September 26, 2018 Posted By: Dr Viroopa 211 viewsRSS
At Sankhya Hospitals, we put a lot of emphasis on acute problems faced by women in general and use this medium to convey what would be the right way to observe, diagnose and treat several issues. A woman’s body could be considered more complicated considering the problems they face at different stages of their life. This particular topic is for women, diagnosed with abnormal uterine bleeding, a problem which could enter a complicated phase if not treated promptly. Abnormal Uterine Bleeding is the problem which tends to cause irregular bleeding which is for a longer duration as well as more substantial than usual. This type of bleeding does not have a specific time interval and is highly irregular in its timings.
Values of normal menstrual cycle:
Before we understand in detail the problem of Abnormal Uterine Bleeding, below are some essential information which shows the values of a normal menstrual cycle experienced by women. The normal menstrual cycles could be different in its duration, as well as the loss of blood during each period of the bleeding.
Normal menstrual bleeding usually lasts somewhere between 3-8 days.
A patient can lose 30-80 ml of blood.
The total length of the cycle is expected to be somewhere between 21-35 days.
Causes of Abnormal Uterine Bleeding:
Changes in hormonal levels are considered as the leading cause of abnormal uterine bleeding. This might be one way to look at the issue, but doctors also are perplexed in many cases where the reasons remain unknown. It is, however, essential to understanding that Abnormal Uterine Bleeding is a symptom and not a disease. In cases where the causes are known for the problem, it is connected with early pregnancy complications like abortion, ectopic and mole. It could also be due to –
Pelvic inflammatory disease (PID)
Benign tumours like fibroids, cervical polyps, endometriosis adenomyosis.
Malignant tumours like endometrial and cervical cancer
Dysfunctional uterine bleeding
Clinical Types of Abnormal Uterine Bleeding:
Menorrhagia (regular and cyclical) Menorrhagia is either consistent or cyclic bleeding which occurs at regular intervals. During these intervals, the bleeding could either be excess in the amount of blood or the duration of the bleeding itself.
Poly-menorrhea – Regular and Cyclical In this type of abnormal uterine bleeding, the patient experiences cyclical bleeding which is standard in the amount of bleeding, although the cycle of this kind is mostly under 21-days.
Poly-menorrhagia This is the total opposite of the regular Poly-menorrhea type. In this, the patient’s cyclical bleeding is both frequent and excessive.
Metrorrhagia – Irregular and Acyclical Here the bleeding for the patient is quite uneven and Acyclical. In most cases, the bleeding is reported to have been continuous.
Intermenstrual bleeding Intermenstrual bleeding has two main characteristics to it. The bleeding is often dysfunctional and is familiar with cervical and endometrial polyps, fibroids and cervical ca.
Dysfunctional Uterine Bleeding The dysfunctional uterine bleeding occurs in unusual circumstances. In most cases of dysfunctional uterine bleeding, the patient will not have any organic diseases of the genital tract. This kind of abnormal uterine bleeding is characterised by the dysfunction of the uterus, ovary, pituitary, hypothalamus or any other part of the reproductive system of the patient’s body.
Primary Dysfunctional Uterine Bleeding
This is the most primary type of this problem. In this the bleeding from the uterus is quite abnormal, where there is no trace of disease of the genital tract.
Secondary Dysfunctional Uterine Bleeding
This type is the secondary one and different from the primary DUB. In the secondary classification, there is presence of abnormal bleeding from the uterus but is secondary to
Administration of hormones
Organic disease outside the genital tract
Pathophysiology of Abnormal Uterine Bleeding:
Doctors, as a first step will be determing the Pathopsyliogy of the condition in the patient. Pathophysiology depends on the pattern of bleeding and the age of the patient. The doctors then classify pathophysiology into two categories; Ovulatory and Anovultory Abnormal Uterine Bleeding.
Ovulatory is usually heavy, regular bleeding with patients experiencing pain. Common in younger women. Increased PGE2 leading to decreased PGF2 α / PGE2 ratio. Decreased activity of endothelin (Strong vasoconstrictors). Synthesis of prostacyclin in the myometrium form increased PGS, Endo peroxide
Anovulatory is basically heavy, irregular bleeding. Occurs after menarche and before menopause. There is persistent proliferative endometrium in the second half of the cycle.
Diagnosis of Dysfunctional Uterine Bleeding Doctors to diagnose Abnormal Uterine Bleeding in the patient will follow the following checks to determine the nature and severity as well as other complications that could further aggrevate or deplete the codtition. Done by exclusion the doctors usually inquire about the patient’s menstrual history, pattern, age and amount of blood loss.
Abdominal & pelvic examination
VSG – TAS/TVS
Doctors will also conduct Endometrial biopsy to rule out hyperplasia
Hormonal checks for progesterone, FSH, CH, TSH.
Doctors will also check for CBP, clotting screen.
Management of Abnormal Uterine Bleeding – Doctors use two primary methods to manage abnormal uterine bleeding problems in women, with medications or through surgical intervention.
Medications If the problem can be solved using medications, doctors will recommend and treat patients using Non-hormonal medicines. They also use NS-AIDS like mefenamic acid, anti-fibrinolytic like tranexamic acid as well as combined oral contraceptive pills. Some patients are also treated using the low dosage of estrogen-like progesterone pills. Estrogen is used to regulate and reduce the overall blood loss for the patient.
Doctors, if they deem it necessary, will use surgical methods to solve the problems that arise with abnormal uterine bleeding in women. The surgical techniques include the following procedures/treatments –
Dilation and Curettage
Endometrial ablation with hysteroscope
Endometrial loop resection using electro diathermy
Rollerball electrode diathermy ablation
Thermal balloon ablation
Abnormal Uterine bleeding could become a complicated problem if not treated promptly. Doctors are always ready, especially at Sankhya Hospital to diagnose, treat and overall manage these problems in women at an excellent rate of success.
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