Dysfunctional Uterine Bleeding Flashcards
1
Q
Define Dysfunctional Uterine Bleeding.
A
Abnormal uterine bleeding in the absence of organic pathology.
2
Q
What are the types of dysfunctional uterine bleeding?
A
-
Anovulatory (90%) = failure of follicular development → no increase in progesterone → cystic hyperplasia of endometrial glands with hypertrophy of columnar epithelium due to unopposed oestrogen stimulation
- Shedding of this may be prolonged or long-term
-
Ovulatory (10%) = prolonged progesterone secretion
- Irregular shedding
3
Q
What are the signs and symptoms of dysfunctional uterine bleeding?
A
- Bleeding - menorrhagia, IMB, dysmenorrhoea
- Anaemia signs/symptoms
- S/S of the cause:
- Relation to the menstrual cycle
- Fertility issues
- Compression symptoms
- Cervical screening history
- DHx and FHx
- Previous STIs
- Coagulopathy disorders (von Williebrand disease)
4
Q
What are the causes of dysfunction uterine bleeding?
A
- Pathology = PALM
- Polyps
- Adenomyosis
- Leiomyoma
- Malignancy
- Endocrine = COEIN
- Coagulopathy
- Ovulation - PCOS, hypothyroid
- Endometriosis
- Iatrogenic
- Not classified
5
Q
What are the appropriate investigations for suspected dysfunctional uterine bleeding?
A
- Examination
- Speculum - ectropion
- Bimanual - bulky, fibroids
- If menorrhagia without other related symptoms consider starting management without any physical examination
- Bloods
- FBC (anaemia)
- TFTs (hypothyroid)
- Clotting screen (if primary menorrhagia or FHx)
- TVUSS - PCOS, fibroids, malignancy
- OPD hysteroscopy / laparoscopy ± biopsy (endometriosis)
6
Q
What is the management of dysfunctional uterine bleeding?
A
- Treat the cause if it known
- 1st line - LNG-IUS
- 2nd line for fertility
- Bleeding - Tranexamic acid, 1g TDS
- Pain - Mefenamic acid
- 2nd line with contraception
- COCP
- Cyclical oral progestogens
- Surgical
- Endometrial ablation
- Hysterectomy
