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overview on
Menstrual
irregularity
And a newer approach to
abnormal uterine
bleeding
Menstruation
Menstruation is the periodic discharge of blood
and mucosal tissue from the inner lining of the
uterus through the vagina due to, orderly cyclic
hormone production and parallel proliferation of
the uterine lining preparing for implantation of the
embryo.
The time frame from the start of one menstrual
episode to the start of next menstrual episode is
called Menstrual Cycle.
The number of days the menstrual bleeding
persists is called menstrual Period.
(average 4 days)
(average 29 days)
Duration of flow
Menstrual cycle is
Less than 21 days
More than 35 days
Flow is heavy
blood loss of greater than 80 ml
Passing of large blood clot during menstruation
Enough flow to soak a pad or tampon every hour for 3
consecutive hours. (Each soaked tampon holds 5ml of blood)
Night time bleeding that requires getting up to change pads or
tampons
Dysmenorrhoea
Menorrhagia
Polymenorrhea
Polymenorrhagia
Oligomenorrhoea
Hypomenorrhoea
Metrorrhagia
Metropathia
Haemorrhagica
Cycle
Period
Normal
menstruation
Normal period of
menstruation
21 35 days
3 7 days
Dysmenorrhoea
3 7 days + PAIN
Menorrhagia
21 35 days
Polymenorrhoea
Decreased Cycle
with normal period
3 7 days
Polymenorrhagia
Cycle
Period
Oligomenorrhoea
3 7 days
Hypomenorrhoea
Metropathia
Haemorrhagica
A special type of
anovulatory uterine
bleeding
6 - 8 weeks of
amenorrhoea
followed by
2 8 weeks of
bleeding which is
painless and life
threatening
Metrorrhagia
Irregular, acyclical
bleeding
Fibroid
PID
Adenomyosis
Endometrosis
Dysmenorrhoea
DUB
Reproductive age
Painless
To diagnose exclude
Pubertal age
Menorrhagia
(Regular/Cyclical)
Hypothyroidism
(TSH, T4)
Bleeding disorder
(BT, CT)
Abortion
Ectopic Pregnancy
Molar Pregnancy
IUCD in utero
Break through bleeding
Metrorrhagia
(Irregular/Acyclical)
ABNORMAL UTERINE
BLEEDING
Abnormal Uterine Bleeding is defined as
bleeding from the uterine corpus that is
abnormal in regularity, volume, frequency, or
duration and occurs in the absence of
pregnancy in women of reproductive age.
Caution
Abnormal Uterine Bleeding excludes the
following situations:
AUB Excludes Gravid patients. A pregnancy test is a
must before trying out for AUB.
AUB deals only with women of reproductive age that
is from definitive onset of Menstruation to
menopause. So, pre-pubertal bleeding or post
menopausal bleeding is not included in AUB.
Lower genital tract bleeding due to any cause is
opted out of AUB. So, cervical or vaginal tears or
malignancies must be excluded first.
Types of AUB
Heavy Menstrual Bleeding
Acute
AUB is defined as an episode of heavy bleeding that, in the
opinion of the clinician, is of sufficient quantity to require
immediate intervention to prevent further blood loss
Chronic
chronic AUB is defined as bleeding from the uterine corpus
that is abnormal in volume, regularity, and/or timing, and
has been present for the majority of the past 6 months
Intermenstrual Bleeding
occurs between clearly defined cyclic and predictable
menses.
Non-Structural
C- Coagulopathy (AUB-C)
O-Ovulatory dysfunction
(AUB-O)
E- Endometrial (AUB-E)
I- Iatrogenic (AUB-I)
N- Not yet classified (AUB-N)
P- Polyp (AUB-P)
Polyps are epithelial proliferations
comprised of a variable vascular,
glandular, and fibromuscular and
connective tissue components and
are often asymptomatic.
Yet, it is generally accepted that at
least some polyps contribute to the
genesis of AUB.
A- Adenomyosis (AUB-A)
The relationship between
adenomyosis and the
genesis of AUB is unclear,
though undeniable.
L- Leiomyoma (AUB-L)
An Important cause
of AUB I has its own
primary, secondary
and tertiary
classification system
C- Coagulopathy (AUB-C)
coagulopathy
encompasses the spectrum
of systemic disorders of
hemostasis that may be
associated with AUB.
Coagulation Disorders
Inherited
von willibrands
haemophilia
Acquired
Drug Induced
ITP
Heparin
DIC
Warferin
Leukemia
Aspirine
E- Endometrial (AUB-E)
When AUB occurs in the context of predictable and cyclic
menstrual bleeding, typical of ovulatory cycles, and
particularly when no other definable causes are
identified, the mechanism is probably a primary disorder
of the endometrium.
Indeed, high-quality evidence has demonstrated
deficiencies in local production of vasoconstrictors such
as endothelin-1 and prostaglandin F2, and/or
accelerated lysis of endometrial clot because of excessive
production of plasminogen activator.
the diagnosis of endometrial disorders should probably
be determined by exclusion of other identifiable
abnormalities in women of reproductive age who seem
to have normal ovulatory function.
I- Iatrogenic (AUB-I)
Drugs that may contribute to
AUB:
Hormonal therapy (estrogen,
progesteron, androgens, Etc )
the use of anticoagulant drugs
such as warfarin, heparin, and
low molecular weight heparin
Systemic agents that interfere
with dopamine metabolism
have the potential to cause AUB
Tricyclic antidepressants
phenothiazines