DUB Flashcards
Definition of dysfunctional uterine bleeding?
- No underlying cause for menorrhagia!/ oligomenorrhea?
- diagnosis is made on clinical casis after excluding other possible organic causes
Name 3 investigations that you will perform in DUB patients.
after P/E and bimanual examination
- CBC (hemoglobin) for any anemia
- Iron profile for iron deficiency
- Endometrial sampling for endometrial pathology
(how about USG? ok)
- can also do hysteroscopy, done only if suspect structural problems, persistent IMB, irregular bleeding, failed ES…
What are the causes of abnormal uterine bleeding in general? (9)
PALM COIEN
Structural causes
- Polyp
- Adenomyosis
- Leiomyoma = Uterine fibroid
- Malignnacy
Non-structural causes
- Coagulopathy
- Ovulatory dysfunction (DUB)
- Iatrogenic (e.g. IUCD, anticoagulants)
- Endometrial (endocrine(
- Not yet classified
Pharmacological treatments of menorrhagia? (4)
First line pharmacological treatment
1. Tranexamic acid (antifibrinolytic, 500mg Q1D, start on Day 1) / Mefenamic acid
- COC/ Norethisterone (oral progestogen) / Depo Provera (IM progestogen)
Second line treatments
1. Mirena (Levonorgestrel intrauterine device)
- GnRH analogue for peri-/postmenopausal women (create pseudomenopause, but has osteoporosis)
Surgical treatment of menorrhagia?
- Endometrial ablation (70% successful rate, hysteroscopic fuided, LA)
- Hysteroscopic myomectomy for submucosal fibroid
- Uterine artery embolization (for uterine fibroids)
- Hysterectomy (if all other Tx options have failed/ contraindicated)
What are the side effects of Mirena?
- Initial irregular PV spotting for first 3-6 months
- Risk of infection at early stage
- Risk of device expulsion
- Risk of uterine perforation
- Amenorrhea
What are the side effects of endometrial ablation?
Surgical method used in menorrhagia patients
- GA risk
- Hemorrhage and infection (if failed to control bleeding, do D&C to remove the endometrium lining)
- Causes adhesions in uterine cavity +/- dysmenorrhea
- Risk of damaging other intra-abdominal structures
In a 48 year old women, name one advantage and disadvantage to add BSO to TAH.
Advantage: Exclude malignancies in ovaries (ovarian cancer)
Disadvantage: (Climacteric symptoms) 1. Surgical menopause increases risk of osteoporosis
- Vasomotor symptoms
- Mood disturbance
- Vaginal atrophy, increased urinary frequency, sexual dysfunction
Give 4 indications for Mirena.
- DUB
- Contraception
- Endometrial hyperplasia without atypia
- Dysmenorrhea (primary or secondary to endometriosis or adenomyosis)
How to counsel patient after insertion of Mirena? (5)
- Reassure the spotting is common in the 1st few weeks and they do not need to worry
- Advise the patient to seek help if they experience complications
- PID: within 21 days
- Ectopic pregnancy: +ve PT, PV bleed, pain - Avoid pulling on the string, check thread every month. Consult doctor if lost thread and practice conraception
- Change device every 5 years, practice contraception 1 week before removal
- FU after 1st and 4th menses
Causes of menorrhagia?
- Primary: DUB (MC)
- Uterus
- Endometritis, endometrial polyp, endometrial hyperplasia or carcinoma
- uterine fibroid, adenomyosis - Endocrine pathologies
- hypothyroidism/hyperthyroidism, - Cushing’s disease
- Exogenous steroids - Coagulation disorders: bleeding tendencies
- Iatrogenic: use of anticoagulatns
- von Willebrand disease
- Immune thromboncytopenic purpura
- Idiopathic thrombocytopenia
What investigations for menorrhagia? (4)
- CBC for anemia,
- Iron profile for iron deficiency
- USG for fibroid or other uterine abnormality
- Endometrial sampling
Give 4 contraindications of Mirena.
- Pregnancy
- Distorted uterus
- Current PID
- History of breast cancer, endometrial cancer
- Gestational trophoblastic disease
