Dysfunctional Uterine Bleeding

Im rewriting the answers for my sessional exams. Urgh, i know it was a disaster.

Definition of DUB : It is a state of abnormal uterine bleeding w/o clinically detectable organic,systemic pathology and iatrogenic causes.

It a diagnosis done by ruling  out :

• pregnancy  related complications
• tumours of uterus -Benign (Cervical polyp, endometrial polyp, fibroids)
• Infections
• foreign body- IUD
• Systemic -Hepatic,Renal,
• Blood disorders
• idiopathic
• endocrinal disorders

Types of DUB

• Anovulatory (80%) -Threshold bleeding of puberty menorhagia,Metropathia Hemorhagica,Premenopausal DUB
• Ovulatory(20%) - Irregular ripening,Irregular shedding, IUCD insertion,following sterilization operation.

Signs and symptoms

.Abnormal bleeding are associated with  or without ovulation and are grouped into:

• Ovuular bleeding (polymenorrhea/polymenorhagia/oligomenorrhea/menorhagia of irregular shedding and ripening)
• Anovular bleeding (usually excessive bleeding due to anovulation causing endometrium growth is under unopposed action of oestrogen in absence of progesterone).

Investigations of anovulatory DUB

• Detailed history of menstruation ( no of pads used, passage of clots size & nomober, and duration of bleeding)
• History of IUCD or  steroidal contraception
• History of abnormal bleeding from gums, injury site, epistaxis.
• Bimanual (per vagina, per rectal) examination done to exclude pelvic pathology.(  PV done  for all except virgins)
• Blood haemoglobin estimation,platelet,PT,prothrombin time,
• TSH,T3,T4 estimation done is suspected thyroid cases.
• D&C ( Diagnostic uterine curretage)
• USG and colour Doppler (endometrial hyperplasia : ET> 12mm,hyperechoic,and regular outline)
• Hysteroscopy
• Laparoscopy
• Hysterography

Plan of investigations : Blood values->USG->D&C->Hysteroscopy/hysterography->laparoscopy

Management of anovulatory DUB

DUB treatment includes a general,medical and surgical treatment.

General treatment - Rest, correct anemia,

Medical treatment - Hormones,Prostaglandins synthethase inhibitors,Antifibrinolytics

Surgical treatment - Uterine curettage,endometrial ablation/resection,hysterectomy