Dub Ppt
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Dub Ppt as PDF for free.
More details
- Words: 1,582
- Pages: 36
Dysfunctional Uterine Bleeding Nadya Al-Faraidy 98240015 21 October 2003 WWW.SMSO.NET
Definition
DUB is abnormal uterine bleeding with no pathological or congenital cause. diagnosis of exclusion Can be: w/in the period: menorrhagia intermenstrual bleeding WWW.SMSO.NET
Terminology
Primary Amenorrhea: no menstruation by age of 14 in absence of secondary sexual characteristics OR before 16 yrs in presence of secondary sexual characteristics Secondary Amenorrhea: cessation of menstruation or 6 months or more in a patient who was menstruating regularly or 12 months in a patient who had a history of oligomenorrheaWWW.SMSO.NET
Menorrhagia: excessive &/or prolonged regular menstruation
Polymenorrhea: frequent regular menses at intervals <21 days
Polymenorrhagia: frequent but w/ prolonged &/or excessive bleeding
Metrorrhagia: irregular periods of uterine bleeding
Oligomenorrhea:
WWW.SMSO.NET
Pathophysiology
DUB is most common near the beginning and end of a woman's reproductive life, but may occur at any time. first 18 months after menarche: immature hypothalamin-pituitary axis obese women: non-ovarian endogenous estrogen production may upset the normal menstrual cycle. Menopause: anovulatory DUB. anovulatory cycles resulting in menometrorrhagia luteal phase deficiency cause the loss of LH surge, may be especially prominent in amenorrheic athletes. >40 years: number and quality of ovarian follicles. (OCPs), Endocrine disorders . Hyperprolactinemia Polycystic ovary disease Hypothyroidism, hyperthyroidism, and Cushing's disease, premature ovarian failure
WWW.SMSO.NET
Causes Pregnancy complications Abortion Ectopic pregnancy. Molar disease. Infection e.g. endometritis in post partum.
WWW.SMSO.NET
Causes Vulvar lesions: Trauma. Infection. Ulcer. Inflammatory lesion. Condylomata. Vulvar tumors (very rare).
WWW.SMSO.NET
Causes Vaginal lesions: Vaginitis. Atrophic vaginitis (common in post menopausal women). Foreign bodies e.g. forgotten tampons. Traumas and lacerations. Vaginal tumors (very rare). Disorders of pelvic support (pelvic relaxation).
WWW.SMSO.NET
Causes Cervical lesions: Polyps. Cervicitis. Cervical condyloma. Cervical tumors.
WWW.SMSO.NET
Causes Uterine lesions: Fibroid. Adenomyosis and endometriosis. Endometrial Polyps. Endometrial hyperplasia Endometritis. Uterine malformation: if severe, menorrhagia Precocious puberty. IUCD. Endometrial ca.
WWW.SMSO.NET
Causes Ovarian lesions: Salpingo-oopheritis (PID). Endometriosis. Ovarian cyst. Ovarian tumors.
WWW.SMSO.NET
Causes GU and GI lesions: Hematuria. Hemorrhoids. Fissures. Rectal cancer. Colon cancer.
WWW.SMSO.NET
Causes General disease: Coagulation disorders. Liver disease. Renal disease Thyroid disease. Adrenal disease. Pituitary disease.
WWW.SMSO.NET
Causes Blood Dyscariasis: ITP Von-Willibrand disease Leukemia Anemias SCA Thalassemia
WWW.SMSO.NET
Causes Medications: Exogenous hormones eg Hormone Replacement Therapy Oral contraceptives. Aspirin. Anticoagulant therapy. Digitalis. Corticosteroids. Others.
WWW.SMSO.NET
Incidence
. One of the most common symptoms in gynecology. . Most frequently at the extremes of age: an-ovulation or Imbalance. 6months – 1 year after menarche and post menopause. Menorrhagia affects approximately 22% of healthy women. In the United States, approximately 7.6 million pre-menopausal women aged between 30 and 55 perceive their menstrual bleeding to be WWW.SMSO.NET excessive.
Age
Evaluation History
Most common cause of bleeding
age New born Maternal estrogen Menstrual history. Childhood Foreign body, cancer Amount of Adolescence due to hormonal imbalance bleeding. Duration of the Due to weaning of ovarian function Perimenopausal loss. -Pregnancy and its complications. reproductive Interval between -Anovulation due to: episodes. 3.polycystic ovarian disease Associated 4.idiopathic symptoms. 5.stress Drugs ingested 6.hypothyroidism 7.hyperprolactinemia b/c of: esp use of hormones or a.pituitary adenoma contraceptives. b.pituitary microadenoma galactorrhea Variation in WWW.SMSO.NET Postdiet andHormone replacement cancer weather,
Evaluation Physical Examination
Examination of all symptoms. Basal temperature charting Pelvic examination & speculum examination Recto-vaginal examination in young children or single women in which you can’t do pelvic examination. WWW.SMSO.NET
Evaluation Lab Investigations
CBC: Hb and Hct + WBCs for infection Indication ESR Test Serum HCG to rule outpregnancy urine pregnancy pregnancy. test anemia Urinalysis CBC coagulpathy (especially in adolescents Pelvic U.S. PT/PTT cervical cancer Hysterosalpingography Pap smear* > 40IU/L suggests ovarian failure (HSG). FSH liver disease Endometrial biopsy. liver function tests thyroid disease TSH pituitary adenoma (with breast Hysteroscopy. prolactin level discharge) Dilatation and curettage (D & Serum C) Diagnostic Ovulation luteal phase and therapeutic. progesterone # Most of the time we don’t need all these investigation, Hb and HCG will be enough. WWW.SMSO.NET
WWW.SMSO.NET
Management Medical
PGSI- PG Synthase Inhibitor:
Combined contraceptive pill: transforms uterus into pseudo-secretory state “short secretory & short proliferative & then shedding occurs Progesterone: for 21 days if uterus hyperplastic Rationale: during DUB, there is excessive PG esp PGE2 which cause excessive bleeding Eg indomethacin, mefenamic acid (Ponstan) Rx 50-70% of DUB Side effect: diarrhea
ECA:
Fibrinolytic Causes thrombosis of spiral uterine blood vessels causes decreased bleeding > side effects
WWW.SMSO.NET
How successful is HRT at preventing menstrual bleeding?
Continuous combined hormone replacement usually results in amenorrhea after about 3 months of use intermittent bleeding during the first 3 months is common. By 6 months, about 2/3's of women will not have bleeding at 1 year 80-85% will be without bleeding. Increasing the estrogen dose as well as the progestin dose may help stop some of the bleeding. WWW.SMSO.NET
WWW.SMSO.NET
Management Surgical
Removal of the endometrium If hormone therapy is not effective, the endometrium may be removed. Endometrial ablation is usually the method of choice, although some patients choose a hysterectomy or D & C.
WWW.SMSO.NET
Endometrial ablation
YAG LASER Thermal balloon Hydrothermablator Resectoscope
WWW.SMSO.NET
YAG LASER Advantages
15 and 30 minutes. discharged two or three hours. The patient should be reassured that discharge is normal 80% successful in reducing heavy periods and may eliminate menstruation altogether. Advantages of the procedure over hysterectomy it is safer, less invasive, and does not require a surgical incision it is less expensive it requires a shorter WWW.SMSO.NET hospital stay
YAG Disadvantages o o o o o o o
fluid overload hyponatremia, perforation of the uterus or adjacent organs, uterine rupture, infection or haemorrhage. Overall, endometrial ablation has a morbidity rate of 3%. sterility WWW.SMSO.NET
The Novasure System
Another new device, the Novasure System™ , is now available, and has a number of advantages over other systems. It only takes a few minutes and has an excellent safety record WWW.SMSO.NET
Thermal balloon
two components - a balloon catheter for heating and a controller local anaesthesia 87 degrees Celsius, for eight minutes. outpatient procedure equal it to inserting an intrauterine device (IUD). SE: pressure or cramping sensation (NSAID) suppository administered 45 minutes prior to the procedure. might experience vaginal discharge or spotting, which normally changes to a watery discharge, between 10 and 30 days. it is normal. intended for use by women who have already completed their families.
WWW.SMSO.NET
HTA Hydrothermablator
hot water, but allows it to circulate freely in the endometrial cavity. It is done under direct vision through a hysteroscope 10 minutes
WWW.SMSO.NET
Who should consider endometrial ablation?
menstrual bleeding that is impacting life, with no other problems that require a hysterectomy >80ml per cycle, >8 days
Activity is limited b/c of periods anemic and tired Bleeding limits intimate time with partner Failure of drug therapy Exclusion of other causes NO desire to retain fertility
WWW.SMSO.NET
Who shouldn't have an endometrial ablation?
endometrial ablation is not for anyone who desires to keep her fertility. malignancy or pre-malignant condition of the uterus severe pelvic pain, unless the pain is coming from an intracavitary myoma Although pregnancy is unlikely after ablation, serious complications could arise. It is essential for to use reliable contraception after an endometrial WWW.SMSO.NET
Who can help me decide if an endometrial ablation is for me?
gynecologist A physician who does not do endometrial ablation on a regular basis is unlikely to have the experience to help you make the best decision. The physician should be expert at vaginalprobe ultrasound and at diagnostic hysteroscopy, and should consider nonsurgical treatments, as well as discussing the advantages and disadvantages of all the options available. While the physician WWW.SMSO.NET can provide you with information, the
How successful is endometrial ablation at stopping uterine bleeding problems?
The various techniques used for endometrial ablation may have slightly different outcomes
in general about 1/3 to 1/2 of women are completely without any bleeding afterwards (amenorrheic)
about 15-20% still have bleeding problems severe enough to warrant further surgery . The overall satisfaction rate of endometrial ablation is about 65%
WWW.SMSO.NET
Other Surgical Options
Hysteroscopy
Resectoscopy
Hysterectomy
D&C
WWW.SMSO.NET
Is hysterectomy a better treatment than endometrial ablation for bleeding problems?
The two procedures are somewhat difficult to compare. outpatient vs. inpatient 1 week vs. 6 weeks 4 year study: 36% of the women having endometrial ablation and 24% of the women having hysterectomy required more sx Satisfaction rates 80% in the ablation group and 89% in the hysterectomy group. (retreatment, PMS) Endometrial ablation allows about 75% of women to avoid hysterectomy Hysterectomy was more successful in the long run in treating the bleeding problems WWW.SMSO.NET as well as premenstrual symptoms
Definition
DUB is abnormal uterine bleeding with no pathological or congenital cause. diagnosis of exclusion Can be: w/in the period: menorrhagia intermenstrual bleeding WWW.SMSO.NET
Terminology
Primary Amenorrhea: no menstruation by age of 14 in absence of secondary sexual characteristics OR before 16 yrs in presence of secondary sexual characteristics Secondary Amenorrhea: cessation of menstruation or 6 months or more in a patient who was menstruating regularly or 12 months in a patient who had a history of oligomenorrheaWWW.SMSO.NET
Menorrhagia: excessive &/or prolonged regular menstruation
Polymenorrhea: frequent regular menses at intervals <21 days
Polymenorrhagia: frequent but w/ prolonged &/or excessive bleeding
Metrorrhagia: irregular periods of uterine bleeding
Oligomenorrhea:
WWW.SMSO.NET
Pathophysiology
DUB is most common near the beginning and end of a woman's reproductive life, but may occur at any time. first 18 months after menarche: immature hypothalamin-pituitary axis obese women: non-ovarian endogenous estrogen production may upset the normal menstrual cycle. Menopause: anovulatory DUB. anovulatory cycles resulting in menometrorrhagia luteal phase deficiency cause the loss of LH surge, may be especially prominent in amenorrheic athletes. >40 years: number and quality of ovarian follicles. (OCPs), Endocrine disorders . Hyperprolactinemia Polycystic ovary disease Hypothyroidism, hyperthyroidism, and Cushing's disease, premature ovarian failure
WWW.SMSO.NET
Causes Pregnancy complications Abortion Ectopic pregnancy. Molar disease. Infection e.g. endometritis in post partum.
WWW.SMSO.NET
Causes Vulvar lesions: Trauma. Infection. Ulcer. Inflammatory lesion. Condylomata. Vulvar tumors (very rare).
WWW.SMSO.NET
Causes Vaginal lesions: Vaginitis. Atrophic vaginitis (common in post menopausal women). Foreign bodies e.g. forgotten tampons. Traumas and lacerations. Vaginal tumors (very rare). Disorders of pelvic support (pelvic relaxation).
WWW.SMSO.NET
Causes Cervical lesions: Polyps. Cervicitis. Cervical condyloma. Cervical tumors.
WWW.SMSO.NET
Causes Uterine lesions: Fibroid. Adenomyosis and endometriosis. Endometrial Polyps. Endometrial hyperplasia Endometritis. Uterine malformation: if severe, menorrhagia Precocious puberty. IUCD. Endometrial ca.
WWW.SMSO.NET
Causes Ovarian lesions: Salpingo-oopheritis (PID). Endometriosis. Ovarian cyst. Ovarian tumors.
WWW.SMSO.NET
Causes GU and GI lesions: Hematuria. Hemorrhoids. Fissures. Rectal cancer. Colon cancer.
WWW.SMSO.NET
Causes General disease: Coagulation disorders. Liver disease. Renal disease Thyroid disease. Adrenal disease. Pituitary disease.
WWW.SMSO.NET
Causes Blood Dyscariasis: ITP Von-Willibrand disease Leukemia Anemias SCA Thalassemia
WWW.SMSO.NET
Causes Medications: Exogenous hormones eg Hormone Replacement Therapy Oral contraceptives. Aspirin. Anticoagulant therapy. Digitalis. Corticosteroids. Others.
WWW.SMSO.NET
Incidence
. One of the most common symptoms in gynecology. . Most frequently at the extremes of age: an-ovulation or Imbalance. 6months – 1 year after menarche and post menopause. Menorrhagia affects approximately 22% of healthy women. In the United States, approximately 7.6 million pre-menopausal women aged between 30 and 55 perceive their menstrual bleeding to be WWW.SMSO.NET excessive.
Age
Evaluation History
Most common cause of bleeding
age New born Maternal estrogen Menstrual history. Childhood Foreign body, cancer Amount of Adolescence due to hormonal imbalance bleeding. Duration of the Due to weaning of ovarian function Perimenopausal loss. -Pregnancy and its complications. reproductive Interval between -Anovulation due to: episodes. 3.polycystic ovarian disease Associated 4.idiopathic symptoms. 5.stress Drugs ingested 6.hypothyroidism 7.hyperprolactinemia b/c of: esp use of hormones or a.pituitary adenoma contraceptives. b.pituitary microadenoma galactorrhea Variation in WWW.SMSO.NET Postdiet andHormone replacement cancer weather,
Evaluation Physical Examination
Examination of all symptoms. Basal temperature charting Pelvic examination & speculum examination Recto-vaginal examination in young children or single women in which you can’t do pelvic examination. WWW.SMSO.NET
Evaluation Lab Investigations
CBC: Hb and Hct + WBCs for infection Indication ESR Test Serum HCG to rule outpregnancy urine pregnancy pregnancy. test anemia Urinalysis CBC coagulpathy (especially in adolescents Pelvic U.S. PT/PTT cervical cancer Hysterosalpingography Pap smear* > 40IU/L suggests ovarian failure (HSG). FSH liver disease Endometrial biopsy. liver function tests thyroid disease TSH pituitary adenoma (with breast Hysteroscopy. prolactin level discharge) Dilatation and curettage (D & Serum C) Diagnostic Ovulation luteal phase and therapeutic. progesterone # Most of the time we don’t need all these investigation, Hb and HCG will be enough. WWW.SMSO.NET
WWW.SMSO.NET
Management Medical
PGSI- PG Synthase Inhibitor:
Combined contraceptive pill: transforms uterus into pseudo-secretory state “short secretory & short proliferative & then shedding occurs Progesterone: for 21 days if uterus hyperplastic Rationale: during DUB, there is excessive PG esp PGE2 which cause excessive bleeding Eg indomethacin, mefenamic acid (Ponstan) Rx 50-70% of DUB Side effect: diarrhea
ECA:
Fibrinolytic Causes thrombosis of spiral uterine blood vessels causes decreased bleeding > side effects
WWW.SMSO.NET
How successful is HRT at preventing menstrual bleeding?
Continuous combined hormone replacement usually results in amenorrhea after about 3 months of use intermittent bleeding during the first 3 months is common. By 6 months, about 2/3's of women will not have bleeding at 1 year 80-85% will be without bleeding. Increasing the estrogen dose as well as the progestin dose may help stop some of the bleeding. WWW.SMSO.NET
WWW.SMSO.NET
Management Surgical
Removal of the endometrium If hormone therapy is not effective, the endometrium may be removed. Endometrial ablation is usually the method of choice, although some patients choose a hysterectomy or D & C.
WWW.SMSO.NET
Endometrial ablation
YAG LASER Thermal balloon Hydrothermablator Resectoscope
WWW.SMSO.NET
YAG LASER Advantages
15 and 30 minutes. discharged two or three hours. The patient should be reassured that discharge is normal 80% successful in reducing heavy periods and may eliminate menstruation altogether. Advantages of the procedure over hysterectomy it is safer, less invasive, and does not require a surgical incision it is less expensive it requires a shorter WWW.SMSO.NET hospital stay
YAG Disadvantages o o o o o o o
fluid overload hyponatremia, perforation of the uterus or adjacent organs, uterine rupture, infection or haemorrhage. Overall, endometrial ablation has a morbidity rate of 3%. sterility WWW.SMSO.NET
The Novasure System
Another new device, the Novasure System™ , is now available, and has a number of advantages over other systems. It only takes a few minutes and has an excellent safety record WWW.SMSO.NET
Thermal balloon
two components - a balloon catheter for heating and a controller local anaesthesia 87 degrees Celsius, for eight minutes. outpatient procedure equal it to inserting an intrauterine device (IUD). SE: pressure or cramping sensation (NSAID) suppository administered 45 minutes prior to the procedure. might experience vaginal discharge or spotting, which normally changes to a watery discharge, between 10 and 30 days. it is normal. intended for use by women who have already completed their families.
WWW.SMSO.NET
HTA Hydrothermablator
hot water, but allows it to circulate freely in the endometrial cavity. It is done under direct vision through a hysteroscope 10 minutes
WWW.SMSO.NET
Who should consider endometrial ablation?
menstrual bleeding that is impacting life, with no other problems that require a hysterectomy >80ml per cycle, >8 days
Activity is limited b/c of periods anemic and tired Bleeding limits intimate time with partner Failure of drug therapy Exclusion of other causes NO desire to retain fertility
WWW.SMSO.NET
Who shouldn't have an endometrial ablation?
endometrial ablation is not for anyone who desires to keep her fertility. malignancy or pre-malignant condition of the uterus severe pelvic pain, unless the pain is coming from an intracavitary myoma Although pregnancy is unlikely after ablation, serious complications could arise. It is essential for to use reliable contraception after an endometrial WWW.SMSO.NET
Who can help me decide if an endometrial ablation is for me?
gynecologist A physician who does not do endometrial ablation on a regular basis is unlikely to have the experience to help you make the best decision. The physician should be expert at vaginalprobe ultrasound and at diagnostic hysteroscopy, and should consider nonsurgical treatments, as well as discussing the advantages and disadvantages of all the options available. While the physician WWW.SMSO.NET can provide you with information, the
How successful is endometrial ablation at stopping uterine bleeding problems?
The various techniques used for endometrial ablation may have slightly different outcomes
in general about 1/3 to 1/2 of women are completely without any bleeding afterwards (amenorrheic)
about 15-20% still have bleeding problems severe enough to warrant further surgery . The overall satisfaction rate of endometrial ablation is about 65%
WWW.SMSO.NET
Other Surgical Options
Hysteroscopy
Resectoscopy
Hysterectomy
D&C
WWW.SMSO.NET
Is hysterectomy a better treatment than endometrial ablation for bleeding problems?
The two procedures are somewhat difficult to compare. outpatient vs. inpatient 1 week vs. 6 weeks 4 year study: 36% of the women having endometrial ablation and 24% of the women having hysterectomy required more sx Satisfaction rates 80% in the ablation group and 89% in the hysterectomy group. (retreatment, PMS) Endometrial ablation allows about 75% of women to avoid hysterectomy Hysterectomy was more successful in the long run in treating the bleeding problems WWW.SMSO.NET as well as premenstrual symptoms
Related Documents
Dub Ppt
April 2020 4
Virtual Dub
May 2020 7
Virtual Dub
November 2019 3
Dub Liners
June 2020 5
Virtual Dub
May 2020 5