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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.

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Abnormal excessive uterine bleeding

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  1. Abnormal excessive uterine bleeding • Prof Lindeque

  2. 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

  3. Modern definitions • Group name: heavy menstrual bleeding • Cyclic excessive bleeding: • Short cycle; n volume; polimennorrhoea • Bleeds more days than normal: hypermenorrhoea • More volume, more days: menorrhagia • Acyclic bleeding: metrorrhagia • Acyclic excessive bleeding: menometrorrhagia

  4. 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)

  5. Age does matter • Adolescents: • >80% dysfunctional, anovulatory DUB: • Unripe HT-pit-ovar axis: produces Estrogen, not Progesterone • An- or oligomenorrhoea or otherwise disorderly cycle • <20% have pathology: bleeding disorders (ITP, Von Willebrandt, leukemia, HIV platelet dysfunction) • Have to do: clinical exam incl. PR, FBC, platelets, HIV • Management: HORMONAL: best is OC pill

  6. 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

  7. 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)]

  8. 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

  9. 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

  10. 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

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