1. MENSTRUAL CYCLE DISORDERS THERAPY
PETR KREPELKA 1

2. Abnorlam uterine bleeding
Regularity of cycle
Iregular – metrorrhagia
Absent – amenorrhoea (primary, secondary)
Frequency of cycle
Frequent - polymenorrhoea
Infrequent - oligomenorrhoea

3. Describing normal uterine bleeding
Duration of menstrual flow
Prolonged – menorrhagia
Shortened - hypomenorrhoea
Volume of menstrual flow
Heavy - hypermenorrhoea
Light - hypomenorrhoea

4. Polymenorrhoea Polymenorrhoe – cycle < 21 days Therapy
Progestines during luteal phase of cycle (normoestrogenic disorders)
Progestines+estrogenes (hypoestrogenic disorders)

5. Oligomenorrhoe Oligomenorrhoe – cycle > 35 days Therapy
No therapy (normoestrogenic disorders)
Progestines during luteal phase of cycle (normoestrogenic disorders)
Progestines+estrogenes (hypoestrogenic disorders)
Induction of ovulation (infertility)

6. Primary amenorrhoe Therapy - casual
Progestines+estrogenes (hypoestrogenic disorders)

7. Secondary amenorrhoe Therapy – normoprolactinemic and normoestrogenic
Progestogenes
Ovulation induction

8. Heavy or prolonged uterine bleeding
Menoragia
Hypermenorhea
DUB =dysfunctional uterine bleeding
AUB = abnormal uterine bleeding

9. Endometrial ablation/destruction / Hysterectomy
Dysfunctional uterine bleeding - therapy
Observation    DG   Pharmacological
  
Spont.normalization   
Recurrence     D & C   Failure 
  
  
- Surgical -
Endometrial ablation/destruction / Hysterectomy 9

10. Pharmacological therapy of DUB
Non-hormonal
Nonsteroidal antirevmatics
Mefenamic acid
Ethamsylate
Antifibrinolytics
EAC
Tranexamic acid
Hormonal
Estrogens (E)
Progestins (P)
E/P
Danazol
GnRh - a
SERM 10

11. Pharmacological therapy of DUB
Individual
Age-specific
Treatment outcome and side effects are unpredictable
Side effects are common
Economic efficiency
Need for surgical treatment is often 11

12. Pharmacological therapy of DUB
Estrogens
CEE mg p.o. a 6 h. or 25 mg i.v. a 4 h. for 48 h.
Progestins
MPA 10 mg/d for d.
NES mg/d 10 d.
LNG-IUS 12

13. Pharmacological therapy of DUB
E/P
Combined orla contraception
Acute DUB μg/d
Prevention – usual pattern, long cycle pattern, continual
Adolescent gynecology
acute DUB
Progesterone 10 mg/ Estradioldipropionate 2 mg i.m. 13

14. Pharmacological therapy of DUB
Danazol mg/d
not available in Czech Republic
GnRH agonists
goserelin (Zoladex Depot 3,75 mg)
tryptorelin (Decapeptyl Depot 4,12 mg, Dipherelin 4,39 mg)
leuprorelin (Lucrin Depot 3,75 mg) 14

15. Pharmacological therapy of DUB
Nonsteroidal antirevmatics
Naproxen (Aleve tbl.220 mg, Apo-naproxen tbl mg, Nalgesin tbl. 270 mg)
Mefenamic acid (Nimesulid tbl. 100 mg)
Antifibrinolytics
Tranexamic acid (Exacyl p.o. tbl. 500 mg , oral solution 10ml/1000 mg a venous injection 5 ml/500mg) 15

16. Effectiveness of pharmacotherapy
Hormonal
Progestins - 21 day cycle 30-90%
Combined oral contraception 43%
Danazol 50-80%
LNG IUS 74-97%
DMPA 50-66%
GnRH agonists >90% 16

17. Effectiveness of pharmacotherapy
Non-hormonal
Non-steroidal antirevmatics 20-50% ?
Tranexamic acid 47-54%
Etamsylate 13%? 17 17

18. Surgical therapy of DUB
Endometrial ablation – hysteroscopical
Roller ball ablation (25-60%)
Transcervical resection (26-40%)
Laser ablation (37%) 18

19. Surgical therapy of DUB
Endometrial ablation – non-hysteroscopical methods
RFEA – Radio Frequency Endometrial Ablation (41%)
TBEA – Thermal Balloon Endometrial Ablation (48%)
MWEA – Microwave Endometrial Ablation (61%) 19

20. Surgical therapy of DUB
Vaginal hysterectomy
LAVH – laparoscopically assisted vaginal hysterectomy
Abdominální hysterektomie (minilaparotomy) 20

21. Surgical therapy of DUB - controversies
Dilatation+curettage
Diagnostic procedure
Endometrial - Resection/ablation
Many costly methods
Many failures selhání
Hysterectomy
Invazive
Operational risks
Expensive
Suitable for women over 40 21

22. Hypomenorrhoe Posttraumatic – Aschermanns syndrome Therapy
Hysteroskopy – lysis of adhaesions – IUD - estrogens

23. Dysmenorrhea - therapy
Secondary dysmenorrhoea – causative
Primary dysmenorrhoea – combined hormonal contraception effectivity – 90%
Progestogens contraception – long acting
LNG-IUS
Non-steroidal anti-inflammatory drugs (NSAIDs)
2-3 days before menstrual bleeding
Continue to the 2.day of bleeding

24. Premenstrual syndrome - therapy
Diet regime – restriction of coffein, alcohol, salt, glycids
Aerobic exercise
Psychological consultation

25. Premenstrual syndrome - therapy
Symptomatic treatment according to prevailing syndrome
Combined oral contraception (drospirenon)
Agnus castus
Non-steroidal anti-inflammatory drugs
SIRS - fluoxetin

26. …thank you for your attention