Menstrual Disorders - Dysfunctional Uterine Bleeding

Question 1

What is DUB? [2]

Answer 1

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

Question 2

In terms of treatments we split them into 3 categories:

Answer 2

1`) Complete family = Surgical

2) Desiring fertility = Non-hormonal medical treatments
3) Not desiring fertility = Hormonal medical treatments

Question 3

What non-hormonal drugs can we use? [2]

Answer 3

• Tranexamic acid, an Antifibrinolytic

- Mefenamic Acid, A prostaglandin Inhibitor

Question 4

Tranexamic acid vs mefenamic acid?
Difference in effects?
NB They’re both taken at the time of periods and are safe if trying to conceive

Answer 4

Tranexamic acid = ~60% decrease in bleeds

Mefenamic Acid = ~30% decrease but also decreases pain

Question 5

What hormonal drugs can we use? [4]

Answer 5

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

Question 6

All hormonal drugs will reduce bleeding. What differences in periods will occur between tablets vs injections/LNG-IUS

Answer 6

cOCP and Progestogen tablets will regulate periods

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

Question 7

What surgical treatments can we offer for DUB? [2]

Answer 7

Endometrial Ablation or Hysterectomy

Question 8

Endometrial ablation is generally preferable to a full on hysterectomy, but it has some caveats [3]

Answer 8

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

Question 9

How do we do endometrial ablation?

Answer 9

With a thermal balloon or by radiofrequency ablation

Question 10

What methods of hysterectomy are available?
Name 3 in increasing order of recovery time
Recovery time from hysterectomy

Answer 10

In increasing order of recovery time:

• Laparoscopic
• Vaginal
• Abdominal

2-3 months

Question 11

What are the variations on hysterectomy? [2]

Answer 11

Sub-total Hysterectomy = leave cervix intact
Total (AH) - Remove cervix
+ Bilateral Salpingo-oophorectomy

Question 12

What are the risks of a hysterectomy?

Name 4 classic surgical risks and 1 specific to hysterectomies

Answer 12

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 13

Pros [2] and cons [1] of adding oophorectomy to hysterectomy?

Answer 13

Pros = Reduces risk of ovarian cancer and helps with endometriosis

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

Question 14

Transexamic acid and Mefanimic acid
Indications of these 2 medications…
Instructions for use

Answer 14

Indicated in those trying to conceive and those where progestogen, estrogen contraindicated
Start day before period, continue throughout period but no more than 7 days at a time