abnormal uterine bleeding presentation
TRANSCRIPT
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Abnormal Uterine Bleeding and the Menstrual Cycle
Susana Martinez
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What is ‘normal’?O A ‘normal’ menstrual pattern is
associated with a monthly bleed (every 21-35 days) with duration of seven days or less.
O A blood loss of 80mls or less, is regarded as being in the normal range
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Menstrual cycle ~ overview
O A regular menstrual patterns depends on the presence of a functioning reproductive hormone feedback system which includes the hypothalamus, anterior pituitary gland and ovaries, as well as normal uterine and vaginal anatomy.
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Menstrual abnormalities
O Menstrual abnormalities include irregular or absent periods, heavy or prolonged menstrual loss (for 3 cycles or more), inter-menstrual and post-coital bleeding, dysmenorrhoea and pre-menstrual disorders.
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AmenorrhoeaO Primary amenorrhoeaO The absence of onset of
menstruation – is regarded as abnormal by the age of 14 years in girls with no other secondary sexual development, and 16 in girls with normal secondary sexual development.
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Causes of primary amenorrhoea
O Anatomical abnormalities (imperforate hymen, congenital absence of uterus or vagina)
O Chromosonal anomalies causing failure to initiate puberty
O Hypogonadotrophic hypogonadism (failure to switch on puberty)
O PCOSO Chronic illness or low body mass (or
excessive exercise)
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Secondary amenorrhoea
O The cessation of menstruation for a period of six months, after regular cycles have been established.
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Causes of secondary amenorrhoea
O Hyphothalamic-pituitary reasons includes:
O Weight loss (BMI <19 unlikely to have regular menstrual cycle)
O Excessive exerciseO ObesityO Secondary to medication: hormonal
contraception, antipsychotics, opiates, chemotherapy
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Causes of secondary amenorrhoea
O Ovarian, uterine or vaginalO Polycystic Ovarian Syndrome (PCOS)O Premature ovarian failureO Other causesO Thyroid hormone deficiency or
excessO Severe generalised disease
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InvestigationsO Investigate after 6 months of
secondary amenorrhoea which is not secondary to contraceptive use such as an implant, Depo injection or Mirena.
O Pregnancy testO FSH, LH, Prolactin and TSH, oestrodialO Testosterone levelsO Consider pelvic/transvaginal ultrasoundO Consider bone density scan
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Management of amenorrhoea
O Primary amenorrhoeaO Refer to a specialist for further
investigationO Secondary amenorrhoeaO Referral to specialist (gynaecologist
or endocrinologist) where diagnosis or management is not clear after initial investigation, and if patient is concerned about fertility.
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DysmenorrhoeaO Dysmenorrhoea is a cyclical lower
abdominal or pelvic pain occuring either before or during menstruation, or both.
O Prevalence is difficult to estimate, but it is thought that dysmenorrhoea affects up to 70% of women at some time during reproductive age.
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EndometriosisO Endometriosis is defined as the
presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction.
O Condition found in women of reproductive age, from all ethnic and social groups
O Estimated prevalence is up to 10%.O Endometriosis often begins in
adolescence
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Adbormal Uterine Bleeding (AUB)
O Abnormal uterine bleeding includes:O Heavy menstrual bleeding (HMB –
previously called menorrhagia)O Intermenstrual bleeding (IMB) and
post-coital bleeding (PCB)
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Management of HMBO IUS (Mirena)O Combined COC (Qlaira)O Tranexamic acidO Nonsteroidal anti-inflammatory drugs
(NSAIDs)O Progestogens (norethisterone (15mg)
daily from days 5-26 of menstrual cycle or long acting injectable progestogens (DMPA -Depo)