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12 Cards in this Set
- Front
- Back
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Define normal uterine bleeding |
Regular cycle after puberty Cyclic bleed of 3-5 days with an 28-30 day interval |
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Define excessive uterine bleeding |
Bleeding for longer period of time, increased volume or decreased interval |
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What types of excessive uterine bleeding exist? |
Menorrhagia = cyclic bleeding Metrorrhagia = acyclic bleeding Meno-metrorrhagia = both symptoms Polymenorrhagia = interval is shortened |
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How do we clinically describe excessive bleeding? |
If the patient clots Number of pads used Pre or post menstrual blood stained discharge is included in the number of bleeding days |
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What is the normal menstrual volume? |
80ml |
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What is the physiology of menstrual bleeding? |
Dependent on hormones (NB thyroid hormones)
During ovulation the corpus luteum producesprogesterone which stabilises the endometrium (grown thick under the influenceof oestrogen) No fertilisation leads the corpus luteumto degenerate after 10 days This decreases progesterone levels causingtheendometrium to necrotise and degenerate (breakdown of glands, stroma and BV) Basal layer remains Blood is mainly arterial, fibrolysinproduced in the endometrium causes theblood not to clot Once the layers have been shed thebleeding stops and the cycle starts again with oestrogen building up theendometrium |
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What are the causes of excessive blood loss? |
Organic = disorders of the genital tract Dysfunctional = no abnormalities of the genital tract |
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What are the types of excessive uterine bleeding? |
Endometrial Hyperplasia: Causedby unopposed oetrogen stimulation
Polyps = benign soft tumors ofthe epithelium - Cause=submucosa myomata and intermenstrual bleeding - Bleeding associated with myomata,infectious diseases, adenomyosis,endometriosis is all cyclical - Pedunculated myomata and malignant tumours = acyclical bleeding Exclude rectal and bladder bleeding Dysfunctional bleeding: Anovulatory (85%) - There is growth of follicles but no dominant follicle is formed therefore oestrogen builds up in endometrium but no progesterone is produced - The outer layer outgrows the blood supply which causes excessive bleeding for a long time Ovulatory (15%) - Corpus luteum retains its function(progesterone production for excessive time…6weeks) and finally degenerates which causes excessive bleeding and pain - Or corpus luteum produces less progestone therefore more frequent bleeding |
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How do we approach excessive uterine bleeding? |
History Full gynecologic exam Blood tests (pregnancy, copper sulphate, Hb) Find and exclude organic pathology of the genital tract or related organs If no pathology = dysfunctional bleeding - special tests: FBC, thyroid function and prolactin Decrease the bleeding and restore the cycle |
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How do we treat excessive uterine bleeding? |
Hormonal: Monophasicoral contraceptive (progesterone dominant)
- double dose if severe bleeding - discontinue after 4-6 months once the cycle has returned - Emergency measure for severe bleeding: Ovral, Porgestonetablets Non-hormonal Rx: Anti-fibronolytic (cyclocapron) - Decreases blood loss by 50% - Expensive and CI in history of thrombosis Non-steroidal anti-inflammatory - Suitable for cyclic excessive bleeding - Decrease blood loss by 25% Organic disorders = if first line therapy doesn’t work then do more SI (US, histerscopy,endometrial sampling) Surgical: In the case of failed medical therapy - Hysterectomy/destruction of endometrial layer Random note in text: Ovulatory dysfunctional bleeding is very similar presentation to ectopic pregnancy…therefore do pregnancy test first before start therapy |
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What are causes of post-coital bleeding? |
Sign of cervical cancer/cervical intra-epithelial neoplasm Other: cervicitis, cervical ectopy where columnar epithelium present Therefore must receive cervical cytological smear |
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What are causes of post menopausal bleeding? |
Malignancy |
