Abnormal uterine bleeding Incidence: the commonest gynecological complaint.
Abnormal uterine bleeding Classification:
A. According to clinical presentation (clinical types).
B. According to the aetiology.
C. According to the age group.
Clinical types of abnormal uterine bleeding
Menorrhagia:
Menorrhagia Definition:
Cyclic bleeding at normal intervals which is either;
Excessive in amount > 180 ml.
Or prolonged in duration > 7 days.
Or more than the usual of the patient.
Menorrhagia Causes:
A. General causes:
1. Organic causes:
a) Cardiac causes: hypertension & CHF.
b) Hematological: blood diseases & anti-coagulant treatment.
c) Endocrinal: hypothyroidism & early hyperthyroidism.
d) Metabolic: liver cirrhosis & chronic renal disease.
e) Infections: syphilis.
2. Psychological causes: (acting through the hypothalamus)
How liver cirrhosis causes menorrhagia?
1. ↓ Estogen metabolism hyperestrogenism
endometrial hyperplasia menorrhagia.
2. ↓ Coagulation factors synthesis.
3. ↓ SHBG synthesis ↑ free estrogen.
B. Local causes:(the commonest causes):
1. Genital:
a) Simple pelvic congestion e.g. coitus interruptus.
b)Congenital anomalies of the uterus.
c) Traumatic: IUD.
d)Displacement: RVF & prolapse.
e) Inflammatory: chronic pelvic infection.
f) Neoplastic: pelvic tumours.
g) Miscellaneous: endometriosis.
2. Extra-genital: e.g. chronic appendicitis.
C. Dysfunctional menorrhagia: (no organic lesion) due to:
a. Irregular ripening of the endometrium.
b. Irregular shedding of the endometrium.
Menorrhagia Investigations:
♦ See later (post menopausal bleeding).
Menorrhagia Treatment:
1. Medical treatment:
a) General measures: * Bed rest.
* Correction of anemia.
* Blood transfusion in severe cases.
b) Drugs: * Anti-fibrinolytic agents.
* Anti-PGs.
* Haemostatic drugs e.g. Ethamsylate & diosmin.
2. Treatment of the cause.
3. Surgical treatment: hysterectomy in:
Women > 40 years.
Failure of medical treatment and repeated curettage.
Polymenorrhea:
Polymenorrhea Definition:
Too frequent menstruation with normal amount.
Polymenorrhea Aetiology:
1. Dysfunctional polymenorrhea.
2. Ovarian congestion: as a part of pelvic congestion.
Metrorrhagia:
Metrorrhagia Definition:
Irregular or continuous acyclic bleeding (not related to menses).
Metrorrhagia Aetiology:
1. Organic local lesion: necrosed fibroid polyp & genital malignancy.
2. Dysfunctional bleeding: metropathia hemorrhagica & threshold bleeding.
3. Pregnancy complications: bleeding in early pregnancy & bleeding in late pregnancy.
4. Contraceptive complications: IUD & irregular use of COCs.
Metrorrhagia Treatment:
treatment of the cause.
Polymenorrhagia:
Polymenorrhagia Definition:
Cyclic bleeding which is too excessive and too frequent.
Polymenorrhagia Aetiology:
1. Hypothalamo-pituitary-ovarian axis disturbance.
2. Uterine causes especially pelvic infection.
Aetiological factors of abnormal uterine bleeding
A. Organic causes:
1. General causes: as menorrhagia.
2. Local causes:
a) Congenital: e.g. uterus didelphys (↑ surface area of bleeding).
b) Traumatic: e.g. • Defloration injury.
• Retained pessary or FB in the vagina & IUCD.
• Trophic ulcers in prolapse.
c) Inflammatory: as chronic cervicitis, senile vaginitis & endometritis.
d) Neoplastic: • Benign: as fibroid & uterine polypi.
• Malignant: as cancer cervix & cancer ovary.
e) Endometriosis.
3. Complications of pregnancy:
Early pregnancy: abortion, ectopic pregnancy & vesicular mole.
Late pregnancy: vasa previa, placenta previa & accidental hemorrhage.
Post partum: PPH, rupture uterus & subinvolution of the uterus.
B. Dysfunctional uterine bleeding: will be discussed later.
Abnormal uterine bleeding according to age group
Neonate: estrogen withdrawal bleeding is the commonest in 1st week of life.
Childhood: 1. Constitutional: precocious puberty (must be excluded 1st).
2. Inflammatory: Vulvo-vaginitis of children.
3. Neoplastic: sarcoma botryoids of the cervix & granulosa cell tumor of the ovary.
At puberty: DUB is mostly suspicious.
Childbearing period: like causes of abnormal uterine bleeding in general.
+ Irregular use of hormones or contraceptive pills.
N.B.: complications of pregnancy are the commonest cause.
Premenopausal ≥ 40 years: DUB is common but malignancy may occur.
Postmenopausal bleeding:
The most common cause in Egypt is senile vaginitis & senile endometritis.
The most common cause in Europe is HRT.
Abnormal Uterine Bleeding for USMLE Video
Abnomral Uterined Bleeding for USMLE, including Dysfunctional Uterine Bleeding. Handwritten tutorial lecture discussing pathophysiology, sign symptoms and treatment. Normal Uterine Bleeding is defined by frequency of 28 days plus or minus 7 days. So anywhere from 21-35 days. Duraiton of menses is 5 to 7 days and on average a woman loses 20-60mL of blood. So menses is measured relative or by the number of pads used. Abnormal can be menorrhagia which is high blood flow either becuase of high duration or high quantity. Metrorrhagia looks more at the frequency and the amount of blood will be normal. Menometrorrhagia will be a combination of the two.
Abnormal uterine bleeding Videos:
Abnormal Uterine Bleeding Video
This is a Learning in 10 voice annotated presentation (VAP) on Abnormal Uterine Bleeding.
Abnormal uterine bleeding power point presentations:
Abnormal uterine bleeding Raheef Alatassi 5th year medical student Obstetrics & Gynecology
Abnormal uterine bleeding