Pathophysiology Dr. HANA OMER

Abnormal Uterine Bleeding(AUB)

2014

Definitions

Normal menstrual cycle Interval: 28 +/- 7 days (21-35 days) Can change from cycle to cycle Length </= 7 days Flow: Average blood loss: 35ml (20-60ml)

Menorrhagia Prolonged – more than 7 days or Heavy – greater than 80ml/day

Definitions

PolymenorrheaBleeding occuring at intervals <21 days

OligomenorrheaIntervals between bleeding episodes vary from 35 days to 6 months

AmenorrheaNo menses for 6 months or more

Etiology of AUB

Pregnancy

Hormonal Imbalance (hypothalamus /pituitary /ovary)

Hemostatic Disorders (systemic and local)

Reproductive Tract Pathology

Pregnancy

• Spontaneous/Incomplete Abortion

• Gestational Trophoblastic Disease (a term used for a group of pregnancy-related tumours. These tumours are rare, and they appear when cells in the womb start to grow out of control)

• “Normal Pregnancy”

• Hormonal Causes can be devided into :

A)ANOVULATORY AUB B)OVULATORY AUB

A) Anovulatory AUB (No Luteal Phase):

The corpus luteum does not form in an anovulatory cycle, resulting in a failure of the cyclical secretion of progesterone

Without progesterone, there is continuous unopposed production of estradiol, which stimulates overgrowth of the endometrium.

The endometrium grows thick until it outgrows its blood supply, resulting in necrosis and irregular bleeding

Hormonal

B) Ovulatory AUB:

Presents as menorrhagia (Abnormally heavy bleeding at menstruation)

A less common cause of AUB; believed to be caused by a defect in local endometrial hemostasis

The mechanism is unknown, but theories include hormonal imbalance and alterations in fibrinolysis.

Hormonal

Inherited disorders Example: Hemophilias (medical condition in which the

ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury)

Acquired disorders Example: Liver Disease

Iatrogenic (drug induced ) Anticoagulants NSAIDS

Systemic Hemostatic Disorders

• Uterine Lesions– Endometrial polyps– Endometritis– Hyperplasia or cancer

Reproductive Tract Disorders

• Pathophysiology– In a reproductive age patient who is not having

regular menses, must determine if• 1. Progesterone Deficient• 2. Estrogen and Progesterone Deficient

Anovulation or Oligo-Ovulation

• Patholophysiology– LACK OF PROGESTERONE

• Estrogen production with lack of progesterone leads to unopposed estrogen stimulation of the endometrium

• Can result in irregular shedding of the endometrium resulting in unscheduled/heavy bleeding

• Potential for development of endometrial hyperplasia or cancer.

Anovulation or Oligo-Ovulation

• Pathophysiology:– lack of ESTROGEN and PROGESTERONE

– Lack of estrogen AND progesterone in reproductive age women can lead to osteoprorosis, increased risk for heart disease, and reduced quality of life

– Examples: anorexia nervosa, athletic amenorrhea,

Anovulation or Oligo-Ovulation

Your doctor will ask you about your personal and family health history as well as your Menstrual Cycle

It may be helpful if you keep track of your menstrual cycle before your doctor visit (dates, length and type of bleeding)

You also may have blood tests (hormonal levels check). And a pregnancy test to check if you are pregnant

Diagnosis of AUB

Some other tests may be needed to diagnose AUB Including:

Sonohysterography: Fluid is placed into the uterus via a thin tube while ultrasound images of the uterus are taken Hysteroscopy:Thin device is inserted through the vagina, allowing your doctor to see inside your uterus

Endometrial Biopsy

Diagnosis of AUB

Medications:

Hormonal medications

Birth control Pills

Antibiotics

Anti-inflammatory drugs

Treatment of AUB

Surgeries:

Surgery to remove abnormal uterine growths (Polyps)

Endometrial ablation

Hysterectomy (removal of the uterus)

Treatment of AUB