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ABNORMAL UTERINE BLEEDING
Dr.Srwa Jamal MuradMBChB,FICOG
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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.
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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.
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Causes 1.Organic2.Non organicOrganic a. Localb. Systemicc. Pregnancy related Non organica. Ovulatoryb. Non ovulatory (DUB)
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Organic causes:Local causes:FibroidIUCDPIDMalignancyEndometrial CaCervical CaEndometrial hyperplasiaUterine abnormality
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Organic causesSystemic causes;Endocrine causes.hypo&hyper thyriod.DM.prolactin abnormality.advanced liver disease.drugs (heparin, asprine,warfarin,tamoxfine)Hematological.VWBD.ITP
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Organic causes
Pregnancy related.ectopic.miscarriage.trophoblastic diseaseOther causes.urinary tract.GIT
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Non organic cause
Non organic cause or DUB • Ovulatory • Non ovulatory
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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
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examination
General exam: for anaemia, thyroid BMIPelvic exam Cervical smear
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investigation
• Influence by age, reproductive status, pattern &severity of symptoms
• 1.haematological & biochemistry
• PT,FBC if clinically indicated• Thyroid function test if
clinically indicated
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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.
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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.
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Commone method of endometrial sample
• Aspiration curettage (pipelle ,vabra).
• Dilatation & curettage( D&C).
• Hysteroscopy.
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Management
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Management
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Thank you