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Difficult to measure
Sanitary pad count
Radioisotope labeling of rbcs
Photometric measurement of hematin in sanitary
pads
Estimate, reports of change in duration of blood
flow
Etiology
Organic
Systemic
reproductive
Dysfunctional or endocrinologic
Organic: Systemic
Organic: Reproductive
Accidents of pregnancy
Malignancies
Infection endometritis
Uterine abnormalities myoma, polyp,
adenomyosis
Cervical lesions erosions, polyps,
cervicitis
Vagina - Traumatic lesions, foreign
body
IUD
OCPs HRT, TRANQUILIZERS,
PSYCHOTROPIC DRUGS
Ovulatory
anovulatory
DUB
Prostaglandins regulation of
vasoconstiction and vasodilation
PGE2 vasodilatation
PGF2 vasoconstriction
Thromboxane platelet
aggregation
Prostacycline inhibits platelet
aggregation
Increasing PGF2 to PGE2 ratio
from midcycle to menses in normal
ovulatory women with normal
MBL
Ovulatory
DUB
Anovulatory
Postmenarcheal
Premenopausal
Continuous estrogen production without corpus
luteum formation and progesterone production
Estrogen proliferation of endometrium
necrosis non-uniform slough off of functionalis
layer excessive bleeding
Not secondary to excessive number of arteries and
abnormal distribution of endometrial glands
DUB
Anovulatory DUB
DUB
Diagnosis
Diagnosis
hcG determination
TSH
Tests for coagulation
Test for ovulation: BBT,
luteal phase serum
progesterone, premenstrual
sampling of endometrium
Diagnosis
Transvaginal ultrasound
D and C
Endometrial biopsy
HSG
Hysteroscopy
sonohysterography
Diagnosis
Endometrial biopsy is
recommended to rule
out hyperplasia or
carcinoma
Age 40
Management
Medical Management
Estrogens
Progestins
Progestins
Anti-estrogen
Medroxyprogesterone acetate
10mg daily for 10 days each
month
19-nortestosterone affects lipid
levels
Levonorgestrel-releasing IUD
OCP
Effect on height
Adolescent anovulation
Medical Management
NSAIDs
Antifibrinolytic agent
Inhibitors of fibrinolysis
Tranexamic Acid may be given as high as 6g/day
in divided doses
Effective for ovulatory DUB
Combined with hormonal tx
Side effects: nausea, dizziness, diarrhea, headache,
abdominal pain, allergy
Medical Management
Medical Management
GnRH Agonists
Surgical Management
Surgical Management
Endometrial ablation
Laser photovaporization
Transcervical resection of endometrium with electrocautery
(ball-end or loop electrode or thermal balloon)
Failed medical treatment
Severe menorrhagia with medical contraindications against
hysterectomy
Ovulatory DUB not amenable to medical management
Not for those who want to retain childbearing capacity
LASER
ROLLERBALL
LOOP
Surgical Management
Hysterectomy
Perimenopause
Dysmenorrhea
Primary Dysmenorrhea
No obvious
pathology
Effects of
endogenous
prostaglandins
Almost always
occurs in women
younger than 20
Usually as soon as
ovulatory cycles
are established
Secondary
dysmenorrhea
Associated with
pelvic conditions or
pathology in
conjunction with
menses
May occur in women
under 20 but most
often seen in women
over 20
Primary Dysmenorrhea
Reduced
IUD no effect
Pathogenesis
Unknown
Close association with elevated prostaglandin
F2 in the secretory endometrium
Hypercontractility, cramping
Prostaglandin synthetase inhibitor - NSAIDS
treatments