Dysfunctional uterine bleeding

1. DYSFUNCTIONAL UTERINE
BLEEDING
By,
Nazni Nazar
2009 MBBS

2. ABNORMAL UTERINE
BLEEDING
• The menstrual bleed that is abnormally heavy or
abnormal in timing
• Assessment-
• Causes-
1. DUB
2. Pelvic pathology
3. Pregnancy related conditions
4. Coagulation &hematological problems
5. Medical problems
6. iatrogenic

3. PALM –COEIN classification
Structural causes
• Polyp
• Adenomyosis
• Leiomyoma-
submucosal and other
• Malignancy & hyperplasia
Non-structural causes
• Coagulopathy
• Ovulatory dysfunction
• Endometrial
• Iatrogenic
• Not yet classified

4. CLINICAL TYPES
1. Menorrhagia (hypermenorrhea): prolonged (>7
days) and/or excessive (>80ml) uterine bleeding
occurring at REGULAR intervals.
[Fibroids,hematological problems]
2. Polymenorrhea: shortened cycles- uterine
bleeding at regular intervals of <21
days.[Endometriosis, PID]
3. Oligomenorrhea: uterine bleeding at regular
intervals from 6weeks to 6 months.[hormonal

5. CLINICAL TYPES….
4. Metorrhagia: acyclical and intermenstrual
uterine bleeding.[surface lesions-cervical
polyps,erosions,cervical ca]
5. Menometorrhagia: uterine bleeding that is
prolonged and occurs at completely irregular
intervals.

6. DYSFUNCTIONAL UTERINE
BLEEDING
• Abnormal uterine bleeding with no demonstrable
organic cause, genital or extragenital.
• Diagnosis by exclusion
• abnormal releasing of sex hormones
50% at near menopause
20% in adolescents
 30% at reproductive age

7. pathophysiology
• ANOVULATORY(80%)
• OVULATORY (20%)

8. Anovulatory DUB
• Irregular cycle,short cycles with scanty flow or
period of amenorrhoea
• Due to alteration in hypothalamic-pituitary axis
corpus luteum not formed
failure of the cyclical secretion of progesterone
continuous unopposed production of estradiol
stimulates overgrowth of the endometrium
endometrium grows thick ,outgrows its blood supply
necrosis and irregular bleeding

9. In adolescents and in perimenopausal women,
the bleeding may be triggered by estrogen
withdrawal
• Threshold bleeding-low estrogen and atropic
endometrium[lactation,menopause]
• Metropathia hemorrhagica-periods of
amenorrhoea followed by prolonged heavy
bleeding[hyperestrogenism]

10. Ovulatory DUB:
• Presents as menorrhagia
• A less common cause of DUB
• caused by a defect in local endometrial
hemostasis
• Absence of progesterone Alterations in
prostaglandin production, with more PGE2 PGI2
[vasodilation and antiplatelet] and less
PGF2[vasoconstriction] , increased
fibrinolytic activity bleeding

11. • Irregular ripening-premenstrual spotting
• Irregular shedding-prolonged mensus and
postmenstrual spotting.
• IUCD insertion
• Following sterlization operation

12. Adolescent age group
• Prevalance -50%
• Hypothalamic-pituitary axis is still immature
• Estrogen withdrawal bleeding-as it takes time
to establish positive feedback and lh surge
well.
• An irregular period with prolonged excessive
flow is suggestive of DUB

13. REPRODUCTIVE AGE GROUP
• DUB less common
• H/o heavy regular cyclical bleedingover
several consecutive cycles.
• Intermenstrual bleeding-polyp
• Post coital bleeding-premalignancy

14. Perimenopausal age group
• Anovulatory DUB more common
• Metropathia