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ABNORMAL UTERINE BLEEDING

ABNORMAL UTERINE BLEEDING. ❏ 90% anovulatory, 10% ovulatory Hypermenorrhea/Menorrhagia cyclic menstrual bleeding that is excessive in amount (>80 mL) or duration (> 7 days) adenomyosis endometriosis leiomyomata endometrial hyperplasia or cancer hypothyroidism. Hypomenorrhea.

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ABNORMAL UTERINE BLEEDING

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  1. ABNORMAL UTERINE BLEEDING • ❏ 90% anovulatory, 10% ovulatory • Hypermenorrhea/Menorrhagia • cyclic menstrual bleeding that is excessive in amount (>80 mL) or duration (> 7 days) • adenomyosis • endometriosis • leiomyomata • endometrial hyperplasia or cancer • hypothyroidism

  2. Hypomenorrhea • decreased menstrual flow or vaginal spotting • Oligomenorrhea • episodic vaginal bleeding occurring at intervals > 35 days • Polymenorrhea • episodic vaginal bleeding occurring at intervals < 21 days • Metrorrhagia • uterine bleeding occurring between periods • organic pathology • endometrial/cervical polyps or cancer • estrogen withdrawal

  3. Menometrorrhagia • uterine bleeding irregular, and also excessive in amount • organic pathology • endocrine abnormality • early pregnancy • Postmenopausal Bleeding • any bleeding > 1 year after menopause • investigations • endometrial sampling - biopsy or D&C • hysteroscopy

  4. DYSFUNCTIONAL UTERINE BLEEDING (DUB) • abnormal bleeding with no organic cause • rule out: blood dyscrasias • thyroid dysfunction • malignancy • endometriosis • PID • fibroids • polyps

  5. Adolescent Age Group • DUB due to immature hypothalamus with irregular LH, FSH, estrogen and progesterone pattern • Reproductive Age Group • ❏ DUB due to an increase or decrease in progesterone level • Perimenopausal Age Group • DUB due to increased ovarian resistance to LH and FSH • treatment • if anemic, iron supplement • medroxyprogesterone acetate (Provera) 5-10 mg

  6. Mid-Cycle Spotting • ❏ may be physiologic due to mid-cycle fall of estradiol • Premenstrual Spotting • may be due to progesterone deficiency, endometriosis, adenomyosis and fibroids

  7. POLYCYSTIC OVARIAN DISEASE • Pathogenesis of PCO • white, smooth, sclerotic ovary with a thick capsule, multiple follicular cysts • high androgens + obesity • chronic anovulation

  8. Treatment • weight reduction • clomiphene, • progesterone (Provera) • for pregnancy • medical induction of ovulation • clomiphene citrate (Clomid)

  9. DYSMENORRHEA • Primary • menstrual pain not caused by organic disease • may be due to prostaglandin-induced uterine contractions and ischemia • begins 6 months - 2 years after menarche • colicky pain in abdomen, radiating to the lower back, labia and inner thighs • begins hours before onset of bleeding and persists for hours or days • associated nausea, vomiting, altered bowel habits, headaches • treatment • Naproxen,must be started before/at onset of pain

  10. Secondary • menstrual pain due to organic disease • begins in women who are in their 20’s • worsens with age • associated dyspareunia, abnormal bleeding, infertility • etiology • endometriosis • adenomyosis • fibroids • PID • ovarian cysts • IUD

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