Menstrual Disorders - Dysfunctional Uterine Bleeding Flashcards Preview

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Flashcards in Menstrual Disorders - Dysfunctional Uterine Bleeding Deck (14)
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1
Q

What is DUB? [2]

A

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

2
Q

In terms of treatments we split them into 3 categories:

A

1`) Complete family = Surgical

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

3
Q

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

A
  • Tranexamic acid, an Antifibrinolytic

- Mefenamic Acid, A prostaglandin Inhibitor

4
Q

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

A

Tranexamic acid = ~60% decrease in bleeds

Mefenamic Acid = ~30% decrease but also decreases pain

5
Q

What hormonal drugs can we use? [4]

A
  • cOCP
  • Progestogen tablets
  • Progestogen injections (Depo-Provera)
  • LNG-IUS
6
Q

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

A

cOCP and Progestogen tablets will regulate periods

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

7
Q

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

A

Endometrial Ablation or Hysterectomy

8
Q

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

A
  • Uterine cavity <11cm
  • If there are submucous fibroids they must be <3cm
  • Must have a normal endometrial biopsy
9
Q

How do we do endometrial ablation?

A

With a thermal balloon or by radiofrequency ablation

10
Q

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

A

In increasing order of recovery time:

  • Laparoscopic
  • Vaginal
  • Abdominal

2-3 months

11
Q

What are the variations on hysterectomy? [2]

A

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

12
Q

What are the risks of a hysterectomy?

Name 4 classic surgical risks and 1 specific to hysterectomies

A

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

13
Q

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

A

Pros = Reduces risk of ovarian cancer and helps with endometriosis

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

14
Q

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

A

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