DYSFUNCTIONAL UTERINE BLEEDING

By, Nazni Nazar2009 MBBS

ABNORMAL UTERINE BLEEDING

• The menstrual bleed that is abnormally heavy or abnormal in timing

• Assessment-

• Causes-1. DUB2. Pelvic pathology 3. Pregnancy related conditions4. Coagulation &hematological problems5. Medical problems6. iatrogenic

PALM –COEIN classification

Structural causes

• Polyp• Adenomyosis• Leiomyoma- submucosal and

other• Malignancy &

hyperplasia

Non-structural causes

• Coagulopathy• Ovulatory dysfunction• Endometrial• Iatrogenic• Not yet classified

CLINICAL TYPES

1. Menorrhagia (hypermenorrhea): prolonged (>7 days) and/or excessive (>80ml) uterine bleeding occurring at REGULAR intervals. [Fibroids,hematological problems]

2. Polymenorrhea: shortened cycles- uterine bleeding at regular intervals of <21 days.[Endometriosis, PID]

3. Oligomenorrhea: uterine bleeding at regular intervals from 6weeks to 6 months.[hormonal problems-PCOS, hypothyroidism, hyperprolactinemia]

CLINICAL TYPES….

4. Metorrhagia: acyclical and intermenstrual uterine bleeding.[surface lesions-cervical polyps,erosions,cervical ca]

5. Menometorrhagia: uterine bleeding that is prolonged and occurs at completely irregular intervals.

DYSFUNCTIONAL UTERINE BLEEDING

• Abnormal uterine bleeding with no demonstrable organic cause, genital or extragenital.

• Diagnosis by exclusion• abnormal releasing of sex hormones50% at near menopause20% in adolescents30% at reproductive age

pathophysiology

• ANOVULATORY(80%)• OVULATORY (20%)

Anovulatory DUB

• Irregular cycle,short cycles with scanty flow or period of amenorrhoea

• Due to alteration in hypothalamic-pituitary axis

corpus luteum not formed failure of the cyclical secretion of progesteronecontinuous unopposed production of estradiol

stimulates overgrowth of the endometriumendometrium grows thick ,outgrows its blood

supplynecrosis and irregular bleeding

In adolescents and in perimenopausal women, the bleeding may be triggered by estrogen withdrawal

• Threshold bleeding-low estrogen and atropic endometrium[lactation,menopause]

• Metropathia hemorrhagica-periods of amenorrhoea followed by prolonged heavy bleeding[hyperestrogenism]

Ovulatory DUB:

• Presents as menorrhagia• A less common cause of DUB• caused by a defect in local

endometrial hemostasis• Absence of progesterone

Alterations in prostaglandin production, with more PGE2 PGI2 [vasodilation and antiplatelet] and less PGF2[vasoconstriction] , increased fibrinolytic activity bleeding

• Irregular ripening-premenstrual spotting

• Irregular shedding-prolonged mensus and postmenstrual spotting.

• IUCD insertion• Following sterlization operation

Adolescent age group

• Prevalance -50%• Hypothalamic-pituitary axis is still

immature• Estrogen withdrawal bleeding-as it

takes time to establish positive feedback and lh surge well.

• An irregular period with prolonged excessive flow is suggestive of DUB

REPRODUCTIVE AGE GROUP

• DUB less common• H/o heavy regular cyclical

bleedingover several consecutive cycles.

• Intermenstrual bleeding-polyp• Post coital bleeding-premalignancy

Perimenopausal age group

• Anovulatory DUB more common• Metropathia

Thank You . . . (: