AUB ec Endometrial Hyperplasia

Mrs. / th uncomfortable and some other supporting

examinations. Do you consent to those
Good morning ma'am, I am dr. Norma who is
procedures?
currently on duty, before I do the examination I
will ask questions, ma'am

Ax: PHYSICAL EXAMINATION

- Since when do you feel heavy menstrual General status:

bleeding?
General condition: GCS:
- How many times have you changed pads?
- LMP? Height: Weight: BMI:
- Is the blood came out in clots?
- History of menstruation: BP: Pulse: RR: T.axillae:
Menarche?
Eyes: a / i
Duration of menstruation?
Neck: enlarged thyroid gland? Acanthosis
Regular?
nigricans?
Distance between menstruation?
Breast: galactorrhea?
How many times have you changed pads?
C / P:
Menstrual pain?
Abd: relaxed, mass? Tenderness? Striae?
- Is there any pelvic pain? Abdominal circumference? (N:<80cm)
- Any lump in the stomach?
Ext: edema? warm / cold?
- Do you feel nauseous / vomiting?
- Post coital bleeding? Signs of hyperandrogen:
- Any complaints in defecation/
micturition? Acne on face & back? Excess hair on both legs?

Parity: Youngest child: Gallway fermentation score? 6

Obstetric history:

Vaginal delivery / with tools / Operation? Gynecologic status:

History of postpartum haemorrhage? I: V / Urethra?

Past medical history: IO: Portio:, Ostium uteri :, Flx / flx: sonde:

HT: DM: Heart: Liver disease / coagulation VT: Uterus shape & size?
disorder? AP D / S: mass in both adnexa: pain?
Is there spontaneous bleeding / bleeding that is parametrium? Limp / stiff?
difficult to stop? Eg. Gum bleeding, epistaxis, easy
bruising?

Is the patient currently in the treatment of chronic Adjunctive exam:

disease?
- Pregnancy test:
Contraception history: - TVS Ultrasound:
o Inspection of uterus:
Ma'am, I will begin doing a physical examination & gestational age:
internal examination which may feel a little
Myometrium: ET:
 Basal stratum: regular / - - Perform patient evaluation

Intracavitary mass? Lab results:

o AP D / S: Mass? Hb: L: PT / APTT:

OV D: Vol: mm, small Hct: PH: MCV: (80-84)

follicles diameter: mm,
MCH: (26-34)
number: fruit, lined up like a
wagon wheel / pearl MCHC: (30-35)
necklace.
FBG:
OV S: Vol: mm, small
follicles, diameter: mm, Fasting insulin:
number: fruit, lined up like a
IR HOMA: (> 4.5  insulin resistance)
wagon wheel / pearl
necklace.

Conclusion: PA results:

- Simple non atypia : <1%

- Non atypia complex : 3%
Ma'am, from the results of the tests that already
- Simple atypia : 10%
done, you are diagnosed with:
- Atypia complex : 17 - 52%
- AUB Ec Endometrial Hyperplasia
Final diagnosis:
- PCOS
- Obesity - PCOS
- Obesity
The bleeding that occurs is due to the thickening of
- AUB- M ec  PA results
the innermost lining of the uterus, this is because
the estrogen level in the body is too high.

Therapy: Advice:

- Check CBC, blood coagulation assays - Progestin preparations:

- FBG, fasting insulin
- Endometrial sampling:
o Dilation and curettage, or
o Hysteroscopy targeted biopsy
- Lifestyle modification
o Aerobic exercise 2-3x per week
o Diet with a calorie calculation of
30 kcal / kg / day
- Noretisterone 2x5mg / day 14 days
ON-OFF or
- Medroxyprogesterone acetate 1x10mg
14 days ON OFF
- Ultrasound evaluation at 3rd and 6th
months
- Insulin resistance (+): Metformin 3x500mg
- LNG-IUS (Levonorgestrel-Intrauterine
System)  If patient’s budget are low