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Irregular uterine bleeding

Irregular uterine bleeding. Gynekologicko - porodnická klinika FN Brno a Masarykovy univerzity Přednosta: prof. MUDr. P. Ventruba, DrSc. I. Crha, A. Belkov. Menstrual cycle. ovarian cycle results in endometrial changes Cycle phases: menstruation prolipheration secretion.

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Irregular uterine bleeding

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  1. Irregular uterine bleeding Gynekologicko - porodnická klinika FN Brno a Masarykovy univerzity Přednosta: prof. MUDr. P. Ventruba, DrSc. I. Crha, A. Belkov

  2. Menstrual cycle • ovarian cycle results in endometrial changes • Cycle phases: • menstruation • prolipheration • secretion The length of the cycle: 25- 32 (35) dní The length of the bleeding: 3-5 dní, max. 7 dní, Blood lost: 1 ml/kg

  3. Menstrual cycle disorders • symptomatic (according to the clinical symptoms) • pathogenetical (according to pathogenesis) • ethiological (according to the ethiology)

  4. Frequency disorders • Polymenorrhoea (less than 22 days) • Oligomenorrhoea (more than 35 days) • Amenorrhoea (no bleeding) • primary amenorrhoea • secundary amenorrhoea

  5. Intensity and length disorders • Hypomenorrhoea (less than 2 tampons/day) • Hypermenorrhoea (more than 5 tampons/day, more than 8 days) • Menorrhagia (more than 5 tampons/day, bleeding less than 7 days)

  6. Intensity and length disorders • Premenstrual bleeding • Ovulation bleeding • Postmenstrual bleeding

  7. Irregular uterine bleeding • Metrorrhagia - dysfunctional bleeding • ovarian function disorder • follicle persistence, corpus luteum absence • estrogens elevation, gestagens shortage • irregular endometrium shedding • glandular cystic endometrial hyperplazia

  8. Stromaglandular dissotiation

  9. Cystic glandular hyperplazia

  10. Amenorrhoea • Physiological(before menarche, gravidity, post menopause) • Pathological (primary, secundary) • A. according to disorder level • anatomical malformations • ovarian disorders • pituitary gland disorders • CNS disorders (hypothalamus, suprahypothalamus)

  11. Amenorrhoea • B. according to ovarian structure • normal ovulating ovaries • anovulating ovaries (regulation centres disorders) • afunctional ovaries (dysgenesis) • Cryptomenorrhoea - anatomical obstruction

  12. Menstrual cycle classification according to WHO I. Hypogonadotropical normoprolactinemia ovarian insufficiency (Kallman syndrom, anorexia nervosa, Sheehan syndrom) II. Normogonadotropical normoprolactinemia ovarian insufficiency IIa.- anovulation, corpus luteum insufficiency IIb.- normogonadotropin normoprolact. amenorea (hyperandrogenemia) III. Hypergonadotropin ovarian insufficiency (Turner sy,POF) IV. Anatomical amenorea (Rokytanski sy) V. Hyperprolaktinemia (prolactinoms) VI. Dysfunctional hyperprolactinemia (thyreoid gland, stress) VII. Organic destruction of hypothalamus (kraniofaryngeom)

  13. Diagnosis • Menstrual calendar (bazal temperature) • Hormonal examinations • basal:FSH, LH, prolactin, 17-betaestradiol, progesteron, testosteron, SHBG • comprehensive:štítná žláza, nadledvina • functional cytology • Ultrasound - morphology of endometrium, uterus, ovaries • Endometrial biopsy - abrasion, microabrasion

  14. Diagnosis Endometrial histology menstruation 1. - 4. day early proliferation 5. - 8. day advanced proliferation 9. - 11. day late proliferation 12. - 14. day early secretion 16. - 18. day advanced secretion 19. - 22. day late secretion 23. - 24. day secretion in regresion 25. - 28. day

  15. Diagnosis Hysteroscopy (diagnostical, operative) Laparoscopy (diagnostical, biopsie) X-ray methods - CT, MRI Genetics Endocrinology Hematology

  16. Diagnosis • Funkctional tests • Progesteron test • Estrogen - progesteron test • Gonadotropin test • Clomifen citrate test • Metoklopramid test

  17. Therapy • Stop the bleeding • hormonal- estrogens, gestagens • surgery- uterine abrasion, hysteroskopie • Prevention - gestagens

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