Dysfunctional Uterine bleeding Flashcards
What is dysfunctional Uterine Bleeding (DUB)
defined as abnormal uterine bleeding in ABSENCE of organic cause
affects 10% of women
RF- hormonal influences and ovulatory cycles
extreme reproductive ages, obesity
2 types - anovulatory (90%) failure of follicular development -> no increase in progesterone -> cystic hyperplasia of glands because of unnposed oestrogen stimu (shedding is the bleed)
Ovulatory (10%)-prolonged progestrone secretion-> irregular shedding
mennorhagia - no volume definition -what ever the individual says
ca
Sx of dysfunctional Uterine Bleeding (DUB)
DIAGNOSIS of EXCLUSION
bleeding (mennoraghia, IMB, dysmennorrhoea)
sx of Aneamia
explore -- relation to menstrual cycle fertility issues compression sx, cervical screens Dhx, Fhx, sexual Hx (STI, etc) coagulopthies (VWD)
What are the causes/ddx of dysfunctional Uterine Bleeding (DUB)
causes of dub is PALM COEIN
pathology -palms polyps adenomyosis Leimyoma Malignancy
endocrine-COEIN C-coagulopathy (eg von willi) O-ovulation (PCOS, hypothyroid) E-endomitriosis I-iatrogenic N-not classified
Ix of dysfunctional Uterine Bleeding (DUB)
Examination - speculum and bimanual -
check for ectropion (cells of cervix growing out), feel for fibroids
1st line - FBC (aneamia), TFT (hypothyroid), clotting screen (if primary mennorhagia, FHx)
2nd line- TVUSS (PCOS, fibroids, maligancy)
3rd line -hysterscopy (outpatient), laproscopy/biopsy
Mx of dysfunctional Uterine Bleeding (DUB)
If cannot identify pathology, firboids <3cm, suspected adenomysosis–
1st line (if need contraception) is LNG IUS (hormonal coil-mirena) (wait till firboids excluded for SURE)
2nd line- ( fertility required)-
bleed- tranexamic acid 1g TDS (contra- renal, thrombotic disease)
Pain -mefanemic acid (NSAIDS–contra indicated in IBD)
2nd line (contraception wanted)
COCP/
Cyclical oral proestrogens ( nerthisterone -care- big bleed when stop)
surgical — endomitrial ablation, hystercomy)
if firboids over 3cm -see firboids card
