:
1. Failure of medical treatment
2. Failure of endometrial ablation
3. Family is completed
Routes:
1. Abdominal
2. Vaginal
3. Laparoscopic
Surgical treatment
65. Advantages
1. Complete cure
2. Avoidance of long term medical treatment
3. Removal of any missed pathology
Disadvantages
1. Major operation
2. Hospital admission
3. ↑ Mortality & morbidity
2. Hysterectomy