1. A BNORMAL UTERINE BLEEDING Dr.Srwa Jamal Murad MBChB,FICOG

2. Abnormal uterine bleeding Menorrhagia(heavy periods’) is blood loss of greater than 80ml per period. Metrorrhagia flow at irregular intervals. Menometrorrhagia frequent, excessive flow. Polymenorrhea bleeding at interval <21 days Dysfunctional uterine bleeding :abnormal uterine bleeding without any obvious structural or systemic abnormality.

3. Menorrhagia is extremely common Is the single leading cause of referral to gynecology clinic. Normal menstrual cycle: Occur each 28days(21-35days) Duration 2-8 days Average 20-80 ml.

5. Causes 1.Organic 2.Non organic Organic a. Local b. Systemic c. Pregnancy related Non organic a. Ovulatory b. Non ovulatory (DUB)

6. Organic causes: Local causes: Fibroid IUCD PID Malignancy Endometrial Ca Cervical Ca Endometrial hyperplasia Uterine abnormality

7. Organic causes Systemic causes; Endocrine causes.hypo&hyper thyriod.DM.prolactin abnormality.advanced liver disease.drugs (heparin, asprine,warfarin,tamoxfine) Hematological.VWBD.ITP

8. Organic causes Pregnancy related.ectopic.miscarriage.trophoblastic disease Other causes.urinary tract.GIT

9. Non organic cause Non organic cause or DUB Ovulatory Non ovulatory

10. Presentation & assesment 1.History :how long have period been heavy, last& how often do they occur. Is there flooding or passage of clots Any intermenstrual bleeding or PCB Pelvic pain & dyspareunia What contraception is being used & PAP smear

11. examination General exam: for anaemia, thyroid BMI Pelvic exam Cervical smear

12. investigation Influence by age, reproductive status, pattern &severity of symptoms 1.haematological & biochemistry PT,FBC if clinically indicated Thyroid function test if clinically indicated

13. imaging 2.TV/US is usually the 1 st invx. measure endometrial thickness (10-12mm in follicular phase is cut off). 3.Endometrial sample: is to exclude endometrial hyperplasia &Ca.

14. Endometrial sample is recommended in female with >40 yr old Those with increase risk of malignancy include obesity,DM, HTN, chronic anovulation, nulliparity, hx of infertility,fhx of endometrial& colon Ca., tamoxifin & HRT therapy. In younger female if no response to clinical Mx.

15. Commone method of endometrial sample Aspiration curettage (pipelle,vabra). Dilatation & curettage( D&C). Hysteroscopy.

16. Management

20. Thank you