logging in or signing up DUB bijji Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2300 Category: Education License: All Rights Reserved Like it (4) Dislike it (0) Added: July 20, 2008 This Presentation is Public Favorites: 0 Presentation Description undergrad OBGYN topic Comments Posting comment... Premium member Presentation Transcript Abnormal and Excessive Menstrual Bleeding : Abnormal and Excessive Menstrual Bleeding Dr Prasanna Kumar Shetty, MD Asst Prof Dept of OBG KSHEMA Definitions : Definitions Menorrhagia: (hypermenorrhoea) regular bleeding at normal intervals which is either excessive in amount (>80ml) or duration(>7days) or both. Polymenorrhoea: cyclic bleeding where the cycle is reduced to 21 days or less and remains constant at that frequency (epimenorrhoea) Definitions : Definitions Metrorrhagia: Irregular, acyclical bleeding from the uterus. Amount of bleeding is variable. Bleeding from any part of genital tract is included under this heading in clinical practice. Oligomenorrhoea: Menstrual bleeding occurring more than 35 days apart and which remains constant at that frequency Definitions : Definitions Hypomenorrhoea: when the menstrual bleeding is unduly scanty and lasts for less than 2 days. Dysfunctional Uterine bleeding (DUB): Abnormal uterine bleeding without any clinically detectable organic pelvic pathology- tumour, inflammation or pregnancy. Common Causes of Abnormal Uterine or Vaginal Bleeding : Common Causes of Abnormal Uterine or Vaginal Bleeding Abnormal menstrual bleeding. Menorrhagia Polymenorrhoea Metrorrhagia Oligomenorrhoea Postmenopausal, Precocious, delayed menopause Non-menstrual Foreign Body Urethral caruncles Genital malignancies Postcoital Intermenstrual Abortion Breakthrough Bleeding Menorrhagia : Menorrhagia Symptom of underlying pathology Pelvic Pathology: Congestion, increased surface area or hyperplasia of the endometrium Fibroid uterus, Adenomyosis, Pelvic Endometriosis, IUCD, Chronic tubo-ovarian mass, granulosa cell tumour of ovary. Common causes: DUB, Fibroid, Adenomyosis, Chronic PID Menorrhagia : Menorrhagia Systemic: Liver Dysfunction, Endocrine: Hypothyroidism, hyperthyroidism Blood Dyscrasias: ITP, leukaemias, von Willebrand’s disease Functional: disturbed hypothalamo-pituitary axis. Menorrhagia : Menorrhagia Long duration of flow, passage of big clots, use of increased no of sanitary pads, pallor, low Hb% Treatment: Definitive treatment of the cause of menorrhagia as the case maybe, eg: fibroid: myomectomy or hysterectomy, removal of IUCD, treatment of hypothyroidism. Polymenorrhoea : Polymenorrhoea Causes: dysfunctional, during adolescence, preceding menopause and following delivery/abortion. ?hyperstimulation of ovary by pituitary gonadotrophins Ovarian hyperaemia: PID, ovarian endometriosis Treatment: Hormonal Metrorrhagia : Metrorrhagia Causes: DUB- adolescence, following childbirth/abortion and perimenopause Submucous fibroid Uterine polyp Carcinoma cervix and endometrial carcinoma Contact bleeding: Ca cervix, mucous polyp of cervix, vascular erosion of cervix esp during pregnancy, infections: chlamydia metrorrhagia : metrorrhagia Causes of Intermenstrual bleeding: urethral caruncle, ovular bleeding, breakthrough bleeding (pill use), IUCD in utero, decubitus ulcer (prolapse) Treatment: directed to underlying cause Malignancy to be excluded prior to any definitive treatment. Oligomenorrhoea : Oligomenorrhoea Common causes: Age related- adolescence, preceding menopause Weight- obesity Stress & exercise related Endocrine: PCOD, hyperprolactinaemia, hyperthyroidism Androgen producing tumours- ovarian, adrenal Tubercular endometritis: late cases. Hypomenorrhoea : Hypomenorrhoea Local causes: uterine synechiae or endometrial tuberculosis Endocrinal: oral contraceptives Thyroid dysfunction Perimenopausal Systemic: malnutrition EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Differential diagnosis Reproductive tract pathology: cervicitis, cervical neoplasia, endometritis, endometrial polyps, endometrial hyperplasia, uterine leiomyomas, adenomyosis, uterine sarcomas, ovarian neoplasms (estrogen producing) EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Medications: Estrogen administration Oral contraceptives Progesterone-only contraceptives Aspirin Anticoagulants Psychotropic medications Trauma Foreign Body Lacerations Intrauterine device . Endocrine gland dysfunction Hypothyroidism Hyperthyroidism EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Ovulatory dysfunction Anovulation Shortened follicular phase Luteal Phase deficiency Prolonged corpus luteum function Pregnancy-related conditions Threatened abortion Spontaneous abortion Ectopic pregnancy Gestational trophoblastic neoplasms EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Systemic disease Haematological disorders Von Willebrand’s disease Thrombocytopaenia Hepatic disease Renal disease EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Complete History Current bleeding history Menstrual history Contraceptive use Medical history Drug history EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Complete Physical Examination: detects organic causes of bleeding, signs of anovulation General physical examination-thyroid enlargement, galactorrhoea, ecchymosis, purpura EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Gynaecological examination- including Pap smear detects organic causes of abnormal bleeding Laboratory studies: not all tests necessary in all patients Pregnancy test Complete blood count EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Contd. TSH/Prolactin Coagulation profile: PT, PTT, BT Androgen profile: Testosterone, DHEA, OH-progesterone-in women with anovulatory bleeding and hirsutism EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Diagnostic studies Endometrial biopsy- all women >40 with chronic anovulatory bleeding D and C Hysteroscopy, or direct visualization of endometrial cavity You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
DUB bijji Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2300 Category: Education License: All Rights Reserved Like it (4) Dislike it (0) Added: July 20, 2008 This Presentation is Public Favorites: 0 Presentation Description undergrad OBGYN topic Comments Posting comment... Premium member Presentation Transcript Abnormal and Excessive Menstrual Bleeding : Abnormal and Excessive Menstrual Bleeding Dr Prasanna Kumar Shetty, MD Asst Prof Dept of OBG KSHEMA Definitions : Definitions Menorrhagia: (hypermenorrhoea) regular bleeding at normal intervals which is either excessive in amount (>80ml) or duration(>7days) or both. Polymenorrhoea: cyclic bleeding where the cycle is reduced to 21 days or less and remains constant at that frequency (epimenorrhoea) Definitions : Definitions Metrorrhagia: Irregular, acyclical bleeding from the uterus. Amount of bleeding is variable. Bleeding from any part of genital tract is included under this heading in clinical practice. Oligomenorrhoea: Menstrual bleeding occurring more than 35 days apart and which remains constant at that frequency Definitions : Definitions Hypomenorrhoea: when the menstrual bleeding is unduly scanty and lasts for less than 2 days. Dysfunctional Uterine bleeding (DUB): Abnormal uterine bleeding without any clinically detectable organic pelvic pathology- tumour, inflammation or pregnancy. Common Causes of Abnormal Uterine or Vaginal Bleeding : Common Causes of Abnormal Uterine or Vaginal Bleeding Abnormal menstrual bleeding. Menorrhagia Polymenorrhoea Metrorrhagia Oligomenorrhoea Postmenopausal, Precocious, delayed menopause Non-menstrual Foreign Body Urethral caruncles Genital malignancies Postcoital Intermenstrual Abortion Breakthrough Bleeding Menorrhagia : Menorrhagia Symptom of underlying pathology Pelvic Pathology: Congestion, increased surface area or hyperplasia of the endometrium Fibroid uterus, Adenomyosis, Pelvic Endometriosis, IUCD, Chronic tubo-ovarian mass, granulosa cell tumour of ovary. Common causes: DUB, Fibroid, Adenomyosis, Chronic PID Menorrhagia : Menorrhagia Systemic: Liver Dysfunction, Endocrine: Hypothyroidism, hyperthyroidism Blood Dyscrasias: ITP, leukaemias, von Willebrand’s disease Functional: disturbed hypothalamo-pituitary axis. Menorrhagia : Menorrhagia Long duration of flow, passage of big clots, use of increased no of sanitary pads, pallor, low Hb% Treatment: Definitive treatment of the cause of menorrhagia as the case maybe, eg: fibroid: myomectomy or hysterectomy, removal of IUCD, treatment of hypothyroidism. Polymenorrhoea : Polymenorrhoea Causes: dysfunctional, during adolescence, preceding menopause and following delivery/abortion. ?hyperstimulation of ovary by pituitary gonadotrophins Ovarian hyperaemia: PID, ovarian endometriosis Treatment: Hormonal Metrorrhagia : Metrorrhagia Causes: DUB- adolescence, following childbirth/abortion and perimenopause Submucous fibroid Uterine polyp Carcinoma cervix and endometrial carcinoma Contact bleeding: Ca cervix, mucous polyp of cervix, vascular erosion of cervix esp during pregnancy, infections: chlamydia metrorrhagia : metrorrhagia Causes of Intermenstrual bleeding: urethral caruncle, ovular bleeding, breakthrough bleeding (pill use), IUCD in utero, decubitus ulcer (prolapse) Treatment: directed to underlying cause Malignancy to be excluded prior to any definitive treatment. Oligomenorrhoea : Oligomenorrhoea Common causes: Age related- adolescence, preceding menopause Weight- obesity Stress & exercise related Endocrine: PCOD, hyperprolactinaemia, hyperthyroidism Androgen producing tumours- ovarian, adrenal Tubercular endometritis: late cases. Hypomenorrhoea : Hypomenorrhoea Local causes: uterine synechiae or endometrial tuberculosis Endocrinal: oral contraceptives Thyroid dysfunction Perimenopausal Systemic: malnutrition EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Differential diagnosis Reproductive tract pathology: cervicitis, cervical neoplasia, endometritis, endometrial polyps, endometrial hyperplasia, uterine leiomyomas, adenomyosis, uterine sarcomas, ovarian neoplasms (estrogen producing) EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Medications: Estrogen administration Oral contraceptives Progesterone-only contraceptives Aspirin Anticoagulants Psychotropic medications Trauma Foreign Body Lacerations Intrauterine device . Endocrine gland dysfunction Hypothyroidism Hyperthyroidism EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Ovulatory dysfunction Anovulation Shortened follicular phase Luteal Phase deficiency Prolonged corpus luteum function Pregnancy-related conditions Threatened abortion Spontaneous abortion Ectopic pregnancy Gestational trophoblastic neoplasms EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Systemic disease Haematological disorders Von Willebrand’s disease Thrombocytopaenia Hepatic disease Renal disease EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Complete History Current bleeding history Menstrual history Contraceptive use Medical history Drug history EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Complete Physical Examination: detects organic causes of bleeding, signs of anovulation General physical examination-thyroid enlargement, galactorrhoea, ecchymosis, purpura EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Gynaecological examination- including Pap smear detects organic causes of abnormal bleeding Laboratory studies: not all tests necessary in all patients Pregnancy test Complete blood count EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Contd. TSH/Prolactin Coagulation profile: PT, PTT, BT Androgen profile: Testosterone, DHEA, OH-progesterone-in women with anovulatory bleeding and hirsutism EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING : EVALUATION AND DIAGNOSIS OF ABNORMAL UTERINE BLEEDING Diagnostic studies Endometrial biopsy- all women >40 with chronic anovulatory bleeding D and C Hysteroscopy, or direct visualization of endometrial cavity