Abnormal Uterine Bleeding

Abnormal Uterine Bleeding
Presentation by:Lloyd Holm, D.O., FACOG
Associate Professor
Department of Obstetrics and Gynecology
University of Nebraska Medical Center

Abnormal Uterine Bleeding
* Definitions
* Etiologies
* Evaluation and workup
* Case presentation
* Management and options

Definitions
Normal
abnormal
Average blood loss with menstruation
Definitions
Menorrhagia
Prolonged
Synonymous with hypermenorrhea
Metrorrhagia
Oligomenorrhea:
Amenorrhea
Etiologies
* Organic
o Systemic
o Reproductive tract disease
o Iatrogenic
* Dysfunctional
o Ovulatory
o Anovulatory

Systemic Etiologies
* Coagulation defects
* Leukemia
* ITP
* Thyroid dysfunction

Most Common Causes of Reproductive Tract AUB
Reproductive Tract Causes
* Gestational events
* Malignancies
* Benign
o Atrophy
o Leiomyoma
o Polyps
o Cervical lesions
o Foreign body
o Infections
* Gestational events
o Abortions
o Ectopic pregnancies
o Trophoblastic disease
o IUP
* Malignancies
o Endometrial
o Ovarian
o Cervical
Incidence of Endometrial Cancer in Premenopausal Women
Reproductive Tract Causes of Benign Origin
* Atrophy
* Leiomyoma
* Polyps
* Cervical lesions
* Foreign body
* Infection

Proposed Etiologies of Menorrhagia with Leiomyoma
* Increased vessel number
* Increased endometrial surface area
* Impeded uterine contraction with menstruation
* Clotting less efficient locally

Leiomyoma in any location is associated with increased risks of gushing or high pad/tampon use.
Iatrogenic Causes of AUB
* Intra-uterine device
* Oral and injectable steroids
* Psychotropic drugs
To determine if DUB is ovulatory or anovulatory
Evaluation and Work-up: Early Reproductive Years/Adolescent
Evaluation and Work-up: Women of Reproductive Age
Evaluation and Work-up: Post-menopausal Women
EMB
Incidence of Endometrial Cancer in Premenopausal Women
Endometrial Cancer Risk Factors
Possible Path Reports with EMB
Hysteroscopy
Management
Management Options:
* Progestins
* Estrogen
* OCs
* NSAIDs
* Antifibrinolytics
* Surgical
Progestins: Mechanisms of Action
Management: Progesterone
Progestational Agents
Intrauterine System
Treatment of menorrhagia with IUD vs endometrial resection
Endometrial Hyperplasia
Management: Estrogen
Management: NSAIDs
Cyclooxygenase Pathway
Arachidonic Acid
Prostaglandins
Thromboxane
Prostacyclin*
Antifibrinolytics:
Surgical Options:
* Laser ablation
* Thermal ablation
* Resection
* Hysterectomy
Comparison of Ablative Techniques
Case Presentation
Summary

Abnormal Uterine Bleeding.ppt