Most Popular Articles – Abnormal Uterine Bleeding: A Management Algorithm

admin    intermenstrual bleeding     abdominal muscles, cardiovascular workout, exercise goals, fitness routine, jump rope

One option is to first rule out neoplasia with the endometrial biopsy, after that, start hormonal therapy, and obtain a TVUS only if abnormal bleeding persists despite hormonal therapy.

Postmenstrual spotting is sometimes caused by endometritis, that can be treated with 100 doxycycline mg twice daily for 10 days.

35 years old, so it is not common and should prompt an endometrial biopsy in women &gt. Generally, the total duration gonna be less than 8 days, in any reproductiveaged woman. I’d say if it is contiguous with the period, can be a normal variant. Certainly, early periods and occasional missed periods are common in younger women and may result from mental stress or illness. Therefore, patients with minor variations of normal bleeding may not require the evaluation outlined in Figure irregular bleeding within 2 menarche years is usually due to anovulation, secondary to an immature hypothalamicpituitaryovarian axis.

Adolescents may request more than simple reassurance and can be offered oral contraceptives or a progestin as described in the algorithm.

Repeated intervals less than 21 days and similar irregular patterns require endometrial sampling, intervals may also decrease in the perimenopause.

Missed periods and prolonged intervals are expected in perimenopause. Brief midcycle spotting can occur at the time of ovulation because of the normal dip in serum estrogen levels. Indicating possible chronic endometritis, the patient could be tested for gonorrhea and chlamydia and initially treated with 100 doxycycline mg twice daily for 10 days, pending culture results, if the uterus is tender. Medications that can cause abnormal uterine bleeding include phenytoin, antipsychotics, tricyclic antidepressants, and corticosteroids. On top of this, laboratory screening for these diseases in the absence of obvious clinical findings ain’t necessary as long as abnormal bleeding is a late manifestation. It’s an interesting fact that the exception is thyroid disease, that should be screened for early in the evaluation with a thyroidstimulating hormone. Although, abnormal uterine bleeding can result from advanced systemic disease similar to liver failure or kidney failure. With that said, irregular bleeding is a heterogenous category that includes metrorrhagia, menometrorrhagia, oligomenorrhea, prolonged bleeding that can last weeks or months, and similar irregular patterns.

In patients with a IUD, abnormal bleeding can be associated with endometritis.

In the absence of endometritis, patients with a copper IUD can be treated with one the oral cycle contraceptive pill or 10 mg of medroxyprogesterone daily for 7 days.

Patients with a tender uterus can be treated with 100 doxycycline mg twice daily for 10 days and possible removal of the IUD, after culturing the cervix. By the way, the IUD can be removed and alternative contraceptive methods discussed, I’d say in case the abnormal bleeding persists. Oftentimes patients with a progestinreleasing IUD can be treated with one the oral cycle contraceptive pill. It is kuppermann M, Varner RE, Summitt RL, Jr, et al. Therefore, effect of hysterectomy versus medical treatment on ‘health related’ quality of life and sexual functioning.

In women more than age 35 and those at risk for endometrial carcinoma, TVUS with or without a saline infused sonohysterogram can be indicated before, after, or instead of endometrial biopsy.

Endometrial biopsy can detect hyperplasia, atypia, and carcinoma.

TVUS can detect endometrial polyps, uterine myomas, and endometrial hyperplasia. Accordingly the conservative approach if a TVUS is obtained. There is some more information about it on this website. TVUS might be indicated if the patient will likely require operative management. Patients on depomedroxyprogesterone with persistent irregular bleeding can be treated with a 7day course of estrogen. Breakthrough bleeding occurs commonly with low dose oral contraceptive pills. We excluded amenorrhea and postmenopausal bleeding as their generally straightforward evaluation is well described elsewhere. We excluded premenarchal bleeding because of its rarity. Normally, we addressed abnormal uterine bleeding between menarche and menopause. Polycystic ovary syndrome is a similar cause of abnormal uterine bleeding. Fact, the diagnostic criteria for PCOS include at least two of the following.

These criteria, other causes of hyperandrogenism or abnormal bleeding must be excluded before making the diagnosis of PCOS.

Severe acute uterine bleeding in the nonpregnant patient usually occurs in one of three settings.

Actually an investigation into the cause of bleeding includes screening coagulation studies and possibly transvaginal ultrasound, whenever the patient is clinically stable. One common oral contraceptive regimen is ethinyl estradiol 30 µg/norgestrel 3 mg 1 active pill 4 times daily for 4 days, followed by 3 times daily for 3 days, followed by 2 times daily for 2 days, followed by once daily for 3 weeks. Because of the increased sensitivity for endometrial polyps and submucous fibroids, the ultrasound may include a ‘saline infused’ sonohysterogram, especially when the endometrial stripe is thick. Initial management is on the basis of hemodynamic stability as outlined in Figure The patient is given high dose estrogen and after all a tapering schedule of oral contraceptives.

Did you know that the patient consequently stops the pill for 1 week and hereupon cycles in the usual manner, 3 weeks on and 1 week off, for at least 3 months.

If you enjoyed this article please consider sharing it!