Menstrual Disorders - Dysfunctional Uterine Bleeding Flashcards

1
Q

What is DUB?

A

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

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2
Q

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

A

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

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3
Q

In terms of treatments we split them into categories:

A

1`) Don’t want more kids? = Surgical

2) Want to conceive? = Non-hormonal medical treatments
3) Not trying to conceive? = Hormonal medical treatments

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4
Q

What non-hormonal drugs can we use?

A
  • Tranexamic acid, an Antifibrinolytic

- Mefenamic Acid, A prostaglandin Inhibitor

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5
Q

Tranexamic acid vs mefenamic acid?

A

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

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6
Q

What hormonal drugs can we use?

A
  • cOCP
  • Progestogen tablets
  • Progestogen injections (Depo-Provera)
  • LNG-IUS
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7
Q

All hormonal drugs will reduce bleeding, whats the differences?

A

cOCP & Progestogen tablets will regulate periods

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

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8
Q

What surgical treatments can we offer for DUB?

A

Endometrial Ablation or Hysterectomy

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9
Q

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

A
  • Uterine cavity <11cm
  • If there are submucous fibroids they must be <3cm
  • Must have a normal endometrial biopsy
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10
Q

How do we do endometrial ablation?

A

With a thermal balloon or by radiofrequency ablation

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11
Q

How effective is endometrial ablation at treating DUB?

A

60% become amenorrhoeic

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

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12
Q

What methods of hysterectomy are available?

A

In increasing order of recovery time:

  • Laparoscopic
  • Vaginal
  • Abdominal
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13
Q

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

A

2-3months

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14
Q

What are the variations on hysterectomy?

A

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

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15
Q

What are the risk of a hysterectomy?

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

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16
Q

Pros and cons of adding oophorectomy to hysterectomy?

A

Pros = Reduces risk of ovarian cancer and helps with endometriosis

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