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Dysfunctional uterine Bleeding. Gem Ashby MD OB/GYN. Cancer Support Services is committed through a spirit of volunteerism to the care of persons with cancer and to bring comfort and support to the affected relatives and dependents. Dysfunctional Uterine Bleeding DUB.
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Dysfunctional uterine Bleeding Gem Ashby MD OB/GYN
Cancer Support Services is committed through a spirit of volunteerism to the care of persons with cancer and to bring comfort and support to the affected relatives and dependents.
Dysfunctional Uterine Bleeding DUB • Bleeding is heavier (passing large clots, soaking through a sanitary pad or tampon every hour for 2 - 3 hours in a row) • Bleeding or spotting that occurs between periods • Time between menstrual periods changes with each cycle • Bleeding lasts for more days than normal
Causes of DUB • GYN cancers • Anovulation • Fibroids • Polyps • Systemic illness
Work up for dub • History and exam • Blood work/PAP smear • Pelvic US • Endometrial biopsy • D&C, hysteroscopy
A: Cervical cancer B: Endometrial(Uterine) cancer C: Ovarian cancer Which two cause DUB? Which one has been linked to a viral infection? Which one is often diagnosed at a very late stage?
Cervical cancer is the second most frequent cancer in women in the world • Third greatest cause of death from cancer in women • 90% of cervical cancer is cause by HPV • Of the estimated more than 270 000 deaths from cervical cancer every year, more than 85% occur in developing countries Stats from WHO
Cervical cancer and dub • Early cervical cancer is frequently asymptomatic • The most common symptoms at presentation are: • Abnormal bleeding • Postcoital bleeding • Vaginal discharge that may be watery, mucoid, or purulent and malodorous
Treatment of cervical • Surgery to remove the cancer • Radiation therapy, which uses high-dose X-rays or implants in the vaginal cavity to kill cancer cells. It is used for certain stages of cervical cancer. It is often used in combination with surgery • Chemotherapy, which uses medicines to kill cancer cells. Chemotherapy may be used to treat advanced cervical cancer
endometrial cancer • Endometrial cancer is rare in women under the age of 45 • The average chance of a woman being diagnosed is about one in 37 • This cancer is slightly more common in white women, but black women are more likely to die from it
Risk factors for endometrial cancer • Being obese. Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out • Taking estrogen without taking a progestin • Polycystic ovary syndrome. This can cause you to produce too much estrogen and not enough progesterone • Having type 2 diabetes • Never having been pregnant
endometrial cancer and DUB The most common symptoms include: • DUB • BLEEDING AFTER MENOPAUSE • Pain during sex • Pelvic pain
Treatments • Surgery to remove the uterus (and cervix), ovaries, and fallopian tubes (hysterectomy with bilateral salpingo-oophorectomy) • Surgery to remove lymph nodes • Radiation therapy to kill cancer cells • Progestin hormone therapy to block cancer growth • Chemotherapy to kill cancer cells
Anovulation • Anovulation is the absents of ovulation
Anovulation • Polycystic ovarian syndrome • Peri-menopause • Thyroid dysfunction (either hyperthyroidism or hypothyroidism) • Extremely high levels of stress
AnovulationTreatment Hormonal manipulation OCP’s Nuvaring Depo Provera Nexplanon Mirena IUD
Fibroids • The most common pelvic tumor in women • They are benign tumors arising from the smooth muscle cells of the myometrium • They can cause DUB, pain, voiding dysfunction and may also have reproductive effects (e.g, infertility, adverse pregnancy outcomes)
Fibroid Treatments • There's no single best approach to uterine fibroid treatment; many treatment options exist
Fibroid Treatments • Hormonal Manipulation (OCP, Nuvaring, Depo Provera, Nexplanon, Mirena) • Gonadotropin-releasing hormone (Gn-RH) agonists • Medications called Gn-RH agonists (Lupron, Synarel, others) treat fibroids by putting you into a temporary postmenopausal state. With the decreased estrogen many fibroids tend to shrink
Fibroid Treatments • Uterine artery embolization • Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die • SHOULD NOT BE DONE if the patient wants more children !!!
Fibroid Treatments • Laparoscopic, robotic or open myomectomy • In a myomectomy, your surgeon removes the fibroids, leaving the uterus in place
Fibroid Treatments • Endometrial ablation and resection of submucosal fibroids • A specialized instrument inserted into your uterus; uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow • Ablations DO NOT remove the fibroids • SHOULD NOT be done if the patient wants more children
Fibroid Treatmentshysterectomy • Abdominal • Vaginal • Laparoscopic • Robotic
Fibroid Treatmentshysterectomy • A hysterectomy is an operation to remove a woman's uterus • Definitions: • In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping the cervix in place • A total hysterectomy removes the whole uterus and cervix • The ovaries may also be removed -- a procedure called oophorectomy -- or may be left in place
Polyps • Overgrowth of cells in the lining of the uterus (endometrium) • Are usually noncancerous (benign), although some can be cancerous or can eventually turn into cancer (precancerous polyps)
Treatment for polyps • Hormonal Manipulation (OCP, Nuvaring, Depo Provera, Nexplanon, Mirena) • Surgical removal: D&C hysteroscopy • A camera is used to look inside the uterus and then the polyp is scraped out • An ablation can be done at the same time
AUB Causes • GYN cancers • Anovulation • Fibroids • Polyps • Systemic illness Treatment Surgery Hormonal Contraception Lupron, Surgery/UAE Surgery Treatment based on affected organ system
Thank You • Wright, Jason and Solange Wyatt. The Washington Manual Obstetrics and Gynecology Survival Guide. Lippincott Williams and Wilkins, 2003. ISBN 0-7817-4363-X • Bravender T, Emans SJ (June 1999). "Menstrual disorders. Dysfunctional uterine bleeding". Pediatr. Clin. North Am.46 (3): 545–53, viii. PMID10384806. • ^"Dysfunctional Uterine Bleeding". http://www.sh.lsuhsc.edu/fammed/OutpatientManual/DUB.htm. Retrieved 2010-01-23.