ABNORMAL UTERINE BLEEDING

Dr.Srwa Jamal MuradMBChB,FICOG

Abnormal uterine bleeding

• Menorrhagia(heavy periods’) is blood loss of greater than 80ml per period.

• Metrorrhagia flow at irregular intervals.• Menometrorrhagia frequent, excessive flow.• Polymenorrhea bleeding at interval <21 days• Dysfunctional uterine bleeding :abnormal

uterine bleeding without any obvious structural or systemic abnormality.

Menorrhagia is extremely commonIs the single leading cause of referral to gynecology clinic.Normal menstrual cycle:Occur each 28days(21-35days)Duration 2-8 daysAverage 20-80 ml.

Causes 1.Organic2.Non organicOrganic a. Localb. Systemicc. Pregnancy related Non organica. Ovulatoryb. Non ovulatory (DUB)

Organic causes:Local causes:FibroidIUCDPIDMalignancyEndometrial CaCervical CaEndometrial hyperplasiaUterine abnormality

Organic causesSystemic causes;Endocrine causes.hypo&hyper thyriod.DM.prolactin abnormality.advanced liver disease.drugs (heparin, asprine,warfarin,tamoxfine)Hematological.VWBD.ITP

Organic causes

Pregnancy related.ectopic.miscarriage.trophoblastic diseaseOther causes.urinary tract.GIT

Non organic cause

Non organic cause or DUB • Ovulatory • Non ovulatory

Presentation & assesment

1.History :how long have period been heavy, last& how often do they occur.Is there flooding or passage of clotsAny intermenstrual bleeding or PCBPelvic pain & dyspareuniaWhat contraception is being used & PAP smear

examination

General exam: for anaemia, thyroid BMIPelvic exam Cervical smear

investigation

• Influence by age, reproductive status, pattern &severity of symptoms

• 1.haematological & biochemistry

• PT,FBC if clinically indicated• Thyroid function test if

clinically indicated

imaging

2.TV/US is usually the 1st invx . measure endometrial thickness (10-12mm in follicular phase is cut off).3.Endometrial sample: is to exclude endometrial hyperplasia &Ca.

Endometrial sampleis recommended in• female with >40 yr old• Those with increase risk of malignancy

include obesity ,DM, HTN, chronic anovulation, nulliparity, hx of infertility ,fhx of endometrial& colon Ca. , tamoxifin & HRT therapy.

• In younger female if no response to clinical Mx.

Commone method of endometrial sample

• Aspiration curettage (pipelle ,vabra).

• Dilatation & curettage( D&C).

• Hysteroscopy.

Management

Management

Thank you