Menstrual Disorders - Dysfunctional Uterine Bleeding

Question 1

What is DUB?

Answer 1

Abnormal uterine bleeding but without any structural, endocrine, neoplastic or infectious cause (that we can find)

Question 2

Don’t jump to treating every woman who complains of abnormal bleeding, consider how subjective a heavy period is.

Answer 2

Important to ensure your treatment isn’t more risky or does more harm to their QOL than the bleed does
Many women with DUB don’t have symptoms that restrict their life they just want to be reassured its nothing sinister

Question 3

In terms of treatments we split them into categories:

Answer 3

1`) Don’t want more kids? = Surgical
2) Want to conceive? = Non-hormonal medical treatments
3) Not trying to conceive? = Hormonal medical treatments

Question 4

What non-hormonal drugs can we use?

Answer 4

• Tranexamic acid, an Antifibrinolytic
• Mefenamic Acid, A prostaglandin Inhibitor

Question 5

Tranexamic acid vs mefenamic acid?

Answer 5

Tranexamic acid = ~60% decrease in bleeds
Mefenamic Acid = ~30% decrease but also decreases pain

They’re both taken at the time of periods and are safe if trying to conceive

Question 6

What hormonal drugs can we use?

Answer 6

• cOCP
• Progestogen tablets
• Progestogen injections (Depo-Provera)
• LNG-IUS

Question 7

All hormonal drugs will reduce bleeding, whats the differences?

Answer 7

cOCP & Progestogen tablets will regulate periods

Whereas Progestogen injections and LNG-IUS can result in irregular periods or even amenorrhoea

Question 8

What surgical treatments can we offer for DUB?

Answer 8

Endometrial Ablation or Hysterectomy

Question 9

Endometrial ablation is generally preferable to a full on hysterectomy, but it has some pre-requisites:

Answer 9

• Uterine cavity <11cm
• If there are submucous fibroids they must be <3cm
• Must have a normal endometrial biopsy

Question 10

How do we do endometrial ablation?

Answer 10

With a thermal balloon or by radiofrequency ablation

Question 11

How effective is endometrial ablation at treating DUB?

Answer 11

60% become amenorrhoeic
of those who undergo it only 15% will decide to progress to a hysterectomy (85% are happy with results)

Question 12

What methods of hysterectomy are available?

Answer 12

In increasing order of recovery time:
- Laparoscopic
- Vaginal
- Abdominal

Question 13

How long does it take to fullly recover from a hysterectomy?

Answer 13

2-3months

Question 14

What are the variations on hysterectomy?

Answer 14

Sub-total = leave cervic
Total - Remove cervix
+ Bilateral Salpingo-oophorectomy

Question 15

What are the risk of a hysterectomy?

Answer 15

Classic surgical risks:
- DVT
- Infection
- Adhesion
- Vessel, bladder or bowel injury

Also has a high risk of damaging the blood supply to the ovaries triggering menopause

Question 16

Pros and cons of adding oophorectomy to hysterectomy?

Answer 16

Pros = Reduces risk of ovarian cancer and helps with endometriosis

Cons = Instant menopause & will need HRT till they turn 50