Heavy Menstrual Bleeding Flashcards
characterize a normal menstrual period
lasts 3-7 days, on avg 35mls of blood loss per cycle. Periods every 21 days.
causes of abnormal uterine bleeding?
PALM-COEIN
- polyps
- adenomyosis
- leimyoma
- malignancy and hyperplasia
- coagulopathy
- ovulatory dysfunction
- endometrial
- iatrogenic
- not yet classified
most common cause of vaginal bleeding during reproductive life?
DUB- dysfunctional uterine bleeding (diagnosis of exclusion, no discernable pathology)
- either ovulatory (10%)
- anovulatory (90%)
histology/pathophysiology of anovulatory DUB?
-no ovulation –> corpus luteum does not develop–> progesterone not produced –> endometrium proliferated under influence of unopposed estrogen–>grows beyond vascular support –> ischaemia, necrosis
histology/pathophysiology of ovulatory DUB?
excessive prostacyclin production–>vasodilation and decreased platelet aggregation–> secretory endometrium
what are the RF’s for anovulatory DUB?
- extremes of reproductive life: ie adolescence (20%), preimenopause (50%)
- although can occur at any time of life
consequences of anovulatory DUB?
any menstrual pattern:
- iron deficiency anaemia
- infertility
- increased risk of endometrial hyperplasia and carcinoma (1-2%)
what are the endocrine causes of DUB?
thyroid disease; pituitary/adrenal disease; PCOS; significant weight changes
–> all initiated by annovulation and unopposed estrogen
uterine causes of DUB?
in myometrium
- fibroids
- adenomyosis
in endometrium
-endometrial polyps, infection (endometritis), IUCD, hyperplasia, carcinoma
-or nearby ovarian pathology
cervical causes of DUB?
cervical polyps
carcinoma
Fibroids - Epi? Sx? Management?
- very common, 20% of women aged 30.
- no symptoms mostly; or pressure, frequency, menstrual disturbance, pregnancy issues
- if symptomatic, hormonal tx (GnRH agonists –>block production of estrogen and progesterone)
