Dr. HANA OMER Abnormal Uterine Bleeding (AUB) 2014

 Normal menstrual cycle  Interval: 28 +/- 7 days (21-35 days)  Can change from cycle to cycle  Length </= 7 days  Flow: Average blood loss: 35ml (20-60ml)  Menorrhagia  Prolonged – more than 7 days  or Heavy – greater than 80ml/day

Polymenorrhea Bleeding occuring at intervals <21 days Oligomenorrhea Intervals between bleeding episodes vary from 35 days to 6 months Amenorrhea No menses for 6 months or more

 Pregnancy  Hormonal Imbalance (hypothalamus /pituitary /ovary)  Hemostatic Disorders (systemic and local)  Reproductive Tract Pathology

Spontaneous/Incomplete Abortion Gestational Trophoblastic Disease (a term used for a group of pregnancy-related tumours. These tumours are rare, and they appear when cells in the womb start to grow out of control) “Normal Pregnancy”

Hormonal Causes can be devided into : A)ANOVULATORY AUBB)OVULATORY AUB A) Anovulatory AUB (No Luteal Phase): The corpus luteum does not form in an anovulatory cycle, resulting in a failure of the cyclical secretion of progesterone Without progesterone, there is continuous unopposed production of estradiol, which stimulates overgrowth of the endometrium. The endometrium grows thick until it outgrows its blood supply, resulting in necrosis and irregular bleeding

B) Ovulatory AUB: Presents as menorrhagia (Abnormally heavy bleeding at menstruation) A less common cause of AUB; believed to be caused by a defect in local endometrial hemostasis The mechanism is unknown, but theories include hormonal imbalance and alterations in fibrinolysis.

 Inherited disorders  Example: Hemophilias (medical condition in which the ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury)  Acquired disorders  Example: Liver Disease  Iatrogenic (drug induced )  Anticoagulants  NSAIDS

Uterine Lesions – Endometrial polyps – Endometritis – Hyperplasia or cancer

Pathophysiology – In a reproductive age patient who is not having regular menses, must determine if 1. Progesterone Deficient 2. Estrogen and Progesterone Deficient

Patholophysiology – LACK OF PROGESTERONE Estrogen production with lack of progesterone leads to unopposed estrogen stimulation of the endometrium Can result in irregular shedding of the endometrium resulting in unscheduled/heavy bleeding Potential for development of endometrial hyperplasia or cancer.

Pathophysiology: – lack of ESTROGEN and PROGESTERONE – Lack of estrogen AND progesterone in reproductive age women can lead to osteoprorosis, increased risk for heart disease, and reduced quality of life – Examples: anorexia nervosa, athletic amenorrhea,

 Your doctor will ask you about your personal and family health history as well as your Menstrual Cycle  It may be helpful if you keep track of your menstrual cycle before your doctor visit (dates, length and type of bleeding)  You also may have blood tests (hormonal levels check). And a pregnancy test to check if you are pregnant

 Some other tests may be needed to diagnose AUB Including:  Sonohysterography: Fluid is placed into the uterus via a thin tube while ultrasound images of the uterus are taken  Hysteroscopy: Thin device is inserted through the vagina, allowing your doctor to see inside your uterus  Endometrial Biopsy

 Medications:  Hormonal medications  Birth control Pills  Antibiotics  Anti-inflammatory drugs

 Surgeries:  Surgery to remove abnormal uterine growths (Polyps)  Endometrial ablation  Hysterectomy (removal of the uterus)