Transcript Abnormal excessive uterine bleeding

Abnormal excessive
uterine bleeding
Prof Lindeque
Everybody bleeds...
• Excessive bleeding is common
• Treatment may have varied success
• A mother and daughter issue - sometimes
people expect the worst
• Few people like menstruation to begin with
Modern definitions
• Group name: heavy menstrual bleeding
• Cyclic excessive bleeding:
o Short cycle; n volume; polimennorrhoea
o Bleeds more days than normal: hypermenorrhoea
o More volume, more days: menorrhagia
• Acyclic bleeding: metrorrhagia
• Acyclic excessive bleeding: menometrorrhagia
Types of AEUB
• 1 Organic causes:
• Pathology detected on examination (list
follows)
• 2 DUB: dysfunctional uterine bleeding
• Healthy woman, no pathology, n
examination
• Whether she ovulates (1/3) or is anovulatory
(2/3)
Age does matter
•
A
•
d
o
>
l
8
e
s
0
c
%
e
n
d
t
y
s
s
:
f
u
n
c
t
i
o
n
a
l
,
a
n
o
v
u
l
a
t
o
r
y
D
U
B
:
Reproductive years: 20-45
• Biggest groups: organic pathology; pregnancy ox
• Gynae pathology: fibroids, adenomiosis,
endometrial hyperplasia, polyps, some ovarian or
uterine tumours, few cervical lesions,
endometriosis, PID, pregnancy, cx of
miscarriages, molar pregnancy, ectopic,
secondary PPH
• Systemic disorders: bleeding disorders, thyroid
dysfunction, systemic disease,medication,
hyperprolactinaemia
Reproductive years
• Anovulatory DUB: common: oligo- or
anovulation due to stress, PCOS, weight
changes, exercise
• Ovulatory DUB: less common: [short luteal
phase with cycle every 2-3 wks]; [persistent
corpus luteum (postponed bleeding then
massive bleeding)]
Reproductive years
Management
• Medical:
• Document bleeding
• Mirena progestogen containing IUCD (NICE no
1)
• Cyclokapron (60% reduction, NICE no2), OC
40% reduction (NICE no 3), NSAIDS 40%
reduction
• Surgical: completed families, failed medication
• Endometrial destruction: ablation, resection:
50% amenorrhoea over 5 years (better initially)
• Hysterectomy: 100% amenorrhoea rate
Perimenopausal: 45-55+/• Important: organic lesions: must exclude
malignancies and pregnancy cx
• Most common: anovulation (tired ovaries)
• Management: clinical examination
• Tests: cervical smears, endometrial biopsy,
endometrial ultrasound, pregnancy test
• Management: Mirena, E+P hormone Rx,
NSAID; surgical: hysterectomy
So: approach to a patient with AEUB
• Hx: menarche, menses as adolescent,
describe bleeding: volume, clots;
pain,contraception. Obstetric, medical,
surgical, medication
• Examination: general,thyroid, breasts,
systems, gynae in detail, decide: organic
causes or FUB
• Tests FBC, pregnancy, cytology, TSH, PRL,
endometrial assessment
• Treatment: according to etiological diagnosis