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Dysfunctional Uterine Bleeding
[object Object],[object Object],[object Object],[object Object]
How do hormones work?
 
Menstrual Period Characteristics >80 cc 20-80cc 35   cc Volume >8   d 1-8   d 4   d Duration <21 or >35   d 21-35 d 28 d Cycle length Abnormal Normal Average M enses
Menorrhagia Prolonged (> 7 days) or excessive (> 80mL) uterine bleeding occurring at regular intervals Metrorrhagia Uterine bleeding occurring at irregular intervals or between periods Menometrorrhagia Uterine bleeding occurring at irregular intervals, with heavy (> 80mL) or prolonged (> 7 days) menstrual flow Polymenhorrhea Uterine bleeding occurring at regular intervals of < 21 days Oligomenorrhea Uterine bleeding occurring at intervals of 35 days or longer Amenorrhea Absence of uterine bleeding for 6 months or longer in a non-menopausal woman
Complications of pregnancy Systemic disease   Intrauterine pregnancy Hepatic disease  Ectopic pregnancy Renal disease  Spontaneous abortion Coagulopathy  Gestational trophoblastic disease Thrombocytopenia  Placenta previa von Willebrand's disease  Leukemia Infection Cervicitis Medications/iatrogenic Endometritis Intrauterine device Hormones (oral contraceptives,  Trauma    estrogen, progesterone)  Laceration, abrasion  Foreign body  Hormonal imbalance Anovulatory cycles  Malignant neoplasm   Hypothyroidism     Cervical  Hyperprolactinemia  Endometrial   Cushing’s disease Ovarian  Polycystic ovarian syndrome  Adrenal dysfunction/tumor Benign pelvic lesions   Stress Cervical polyp Excessive exercise Endometrial polyp Leiomyoma  Adenomyosis
Pathophysiology of DUB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology  of DUB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation of DUB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation of DUB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation of DUB
TVUS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Enhanced contrast/relief of endometrial lesions: fibroids, polyps CA Sensitivity/Specificity at 93 to 94 %  for focal lesions ( vs 75% for TVUS alone) Combined with EB:  very high rate of Dx Focal lesions then result in Hysteroscopy
Evaluation of DUB 4.Endometrial Suction Curette Pippelle :  most commonly  used, least discomfort Vabra Aspirator and  Karman Cannula 5.Endometrial Brush Superior in Post-Menopausal Same as Pipelle in Pre-Menop. (A) Pipelle endometrial suction curette. (B) Vabra aspirator. Tao Endometrial Brush
Evaluation of DUB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical treatment of DUB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical treatment of DUB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical treatment of DUB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical treatment of DUB ,[object Object],[object Object],[object Object],[object Object]
Surgery treatment of DUB ,[object Object],[object Object],[object Object],[object Object]
Surgery treatment of DUB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgery treatment of DUB ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]

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DUB

  • 2.
  • 4.  
  • 5. Menstrual Period Characteristics >80 cc 20-80cc 35 cc Volume >8 d 1-8 d 4 d Duration <21 or >35 d 21-35 d 28 d Cycle length Abnormal Normal Average M enses
  • 6. Menorrhagia Prolonged (> 7 days) or excessive (> 80mL) uterine bleeding occurring at regular intervals Metrorrhagia Uterine bleeding occurring at irregular intervals or between periods Menometrorrhagia Uterine bleeding occurring at irregular intervals, with heavy (> 80mL) or prolonged (> 7 days) menstrual flow Polymenhorrhea Uterine bleeding occurring at regular intervals of < 21 days Oligomenorrhea Uterine bleeding occurring at intervals of 35 days or longer Amenorrhea Absence of uterine bleeding for 6 months or longer in a non-menopausal woman
  • 7. Complications of pregnancy Systemic disease Intrauterine pregnancy Hepatic disease Ectopic pregnancy Renal disease Spontaneous abortion Coagulopathy Gestational trophoblastic disease Thrombocytopenia Placenta previa von Willebrand's disease Leukemia Infection Cervicitis Medications/iatrogenic Endometritis Intrauterine device Hormones (oral contraceptives, Trauma estrogen, progesterone) Laceration, abrasion Foreign body Hormonal imbalance Anovulatory cycles Malignant neoplasm Hypothyroidism Cervical Hyperprolactinemia Endometrial Cushing’s disease Ovarian Polycystic ovarian syndrome Adrenal dysfunction/tumor Benign pelvic lesions Stress Cervical polyp Excessive exercise Endometrial polyp Leiomyoma Adenomyosis
  • 8.
  • 9.
  • 10.
  • 11.
  • 13.
  • 14. Enhanced contrast/relief of endometrial lesions: fibroids, polyps CA Sensitivity/Specificity at 93 to 94 % for focal lesions ( vs 75% for TVUS alone) Combined with EB: very high rate of Dx Focal lesions then result in Hysteroscopy
  • 15. Evaluation of DUB 4.Endometrial Suction Curette Pippelle : most commonly used, least discomfort Vabra Aspirator and Karman Cannula 5.Endometrial Brush Superior in Post-Menopausal Same as Pipelle in Pre-Menop. (A) Pipelle endometrial suction curette. (B) Vabra aspirator. Tao Endometrial Brush
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.