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
