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AUB Last Papers
AUB Last Papers
2) Threshold bleeding: → ↓↓ estrogen level below level (threshold) w' can maintain
endometrium
D) Dysfunctional Polymenorrhea:
a) Short follicular phase In perimenopause.
b) Short luteal phase Following abortion or delivery LPD???
E) Ovulatory spotting
Def.: → spotting occurring in midcycle (around date of ovulation)
Pathogenesis: → Type of estrogen withdrawal bleeding
deprivation of endometrium from estrogen during changing from follicular to luteal phase
ttt: → No treatment needed
Diagnosis:
→ Diagnosis of DUB is by exclusion (see above)
Treatment Depends on age, severity of bleeding & desire of fertility
❶ General measures
1) 1st aid measures (during bleeding episode)
2) Reassurance.
3) Rest & sedation
4) Correction of anemia By hematinics* (Iron supplementation, ….) & even blood
transfusion if needed
Hematinics (iron, B12 & folate,…) a nutrient required for the formation of RBCs in process of hematopoiesis
Actions Efficacy
1) Anti-PGs (--) of PGs synthesis & alteration of Most effective in ovulatory
(PG synthetase inhibitors) balance () TXA2 [VC] & PGI2 [VD] DUB (↓↓ blood loss by
→ As Mefenamic acid 50%) & è IUD
500 mg tds TXA2=Thromboxane
→ Ibuprofen PGI2= prostacyclin
2) Antifibrinolytics ↓↓ fibrinolytic activity
→ Tranexamic acid (kapron ®)
● C/I Patients è ↓↓ blood loss by 50%.
Epsilon amino-caproic
acid [EACA] thromboembolism.
3) Ethamsylate Stabilization of capillary wall & ↑↑
(Dicynone ®) platelet adhesiveness ↓↓ blood loss by 50%.
❶ ↓↓ estrogen Rc on endometrium
❷ ↑↑ conversion of E2 to E1 (weak & easily displaced from cells).
❸ Antimitotic & antigrowth effects
❹ Convert endometrium from hyperplastic to secretory followed by shedding
(Medical curettage)
Regimen
a) To arrest acute bleeding: → 10-30 mg/d orally for 10d'
(bleeding is usually controlled èin 48h').
b) Cyclic regimen: Short for CL insufficiency & Long for Metropathia Hemorrhagica
1- Short (10d') regimen: → 5-10 mg/d from day 15 to day 25 in each cycle for 3-6m'
2- Long (21d') regimen: → 5-10 mg/d from day 5 to day 25 in each cycle for 3-6m'
c) Continuous regimen: → Depot MPA / 2m' IM for 3 doses.
d) Progesterone medicated IUD [Mirena] : → Can be used in ovulatory DUB
disadvantages may cause irregular bleeding for many weeks after insertion
S/E → Headache, depression, wt gain, breast discomfort, Vagina dryness & ↓↓ libido
2) COCs (Combined Estrogen & Progesterone) The best preparations are low dose COCs.
Indications
3) Estrogen
Action: → Rapid proliferation of endometrium → covers denuded & raw areas of
endometrium →Stop bleeding
Indications: Has limited use now d2 high S/E
a) Prolonged heavy bleeding (high estrogen doses can arrest bleeding èin 24h').
b) Threshold bleeding.
c) Progesterone breakthrough bleeding
d) Atrophic endometrium
Methods
a) Hysteroscopic ablation: → Laser ablation, Endometrial electrocautery & resection or
Rollerball ablation.
b) Thermal balloon ablation
c) Radiofrequency induced thermal ablation.
d) Microwave ablation.
Results:
a) Amenorrhea: → In 50% of cases.
b) ↓↓ bleeding: → In 20-40% of cases.
c) No improvement: → In 20% of cases.
b) Bilateral uterine artery embolization:
C) Laparoscopic Myolysis
Def. A/E ttt
PMB ttt of the Cause
Atrophic Estrogen
See Table Hyperplastic See Later
Mg See Later
Menorrhagia Organic
-Simple pelvic congestion
(
-Pathological pelvic congestion
Dysfunctional
-General causes
-CL insufficiency Irreg ripening
-Persistent CL function Irreg shedding
Metrorrhagia Organic
-Obstetric Causes
-Gynecological cause C T I N
Dysfunctional
See Before
-General causes
Polymenorrhea Organic
-Ovarian congestion
-Pathological pelvic congestion Regulation of Cycle by Cyclic
Dysfunctional E&P
-Short
-Short
Oligomenorrhea 1) Constitutional:
Present since puberty & is ovulatory.
2) During 1st or 2nd y' after
menarche.
3) Before natural menopause.
4) PCOS: → MC cause (88%)
Hypomenorrhea 1) Constitutional:
Present since puberty & is ovulatory.
2) Uterine causes: → Uterine
hypoplasia or intrauterine synechiae.
3) Other pathological causes of 2ry
amenorrhea: → Hypomenorrhea is
commonly seen as a forerunner to
amenorrhea