DUB

Question 1

Define DUB.

Answer 1

Abnormal uterine bleeding which is not a/w genital tract abnormalities

Question 2

What is the root cause of endometrial hyperplasia that causes menorrhagia?

Answer 2

Hormonal imbalance

Question 3

Mention etiology of AUB.

Answer 3

1. Hypothalamic-pituitary-ovarian dysfunction
2. Tumors, Trauma
3. Infections, foreign body
4. Pregnancy related causes
5. Systemic disorders= hypothyroidism, liver disorders, increased prolactin
6. Coagulation defects= Von willebrand disease, ITP
7. Drugs= heparin, warfarin, COCP, atiepileptics
8. IUCD

Question 4

Etiology of DUB acc to Nitin Yadav notes.

Answer 4

Abnormal uterine bleedings without any clinically detectable pelvic pathology

Question 5

(Etiology of DUB acc to Babloyan) Bleeding parameters.

Answer 5

1. > 8 days, >80 ml
2. intermenstrual or post-coital bleeding
3. amenorrhea
4. oligomenorrhea (>35 days), polymenorrhea (<21 days)

Question 6

Explain Prostaglandin secretion and their functions.

Answer 6

• Normally endometrium produces PG from arachidonic acid
• Progesterone responsible for PGF2alpha secretion

1. PGE2 & PGI2= vasodilators & antiplatelet aggregates
2. PGF2alpha & TxA2= vasoconstrictors & platelet aggregates

Question 7

Explain pathogenesis of DUB. How is menorrhagia caused?

Answer 7

1. Anovulatory cycles= -nce of progesterone & PGF2alpha= Menorrhagia
2. In some cases= tPA increased (tissue plasminogen activator- fibrinolytic enzyme)= menorrhagia

Question 8

Classification of DUB.

Answer 8

1. Anovulatory cycles (80%)
2. Ovulatory cycles (20%)

Question 9

What is included in anovulatory cycles?

Answer 9

a) Puberty menorrhagia
b) Metropathica hemorrhagica
c) In reproductive age female= structural and non-structural causes

Question 10

Explain Metropathica hemorrhagica. c/f. Dx.

Answer 10

• in 40-45 yrs old females (Perimenopausal)
• continuous painless vaginal bleeding preceded by 6-8 weeks of amenorrhea

C/F= bulky uterus, cystic glandular hyperplasia (swiss-cheese pattern)

Dx= History, TSH, USG

Question 11

Mention structural & non-structural changes in reproductive age feamles.

Answer 11

STRUCTURAL CHANGES
P- polyps
A- adenomyosis
L- leiomyoma
M- malignancy & premalignant lesions
NON-STRUCTURAL CHANGES
C- coagulopathy
O- ovulatory disorders
E- endometrial causes
I- iatrogenic
N- not classified eg= atriovenous malformations, varicose veins of uterus

Question 12

What is included in ovulatory cycles?

Answer 12

1. Irregular ripening
2. Irregular shedding

Question 13

Explain irregular ripening. Tx.

Answer 13

• d/t decreased corpus luteal function
• premenstrual spotting/ bleeding

Tx= Progesterone

Question 14

Explain irregular shedding. Tx.

Answer 14

• d/t persistent corpus luteum
• menses is prolonged but not heavy
• postmenstrual spotting/ bleeding

Tx= Progesterone

Question 15

Give therapeutic Tx of DUB.

Answer 15

1. NSAIDs= Mefenamic acid (decrease Pg prod= decrease bleeding)
2. Tranexamic acid { (-) conversion of plasminogen to plasmin}
3. Hormonal therapy= Progestogens, COCP
4. Danazol (antiandrogen)
5. Cloniphene= if pregnancy is desired
6. GnRH analogues= if above therapy fails
7. SERM (Selective Estrogen Receptor Modulator)
8. Iron, Folic acid (anemia correction)

Question 16

Mention instrumental Tx in DUB?

Answer 16

1. IUCD= Mirena
2. D&C
3. Ablative techniques
4. Hysterectomy
5. Biopsy (cancer risk in <35 yr & >35 yr old females)

Question 17

Mention ablative techniques used in DUB.

Answer 17

1. Radiofrequency induced thermal ablation
2. Balloon therapy
3. Microwave ablation
4. Laser therapy
5. Hysteroscopic endometrial ablation by retroscope
6. Uterine tamponade
7. Bilateral uterine artery embolization

Question 18

Mention ways by which hysterectomy is done.

Answer 18

1. Vaginal
2. Abdominal
3. Laparoscopy