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Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding. Dr. Nasira Sabiha Dawood. Definition. Abnormal bleeding from the uterus in the absence of organic disease of the genital tract Disturbance of menstrual cycle ,regular irregular or alteration in amount and duration of bleeding

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Dysfunctional Uterine Bleeding

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  1. Dysfunctional Uterine Bleeding Dr. NasiraSabihaDawood

  2. Definition • Abnormal bleeding from the uterus in the absence of organic disease of the genital tract • Disturbance of menstrual cycle ,regular irregular or alteration in amount and duration of bleeding • Group of disorders characterized by dysfunction of uterus ,ovary ,pituitary, hypothalamus • Incidence:40/1000

  3. Classification • Primary: primary dysfunction of uterus ,ovary, pituitary, hypothalamus, or higher centres • Secondary: to IUCD ,hormones for contraception or other use,

  4. Normal menstrual cycle • Mean cycle length 28 days • At age 40 20-27 days • Duration 2-7 days • Excessive 8days or longer • MBL 40 ml • Menorrhagia >80 ml

  5. Mechanism of normal menstrual cycle • Proliferative phase: intence vasoconstriction ,ischemia of endometrium and shedding,re-epithelisation by estrogen from ovarian follicle • Secretary phase

  6. Endometrial pathology • Irregular ripening and irregular shedding :15-25% cases deficient corpus luteum • Endometrial hyperplasia : endomerial stroma and glands with abnormal vascularization Atrophy of endometrium : large dilated venules under thin epithilium venules rupture causing post menopausal bleeding pv

  7. Eetiolgy of Primary DUB • Disturbance in eicosanoidsfibrinolytic and lysosomal enzyme system • Ischemia and cell death • Arachidonic acid • PGF2@(vasoconstrictor and weak platelet aggregator) • PGE2 (vasodilator and platelet ant aggregator) • TxA2(potent vasoconstrictor and platelet aggregator)

  8. Secondary DUB • Hormones or IUCD: low dose progesterone underdevelopment of spiral arterioles degeneration of large venules • large doses of progesterone produce superficial dilated venules with atrophy of endometrium • IUCD: ulceration of endometrium and increased vascularity • Bleeding disorder, thrombocytopenia, von Wille brand disease, factor 2,5,7,10 def • Hypothyroidism: direct effect of thyroxine on spiral arterioles

  9. Clinical presentation • Adolescent and teen age : anovulatory immaturity of hypothalamus • Adults: Ovulatory, rule out PID fibroids complications of pregnancy • Perimenopausal: Anovulatory ,rule out fibroids ca cervix and endometrium

  10. Clinical presentation • Regular cyclical : ovulatory for short duration ,rule out fibroids and PID • Irregular or acyclic: anovulatory, rule out ca cervix or endometrium • Intermenstrual : ovulatory fall in estrogen secretion following ovulation ,rule out cx polyp sub mucous fibroid and cervical carcinoma

  11. Diagnosis • History : Age, parity, fertility , occupation • Amount duration and pattern of bleeding associated gynecological problem dysmenorrheal infertility or menopausal symptoms bleeding disorders or thyroid dysfunction contraception future pregnancies possible hysterectomy social and personal background

  12. Examination • Abdominal and pelvic examination • Investigations: blood CP Hb platelets coagulation screen day 21 progesterone thyroid function tests laparoscopy ultrasound scan, endometrial biopsy by dx D and C, aspirate, brush, levage or hysteroscopy

  13. Management • Menstrual calendar • Oral iron therapy • Treatment of sec disease • Medical therapy : NSAID • antifibrinolytics • Prostaglandin inhibitors • Hormone therapy COC progesterone estrogens androgens and danazol

  14. Management • Endometrial ablation • Laser • Rafea • Cryo • TUMR • Hystrectomy • Radiotherapy

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