Please enable JavaScript.
Coggle requires JavaScript to display documents.
Dysfunctional uterine bleeding (DUB) (Pathophysiology (Unclear, Abnormal…
Dysfunctional uterine
bleeding (DUB)
Definition
Abnormally heavy uterine bleeding
during menses in absence of pregnancy,
genital pathology or systemic disease
Pathophysiology
Unclear
Abnormal PG activity, causing vasodilatation
and non-aggregation of platelets
Excessive fibrinolysis
Defects in MMPs, vascular growth factors,
steroid receptors, endometrial structure
Clinical
presentation
Menorrhagia
(heavy menses)
Diagnosis
Examination
Abdo
Normal
Pelvic
Normal
Investigations
Bloods
FBC (anaemia), haematinics (anaemia)
TFTs (rule out hypothyroidism)
U+Es, LFTs, clotting (clotting disorders)
Investigations
TV USS: normal
Hysteroscopy: normal
Bedside
Obs (nil)
Urine
Pregnancy test (-ve)
Swabs
STI screen (HVS, endocervical)
History
PGH
Known conditions, menses, contraception, STIs, smear
POH
Gravidy/parity, birth methods, complications, family complete?
PC/HPC
Menorrhagia, often nil pain, bladder/bowel
PMH/PSH
Medical conditions, abdo/pelvic surgery
DH
Anticoagulants, allergies
FH
Menorrhagia, gynae conditions, hypothyroidism
SH
Occupation, smoking/alcohol, ADLs
Management
Medical
Hormonal
Progestrogen-only
Indication: 2L fertility not needed
E.g. POP, implant, IM depot
MOA: inhibits endometrium
Levornogestrel IUS
Indication: 1L not needing fertility
MOA: inhibits endometrium
SEs: irregular bleeding, expulsion
COCP
Indication: 2L fertility not needed
E.g. microgynon, yasmin
SEs: headache, stroke
GnRH analogues
Indication: 3L, short term
MOA: induce medical menopause
Non-hormonal
Antifibrinolytic
E.g. tranexamic acid
Indication: need fertility
MOA: reduces bleeding by inhibiting fibrinolysis
NB: only take during bleeds
SE: leg cramps, GI upset
Mefanamic acid
Indication: need fertility
MOA: inhibit PGs, reducing bleeds
NB: only take during bleeds
SE: GI upset, peptic ulcers
Surgical
Endometrial ablation
Indication: medical failed, family complete
MOA: hysteroscopy and microwave/balloon/electrical ablation
Hysterectomy
Indication: medical failure, family complete
MOA: laparoscopic or vaginal, rarely open
Conservative
Information and advice
Referral to gynae for investigation and tx