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AUB

Definitions Significance. Classifications. AUB. Definition. Any deviation in normal frequency, duration amount of menstruation. Normal?? 28 ± 7 1-8 (3-5) 10-80ml (30-50). Can also include vaginal bleeding before menarche and after menopause. Definitions contd.

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AUB

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  1. Definitions • Significance. • Classifications AUB

  2. Definition • Any deviation in normal • frequency, • duration • amount of menstruation • Normal?? • 28 ± 7 • 1-8 (3-5) • 10-80ml (30-50) Can also include vaginal bleeding before menarche and after menopause

  3. Definitions contd • Menorrhagia:Excessive (>80 ml) & / or prolonged menstruation(>7), at regular intervals • Metrorrhagia- Irregular, frequent bleeding of varying amounts but not excessive • Menometrorrhagia Prolonged or excessive bleeding at irregular intervals • Polymenorrhea Regular bleeding at intervals of less than 21 days • OligomenorrheaBleeding at intervals greater than 35 days – may be irregular • Intermenstrual Uterine bleeding between regular cycles

  4. Others… • Hypermenorrhea – similar to menorrhagia but usually refers to heavy mensus (in terms of amount) • Hypomenorrhea (cryptomenorrhea) – regular scanty bleeding • Could be due to anatomic or hormonal abnormalities • Anatomic – imperforated hymen, incomplete transverse vaginal septum, cervical or vaginal stenosis, asherman’s syndrome. • Hormonal – hypothyroidism, hyperprolactinemia, hyperinsulinemia

  5. Contact bleeding – post coital or post examination bleeding. 2/3 – unknown causes • Cervicitis or vaginitis – e.g. – Chlamydia, trichomonas • Cervical ca • Cervical polyps • Cervical eversion • Atrophic vaginitis • METROTAXIS: continuous uterine bleeding without interruption • Amenorrhea – no mensus for 6 months • cervical cancer unless R/O

  6. Novak’s gynaecology 14th edition

  7. Why do we have to know about AUB?? • Abnormal uterine bleeding affects 10 to 30 percent of reproductive-aged women and up to 50 percent of perimenopausal women • It is a common reason for gynecologic consultation. • Responsible for over one third of hysterectomies.

  8. Classification of AUB

  9. Classification of causes

  10. Classifications contd. • Endocrinopathies • Coagulopathies • Hepatic and renal failure • DUB • Lieomyoma • Adenomyosis • Polyps • Tumors • Infections • Trauma • Urethral bleeding • Rectal bleeding • Abortion • Ectopic pregnancy • GTD • Implantation bleeding

  11. Gynecologic causes - uterus • Uterine fibroids Adenomyosis – also called ‘endometriosis interna’, refers to ectopic endometrial tissue within the myometrium • possibly results from increased and abnormal vascularization of the endometrial lining • Is also associated with dysmenorrhea

  12. Gyn. Contd. • Endometrial polyps – are also associated with AUB possibly due to asynchronous shedding to that of the normal endometrium • Thus usually associated with intermenustrial bleeding. • Endometrial hyperplasia and cancer – Endometrial cancer should be suspected in any woman in menopausal transition with abnormal uterine bleeding Two thirds of women with endometrial cancer present with postmenopausal bleeding Only about 5% of endometrial ca occurs in patients younger than 40 yrs

  13. Gyn. Contd. • Otheruterine lesions include: • Atrophic endometrium • Infections – STD, TB • Mechanical causes – e.g. - IUD • Arteriovenous malformation

  14. Non uterine gyn, causes • Ovary - ??? • Fallopian tube – salphingitis, Cancer • Cervix – Cancer, polyps, Infections • Vagina – Cancer, infections, atrophic vaginitis, foreinbody, Trauma

  15. Systemic causes… • Endocrinopathies – Hypo or hyperthyroidism, hyperprolactinemia, adrenal disorders, DM • Coagulopathies • Factor deficiency – von willebrand’s disease, hemophilia • Palate disorders – ITP, leukemia, aplastic anemia etc. • Hepatic and renal failure – deficiency due to decreased synthesis and increased loss respectively

  16. What is the most common cause of AUB??? DUB (50%)

  17. References • Williams Gynecology • Berek & Novak's Gynecology, 14th Edition • Danforth's Obstetrics and Gynecology, 9th Ed • Wikipedia • www.figo.com • www.acog.com • www.slideshare.com

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