AUB Definitions Significance. Classifications
Definition Any deviation in normal Normal?? frequency, 28 ± 7 duration amount of menstruation Normal?? 28 ± 7 1-8 (3-5) 10-80ml (30-50) Can also include vaginal bleeding before menarche and after menopause
Definitions contd Menorrhagia: Excessive (>80 ml) & / or prolonged menstruation(>7), at regular intervals Metrorrhagia - Irregular, frequent bleeding of varying amounts but not excessive Menometrorrhagia Prolonged or excessive bleeding at irregular intervals Polymenorrhea Regular bleeding at intervals of less than 21 days Oligomenorrhea Bleeding at intervals greater than 35 days – may be irregular Intermenstrual Uterine bleeding between regular cycles
Others… Hypermenorrhea – similar to menorrhagia but usually refers to heavy mensus (in terms of amount) Hypomenorrhea (cryptomenorrhea) – regular scanty bleeding Could be due to anatomic or hormonal abnormalities Anatomic – imperforated hymen, incomplete transverse vaginal septum, cervical or vaginal stenosis, asherman’s syndrome. Hormonal – hypothyroidism, hyperprolactinemia, hyperinsulinemia
METROTAXIS: continuous uterine bleeding without interruption Contact bleeding – post coital or post examination bleeding. 2/3 – unknown causes Cervicitis or vaginitis – e.g. – Chlamydia, trichomonas Cervical ca Cervical polyps Cervical eversion Atrophic vaginitis METROTAXIS: continuous uterine bleeding without interruption Amenorrhea – no mensus for 6 months cervical cancer unless R/O
Novak’s gynaecology 14th edition
Why do we have to know about AUB?? Abnormal uterine bleeding affects 10 to 30 percent of reproductive-aged women and up to 50 percent of perimenopausal women It is a common reason for gynecologic consultation. Responsible for over one third of hysterectomies.
Classification of AUB Childhood Adolescence Mostly vaginal – vulvovaginitis, trauma, neoplasms, precosious puberty Adolescence DUB – anovulation mostly…., sexual abuse, STDs Child bearing age – r/o pregnancy Pregnancy related, STDs, myomas. Etc. Peri menopausal DUB Post menopausal - r/o malignancies Tumors, atrophy
Classification of causes
Classifications contd. AUB Non- Obstetric Non- gynaecologic Systemic Local Gynaecologic Obstetric Classifications contd. Endocrinopathies Coagulopathies Hepatic and renal failure DUB Lieomyoma Adenomyosis Polyps Tumors Infections Trauma Urethral bleeding Rectal bleeding Abortion Ectopic pregnancy GTD Implantation bleeding
Gynecologic causes - uterus Uterine fibroids Adenomyosis – also called ‘endometriosis interna’, refers to ectopic endometrial tissue within the myometrium possibly results from increased and abnormal vascularization of the endometrial lining Is also associated with dysmenorrhea
Gyn. Contd. Endometrial polyps – are also associated with AUB possibly due to asynchronous shedding to that of the normal endometrium Thus usually associated with intermenustrial bleeding. Endometrial hyperplasia and cancer – Endometrial cancer should be suspected in any woman in menopausal transition with abnormal uterine bleeding Two thirds of women with endometrial cancer present with postmenopausal bleeding Only about 5% of endometrial ca occurs in patients younger than 40 yrs
Gyn. Contd. Other uterine lesions include: Atrophic endometrium Infections – STD, TB Mechanical causes – e.g. - IUD Arteriovenous malformation
Non uterine gyn, causes Ovary - ??? Fallopian tube – salphingitis, Cancer Cervix – Cancer, polyps, Infections Vagina – Cancer, infections, atrophic vaginitis, foreinbody, Trauma
Systemic causes… Endocrinopathies – Hypo or hyperthyroidism, hyperprolactinemia, adrenal disorders, DM Coagulopathies Factor deficiency – von willebrand’s disease, hemophilia Palate disorders – ITP, leukemia, aplastic anemia etc. Hepatic and renal failure – deficiency due to decreased synthesis and increased loss respectively
What is the most common cause of AUB??? DUB (50%)
References Williams Gynecology Berek & Novak's Gynecology, 14th Edition Danforth's Obstetrics and Gynecology, 9th Ed Wikipedia www.figo.com www.acog.com www.slideshare.com