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ABNORMAL UTERINE BLEEDING, ANGGRAINI BARUS 1808260110 - Coggle Diagram
ABNORMAL UTERINE BLEEDING
Normal Menstrual Cycle
The menstrual cycle may be divided into two phases:
(1) follicular or proliferative phase, and
(2) the luteal or secretory phase.
The normal length of a menstrual cycle is 28 days with most cycle lengths between 21-35 days
Normal duration : 3-7 days
Normal volume : 35-80 mL
Definition, Etiology & Classification, and Risk Factor
Etiology & Classification
Structural cause :
Polyps
Adenomyosis
Leiomyoma
Malignancy
Non-Structural cause :
Coagulopathy
Ovulatory disorder
Endometrial
Iatrogenic
Not classified
Risk Factor
Hormone function
Age (reproductive-perimenopouse)
Obesity
Diabetes Mellitus
Definition
Abnormal uterine bleeding (AUB) is a broad term that describes irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy.
Diagnostic Approach
Physical exam
Vital signs, including blood pressure and body mass index (BMI)
Signs of pallor, such as skin or mucosal pallor
Signs of endocrine disorders
Examination of the thyroid for enlargement or tenderness
Excessive or abnormal hair growth patterns, clitoromegaly, acne that could indicate hyperandrogenism
Moon facies, abnormal fat distribution, striae that could indicate Cushing's
Signs of coagulopathies, such as bruising or petechiae
Abdominal exam to palpate for any pelvic or abdominal masses
Pelvic exam: Speculum and bimanual
PAP smear if indicated
STI screening (such as for gonorrhea and chlamydia) and wet prep if indicated
Endometrial biopsy, if indicated
Evaluation
Laboratory
human chorionic gonadotropin (HCG), complete blood count (CBC), Pap smear, endometrial sampling, thyroid functions and prolactin, liver functions, coagulation studies/factors, and other hormone assays as indicated.
Imaging Studies
Transvaginal ultrasound, MRI, hysteroscopy
Anamnesis
Menstrual history
Age at menarche
Last menstrual period
Menses frequency, regularity, duration, volume of flow
Intermenstrual and postcoital bleeding
Sexual and reproductive history
Obstetrical history including the number of pregnancies and mode of delivery
Fertility desire and subfertility
Current contraception
History of sexually transmitted infections (STIs)
PAP smear history
Associated symptoms/Systemic symptoms
Weight loss
Pain
Discharge
Bowel or bladder symptoms
Signs/symptoms of anemia
Signs/symptoms or history of a bleeding disorder
Signs/symptoms or history of endocrine disorders
Current medications
Family history, including questions concerning coagulopathies, malignancy, endocrine disorders
Social history, including tobacco, alcohol, and drug uses; occupation; impact of symptoms on quality of life
Surgical history
Menstrual Disorder
Flow volume
Hipermenorrhea
Hipomenorrhea
Duration
Menorrhagia
Brakimenore
Frequency
Polymenorrhea
Oligomenorrhea
Amnorrhea
Others
Metrorrhagia
Dismenorrhea
Premenstrual syndrome
Abnormal Uterine Bleeding
Pathophysiology
Progesterone levels fall at the end of the menstrual cycle, leading to enzyme breakdown of the functionalis layer of the endometrium. This breakdown leads to blood loss and sloughing which makes up menstruation.
Functioning platelets and thrombin, and vasoconstriction of the arteries to the endometrium control blood loss.
Any derangement in the structure of the uterus (such as leiomyoma, polyps, adenomyosis, malignancy or hyperplasia),
derangements to the
clotting pathways
(coagulopathies or
iatrogenically
), or disruption of the hypothalamic-pituitary-ovarian axis (through ovulatory/endocrine disorders or iatrogenically) can affect menstruation and lead to abnormal uterine bleeding.
Treatment & Education
Treatment
Iatrogenic causes of AUB should be managed based on the offending drug and/or drugs.
If a certain method of contraception is the suspected culprit for AUB, alternative methods can be considered, such as the levonorgestrel-releasing IUD, combined oral contraceptive pills (in monthly or extended cycles), or systemic progestins.
If other medications are suspected and cannot be discontinued, the aforementioned methods can also be helpful to control AUB. Individual therapy should be tailored based on a patient's reproductive wishes and medical comorbidities.
Education
Foster an environment of open discussion on menstruation.
Primary care physicians should ask women about their last menstrual cycle, regularity, desire for fertility, contraception, and sexual health.
If abnormal uterine bleeding can be identified at the primary care level, then further history, examination, and testing can be performed, and the proper consultations can be arranged.
Islamic Education
Abnormal vaginal bleeding (istihada) is invalid blood. Practically speaking, it is any colored vaginal discharge that is not ruled as menstruation (hayd) or lochia (nifas).
The days that a woman experiences istihada (15 days) are also known as legal purity (ṭuhr hukmi). This means that even though she is seeing blood, she must act like a woman in a state of purity.
Complication & Prognosis
Complications
Anemia, infertility, and endometrial cancer, hypotension, shock, and even death may result if prompt treatment and supportive care are not initiated.
Prognosis
Prognosis for abnormal uterine bleeding is favorable but also depends on the etiology. The main goal of evaluation and treatment of chronic AUB is to rule out serious conditions such as malignancy and to improve the patient's quality of life.
Prognosis also differs based on medical versus surgical treatment. Non-hormonal treatment with anti-fibrinolytic and non-steroidal anti-inflammatory medications has been shown to reduce blood loss during menstruation by up to 50%.
ANGGRAINI BARUS
1808260110