Treatment Of DUB

Question 1

Cyclical Progestogen:

• Physiology for Use
• Advantages
• Disadvantages

Answer 1

Physiology for use:

• w/o ovulation, CL doesn’t prod progesterone to signal withdrawal of endometrium and stimulate the development of a secretory phase - unopposed oestrogen causes continued proliferation of endometrium, which outgrows its blood supply and sloughs off in an unpredictable fashion
• Progestogen halts endometrial growth and stimulates secretory phase
• Also regularises cycle - given 2/3 times a day for 10 days (luteal phase)

Advantages:
- Effective tx for DUB, dysmenorrhea, endometriosis and infertility

Disadvantages:
- Ovulatory menorrhagia is unresponsive, prolonged use is associated with mood changes, decreased libido, bloating and increased LDL

Question 2

Anti-PG therapy (NSAIDS):

• Physiology for Use
• Advantages
• Disadvantages

Answer 2

Physiology for Use

• Suspected role of PGs in pathogenesis of DUB. Although PGs are decreased in annovulatory DUB, their receptors are up-regulated, which means the endometrium is more susceptible and they will cause endometrial inflammation.
• NSAIDS will cause vasoconstriction
• Given at the time of menses and continued t/o menstruation

Advantages
- Cheap, well tolerated, effective, low risk of side effects and VTE

Disadvantages:
- GI upset

Question 3

Transexamic acid:

• Physiology for Use
• Advantages
• Disadvantages

Answer 3

Physiology for Use

• Increased fibrinolytic activity in people with DUB
• Anti-fibrinolytics will inhibit the conversion of plasminogen to plasmin which will decrease the dissolution of fibrin

Advantages:

• Admin only during menstruation
• Can be used while trying to conceive

Disadvantages:
- Increased risk of intravascular thrombosis

Question 4

COCP:

• Physiology for Use
• Advantages
• Disadvantages

Answer 4

Physiology for Use
- Exogenous hormones mimic female cycle of oestrogen and progesterone

Advantages:
- effective in decreasing decreasing dysmenorrhea, menorrhagia

Disadvantages:
- Oestrogen and Progesterone related

Question 5

Mirena Coil:

• Physiology for Use
• Advantages
• Disadvantages

Answer 5

Physiology for Use

• slow release of progesterone to mimic cycle
• suppresses endometrial growth by promoting secretory phase

Advantages

• as effective as hysterectomy
• more effective than cyclical P and decreasing bleeding

Disadvantages

• Irregular bleeding for first few cycles
• Progesterone related side effects