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dysfunctional uterine bleeding
The document summarizes dysfunctional uterine bleeding (DUB), abnormal bleeding caused by hormonal abnormalities without pregnancy, tumor, or coagulopathy. DUB is often associated with anovulation and a nonsecretory endometrium. It may result from disorders of the central nervous system, pituitary, ovaries, or effects of steroids. Signs include amenorrhea, continuous bleeding, and anemia. Treatment depends on age, fertility desires, and involves hormonal therapy, NSAIDs, endometrial ablation, or hysterectomy for severe cases.
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dysfunctional uterine bleeding
- 1. Dysfunctional Uterine Bleeding Semyatov S., M.D., Ph.d Department of Obstetrics and Gynecology PFUR
- 2. Definition: Dysfunctional Uterine Bleeding(DUB) - abnormal bleeding caused by hormonal abnormalities in the absence of pregnancy, tumor, infection, coagulopathy. It is often associated with anovulation, continuos ovarian estrogen production and a nonsecretory endometrium.
- 3. Aetiology: DUB may result from disorders of: •The central nervous system; •Pituitary; •Ovary; •From the effects of exogenous or endogenous steroids; •Systemic metabolic disorders (hyper,- hypotheroidism, hepatic dysfunction and various chronic diseases).
- 4. Signs and Symptoms: •Amenorrhoea. •Continuous uterine bleeding (may last for many weeks). •Secondary anaemia. •Infertility.
- 5. Diagnosis History Afull general examination Pelvic Exam Papanicolaou smear test US exam (endometrium, ovaries) A diagnostic curettage Hystero-salpingography Hysteroscopy Hematologic studies
- 6. Differential Diagnosis: 1. Complicationsof pregnancy (abortion, ectopic gestation, bleeding corpus luteum, hydatidiform mole, choriocarcinoma) 2. Organic lesions of: - the corpus: myoma, carcinoma, polyps, hyperplasia of endometrium; - cervix: chronic cervicitis, carcinoma, polyps; - ovary: functional ovarian cysts and functioning neoplasms; - oviducts: carcinoma; - vagina: carcinoma.
- 7. Differential Diagnosis: Extragenital causes: • blood dyscrasias; • thrombocytopenia; •deficient clotting factors; •endocrinopathies; •hypertension; •bleeding from urinary tract and rectum.
- 8. Treatment: Overall Approach Recognize Goals: – Haemostasis – Restoration of Menstrual Cycle and Fertility – Regularize and control menstrual bleeding – Prevention of DUB
- 9. Treatment: Depends on: 1. The age of the patient, her fertility and her desire for children. 2. The degree of anaemia. 3. The response to curettage, which is performed primarily as an aid to diagnosis, may be therapeutically beneficial.
- 10. Continuous OCPs “Pseudopregnancy”(Kistner) ? Minimizes Retrograde Menstruation Lower Fertility Rates than Other Medical Treatments Choose OCPs with Least Estrogenic Effects, Maximal Androgenic / Progestin Effects
- 11. Progestins May beas Effective as GnRH-a for Pain Control MPA 10 mg/day, DP 150 mg Semi-Monthly May be Taken Long-Term Relatively Inexpensive Side-Effects: AUB, Mood Swings, Weight Gain, Amenorrhoea
- 12. Danazol Weak Androgen Suppresses LH / FSH 200 mg daily for 4-6 months Causes Endometrial Regression, Atrophy Expensive Not recommended in young women Side-Effects: Weight Gain, Masculinization, Occ. Permanent Vocal Changes….
- 13. Oestrogen Suppresses LH/ FSH Causes Endometrial Regression, Atrophy
- 14. Clomiphen Induce ovulation. 50-150 mg daily from 5 to 9 day of menstrual cycle. Complications: multiple pregnancy, hyperstimulation of ovaries.
- 15. Ethamsylate Reduces thecapillary fragility. Reduces menorragia by 50%. 500 mg 4 times a day started from 5 day prior to the anticipated start of the period to 10 days after.
- 16. Nonsteroidal anti-inflammatory drugs (NSAID) Mefenamic acid 500 mg for 5-6 days controls menorrhagia in 70% cases of ovulatory cycles. Side effects: nausea, vomiting, dyspepsia, diarrhoea, headache, auto-haemolytic anaemia.
- 17. Combined oral contraceptivepills More effective than oestrogen and progesteron alone. Reduces blood loss by 50% and eliminates dysmenorrhoea. Not expensive
- 18. Antifibrinolytic agents Tranexamicacid, epsilon-amino-caproic acid, 1-2 g 4 times a day for 6-7 days during menstruation - with 50% success. Side effects: nausea, vomiting, diarrhoea, headache, visual disturbances, intracranial thrombosis Not expensive
- 19. GnRH is usedas a last drug when others fail. Depot injection 3.6 mg monthly for 4-6 month - nearly 100% successful. Expensive. Side effects: anti-oestrogenic effect for more than 6 monhts can cause menopausal symptoms and osteoporosis.
- 20. Surgical Treatment 1. D&C- removal of endometrium’s hyperplasia D&C will be required in young women, if hormonal therapy failed. 30-40% may be cured by curettage alone. 2. Hysterectomy - in older women with severe menorrhagia; recurrent irregular uterine bleeding that is unresponsive to progestin therapy. The ovaries should be conserved in women below the age of 50 yrs.
- 21. Surgical Treatment 3. Hysteroscopicendometrial ablation by Nd:YAG laser electro-cautery resection (TCRE) roller-ball electrocoagulation radio-frequency induced ablation (RITEA) - thermal destruction of endometrium at 66°C. 85% get cured. balloon therapy - hot fluid is used which causes superficial burn.