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    Abnormal Uterine Bleeding

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    lovelots1234
    This document discusses abnormal uterine bleeding, describing it as bleeding that is abnormal in amount, duration, or timing. It then provides details on different types of abnormal bleeding patterns based on periodicity and flow quantity. These include oligomenorrhea, polymenorrhea, hypermenorrhea, menometrorrhagia, and hypomenorrhea. The document also outlines steps to determine if the bleeding is uterine in origin, organic or not, and ovulatory or anovulatory. Causes, diagnoses, and management are discussed for abnormal bleeding in the prepubertal, adolescent, reproductive age, and post-menopausal groups.

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    Abnormal Uterine Bleeding

    Uploaded by

    lovelots1234
    2K views29 pages
    This document discusses abnormal uterine bleeding, describing it as bleeding that is abnormal in amount, duration, or timing. It then provides details on different types of abnormal bleeding patterns based on periodicity and flow quantity. These include oligomenorrhea, polymenorrhea, hypermenorrhea, menometrorrhagia, and hypomenorrhea. The document also outlines steps to determine if the bleeding is uterine in origin, organic or not, and ovulatory or anovulatory. Causes, diagnoses, and management are discussed for abnormal bleeding in the prepubertal, adolescent, reproductive age, and post-menopausal groups.

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    This document discusses abnormal uterine bleeding, describing it as bleeding that is abnormal in amount, duration, or timing. It then provides details on different types of abnormal bleeding patterns based on periodicity and flow quantity. These include oligomenorrhea, polymenorrhea, hypermenorrhea, menometrorrhagia, and hypomenorrhea. The document also outlines steps to determine if the bleeding is uterine in origin, organic or not, and ovulatory or anovulatory. Causes, diagnoses, and management are discussed for abnormal bleeding in the prepubertal, adolescent, reproductive age, and post-menopausal groups.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    2K views29 pages

    Abnormal Uterine Bleeding

    Uploaded by

    lovelots1234
    This document discusses abnormal uterine bleeding, describing it as bleeding that is abnormal in amount, duration, or timing. It then provides details on different types of abnormal bleeding patterns based on periodicity and flow quantity. These include oligomenorrhea, polymenorrhea, hypermenorrhea, menometrorrhagia, and hypomenorrhea. The document also outlines steps to determine if the bleeding is uterine in origin, organic or not, and ovulatory or anovulatory. Causes, diagnoses, and management are discussed for abnormal bleeding in the prepubertal, adolescent, reproductive age, and post-menopausal groups.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
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    The document discusses abnormal uterine bleeding across different age groups from prepubertal to post-menopausal. It describes the various types of abnormal bleeding, factors to consider in diagnosis, and potential causes and management strategies.

    The main types of abnormal uterine bleeding described are oligomenorrhea, polymenorrhea, hypermenorrhea, menometrorrhagia, hypomenorrhea, and intermenstrual bleeding based on periodicity and quantity of flow.

    To identify the cause, it is important to determine if the bleeding is uterine in origin, if there is an underlying organic pathology, and if the bleeding is ovulatory or anovulatory.

    Abnormal Uterine Bleeding

    Uterine bleeding that is


    abnormal in amount, duration
    or timing
    Terms used to describe
    patterns are based on
    periodicity and quantity of flow

    Types of Abnormal
    Bleeding
    oligomenorrhe Infrequent, irregular
    a
    episodes, intervals > 40
    days
    polymenorrhe
    a
    hypermenorrh
    ea

    Frequent, regular episode,


    intervals of < 21 days
    Excessive in amount
    (menorrhagia) and
    duration of flow, regular
    intervals, >7 days, >80
    ml

    Types of Abnormal
    Bleeding
    menometorrhea Excessive and
    prolonged, frequent,
    irregular interval
    hypomenorrhea Regular but decreased in
    amount
    Intermenstrual Bleeding which is not
    bleeding
    excessive, occuring
    between regular
    menstruation

    Determine whether
    bleeding is:

    1. Uterine in origin

    2. Organic or not

    Through insertion of speculum


    Acute cystitis: from urethra
    Is there an underlying pathology?
    Cervical cancer / polyp

    3. Ovulatory or anovulatory

    Abnormal Uterine Bleeding


    JI Ruby Lyn P. Roque

    Prepubertal Age Group

    Slight vaginal bleeding within the


    first few days of life due to
    withdrawal from high levels of
    maternal estrogen
    Vulvar lesions

    Pruritus with excoriations ->


    macerations or fissures that can bleed

    Prepubertal Age Group

    Urethral prolapse

    Rare
    Bladder mass that is friable and can
    bleed slightly
    Mass surrounding the urethra
    Tx: topical estrogens, urethral biopsy

    Prepubertal Age Group

    Condyloma

    Grapelike growth in cervix and vagina


    Child abuse considered
    First 2 years of life: acquired
    perinatally from mother
    Excoriations can produce bleeding

    Prepubertal Age Group

    Foreign body

    Common cause of vaginal discharge,


    either purulent or bloody
    Possibility of abuse must be
    considered

    Prepubertal Age Group

    Precocious puberty

    Vaginal bleeding in the absence of


    secondary seual characteristics

    Management:

    Directed to the cause of bleeding


    Persistence of bloody discharge after tx as
    a cause of non-specific vulvovaginitis ->
    rule out foreign body

    Prepubertal Age Group

    Trauma

    Hx from parents or caretaker to rule out


    abuse
    Medicolegal case
    Straddle injury: affects ant. vulvar area
    Sexual abuse: penetrating injury with
    lesions of the fourchette or thru hymenal
    ring

    Prepubertal Age Group

    Vaginal tumors

    Sarcoma botryoides

    Most common
    Presents with bleeding and grapelike
    clustered mass in vagina

    Adolescent Age Group

    Normal menses

    1st 2 years: most cycles are


    anovulatory
    2/3 of girls establish pattern within 2
    years of menarche
    Cycle length: 21 40 days
    Mean duration: 4.7 days
    Average blood loss : 35 ml / cycle

    Adolescent Age Group

    Recurrent bleeding of > 80 ml / cycle


    anemia
    Major component is endometrial
    tissue
    3 5 pads / day
    Cycles > 40 days, < 21 days and
    lasting > 7 days are considered
    abnormal

    Adolescent Age Group

    Anovulation

    Frequent, prolonged or heavy


    bleeding after a long interval of
    amenorrhea
    The younger the age of menarche,
    the sooner ovulation is established

    Adolescent Age Group

    Pregnancy-related bleeding

    Spontaneous abortion, ectopic


    pregnancy, molar pregnancy

    Exogenous hormones

    Breakthrough bleeding in OC users


    due to missed pills
    DMPA

    Adolescent Age Group

    Infections

    Chlamydial infection can cause postcoital


    bleeding

    Endocrine or systemic problems

    Thyroid dysfunction
    Hepatic dysfunction
    Polycystic ovarian syndrome
    Genital anomalies

    Adolescent Age Group

    Diagnosis:

    Pregnancy test
    CBC, plt, CT, BT, coagulation studies
    Thyroid function
    Test for chlamydia : for sexually active
    UTZ : TV / TR

    Adolescent Age Group

    Management

    Mild bleeding : reassurance, close


    follow up, supplementation; if mildly
    anemic, combination OC or cyclic
    progestin
    Moderate: combined monophasic OC
    q 6H x 4 7 days; MPA 10 30 mg /
    day x 7 10 days

    Adolescent Age Group

    Management

    Mild bleeding : reassurance, close


    follow up, supplementation; if mildly
    anemic, combination OC or cyclic
    progestin
    Moderate: combined monophasic OC
    q 6H x 4 7 days; MPA 10 30 mg /
    day x 7 10 days

    Adolescent Age Group

    Profuse bleeding

    Hospitalization
    Rule out coagulation disorders

    Reproductive Age Group

    Dysfunctional Uterine Bleeding


    ( DUB)

    No specific cause
    Most often due to anovulation
    Low levels of estrogen prolonged
    irregular bleeding
    High levels of estrogen amenorrhea
    followed by acute heavy bleeding

    Reproductive Age Group

    Pregnancy related
    Exogenous hormones
    Endocrine
    Anatomic and organic causes

    Reproductive Age Group

    Diagnosis

    Blood studies
    Pregnancy Test
    Pelvic UTZ
    Endometrial sampling of D & C or
    hysteroscopy

    Reproductive Age Group

    Management

    Non surgical
    Surgical

    Post Menopausal Age

    Benign

    HRT
    Atrophic vaginitis most common or
    endometritis mucosa easily bleeds
    Cervical Polyps
    Endometrial polyps

    Neoplasia

    Post Menopausal Age

    Daiagnosis

    Pelvic examination
    PAP smear
    Endometrial biopsy / hysteroscopy / D
    &C
    Transvaginal UTZ

    Post Menopausal Age

    Management

    Atrophic vaginitis estrogen therapy


    Polypectomy and curettage

    THANK YOU (,)

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