Tiêu đề ABNORMAL UTERINE BLEEDING ✅

ABNORMAL UTERINE BLEEDING HMB PCM https://docs.google.com/document/d/1XC4ihVkhAPb8FPGQO75GKE0fwse6f3JmJfiCOM5N MBs/edit#heading=h.36e9k0nuo0fp Normal uterus size : 7 x 4 cm (5 - 7 cm) Normal ET : pre-menopausal ● during menstruation: 2-4 mm ● early proliferative phase (day 6-14): 5-7 mm ● late proliferative / preovulatory phase: up to 11 mm ● secretory phase: 7-16 mm ● following dilatation and curettage or spontaneous abortion: <5 mm, if it is thicker consider retained POC Normal menses <8days Freq: 24-38 days Flow = compared to previous flow HMB = Uterine fibroid HMB + irregular menses + dysmenorrhea = Adenomyosis Dysmenorrhea + regular menses +/- HMB = Endometriosis Heavy menstrual bleeding (HMB) PALM COIEN (by FIGO) - Structural causes - Systemic causes Polyp (fleshy tissue and hormonal responsive) - endometrial - cervical (asympto → incidental finding on smear) HMB + IMB +PCB + dyspareunia RF: obesity, late menopause, HRT-tamoxifen Adenomyosis - Reproductive age - IMB - Severe dysmenorrhea - Abdo distension +/- compressive/obstructive sx (Bladder (anterior relation): LUTS sx: storage and voiding symptom/Bowel (posterior relation):constipation/ diarrhea/ tenesmus - Diffuse, enlarged tender globular uterus - NO PMB!! (regress post-menopausal) Leiomyoma (fibroids) - Reproductive age - HMB + PCB + IMB + dysmenorrhea - Abdo distension / bloating - Subfertility - Obstructive sx/ Compressive sx→ urinary sx (freq, urgency) & constipation Malignancy - Ovarian CA - Endometrial CA - Cervical CA - Vaginal CA LOA/LOW, abdominal distension/discomfort, Fam hx malignancy (colon, breast, endometrial, ovarian) - Ovarian → HMB +IMB + deep dyspareunia + ascites - Leiomyosarcoma : HMB - Endo → PMB!! - Cervical → HMB + PCB + IMB + dyspareunia + PV Iman, Izzaty, Nisa, Lissa (1/4/21) Forti
- Leiomyosarc oma discharge - Vaginal → HMB + PCB + dyspareunia + PV discharge *brca cancer - breast, ovarian, pancreas, prostate Coagulopathy Due to late stage liver disease or bleeding disorder (vWD) +Hx of blood transfusion Ovulatory dysfunction - PCOS - Hypothyroidi sm - Anovulation (near menopause) PCOS - Oligomenorrhea - Hirsutism - Acne vulgaris - Acanthosis nigricans / DM sx - Subfertility - Obesity Hypothyroid: -Hypothyroid sx: cold intolerance, weight gain, bradycardia, constipation, dry skin, hair loss, lethargy -Menorrhagia -/+ goiter/ neck swelling Endometrial causes - Hyperplasia - Endometriosi s - Ca - Polyps Endometriosis (pelvic pain) – usually worse during this period. - IMB - Dysmenorrhea - Dyspareunia. - pain when PU / BO - feeling sick, constipation, diarrhoea, or blood in your pee during your period. - Infertility Endometrial hyperplasia ● Menorrhagia ● Menstrual cycles (amount of time between periods) that are shorter than 21 days. Iman, Izzaty, Nisa, Lissa (1/4/21) Forti
● IMB ● PMB ● RF: Obesity, PCOS, HRT. nulliparity, early menarche, late menopause, long term tamoxifen ● Age > 35 y/o (ACOG) Iatrogenic - Drugs- anticoagulant s/antiplatelet s (Warfarin) - IUCD (Mirena, Copper) - Dienogest - Implanon - SERM - Trauma • Any contraceptives currently used -SERMs : SERM used in breast cancer Agonist = uterus (EH), bone Antagonist = breast & braim Not yet classified - DUB/BEO (bleeding endo origin) - AVM - Endometrial pseudoaneur ysms - Myometrial hypertrophy - Chronic endometritis Post-coital bleeding (bleeding after/during SI) Ask AGE → causes in repro or post menopausal causes Cervical causes Non-infectious - Cervical ectropion - Intraepithelial neoplasia/ Cervical cancer - Polyp (cervical/en dometrial) -common Infectious - Acute cervicitis - Atrophic vaginitis - Genital warts - STI (PV discharge, Cervical ectropion → commonly asymptomatic can present with → IMB or excessive discharge (non-purulent). → Very common during pregnancy(3rd tri) → due to hormonal changes and high levels of oestrogen in the body. Cervicitis → Grayish or pale yellow vaginal discharge. → IMB + Dyspareunia + dysuria, Polyuria → Vulvovaginal irritation → abdominal pain or fever (rare) -Inflammation of the uterine cervix. -Primarily affects the columnar epithelial cells of the endocervical glands / affect the squamous epithelium of the ectocervix - Acute cervicitis is often d/t infection (eg, chlamydia, gonorrhea) - Chronic cervicitis usually → noninfectious source Iman, Izzaty, Nisa, Lissa (1/4/21) Forti
change colour discharge, prolonged fever, hx sexual partner) (mechanical-eg, pessary, diaphragm, tampon, or chemical irritation eg: vaginal douches, spermicides) Atrophic vaginitis (d/t hypoestrogenic state from menopause) symptomatic inflammatory process involving the thinned vaginal epithelium affecting some pre-menopausal and up to 50% of post-menopausal women - Usually > 50 y/o unless incurred induced menopause - RF: No vaginal birth, smoking Dx by sx→ vulvovaginal dryness, burning, dyspareunia, loss of vaginal secretions, leukorrhea, vulvar pruritus, feeling of pressure, itching and yellow malodorous discharge, recurrent UTI, urethral pain, haematuria Vaginal changes→ Thinning vaginal epithelium, decreased vaginal rugae and elasticity, and decreased vaginal secretions→ shift normal flora dt diff in vaginal pH→ ↓ Lactobacillus, ↑ skin & rectal pathogens overgrowth Tx→ - Intravaginal estrogen/ estradiol cream estradiol vaginal ring/ estradiol tablets/estradiol transdermal patch - (if CI)--> Lubricants for symptomatic improvement Cervical / vaginal trauma / laceration - Hx of sexual abuse - Hx of obstetric injury (perineal laceration) -Foreign bodies, straddle injuries Malignancy - Cervical CA - Vaginal CA - Hx HPV infection - Young age at first coitus - Offensive vaginal discharge Intermenstrua l bleeding (common in extreme reproductive age) Anovulatory (PCOS) - Not cyclical bleeding PID -high-risk behaviors (young age at first sexual encounter,multiple, or symptomatic sex partners) -Hx of lower abdominal or pelvic pain, abnormal vaginal discharge, fever or chills, cramping, dyspareunia, dysuria, and PCB. - low back pain, nausea, and vomiting. Cervical CA / polyps -longer menses + dysmenorrhea + PCB -as above Endometrial CA As above Mittelshermz IMB at mid cycle + abd pain Iman, Izzaty, Nisa, Lissa (1/4/21) Forti