Abnormal Uterine Bleeding




Pathophysiology

  1. Estrogen overstimulation of proliferative endometrium is unopposed by progesterone leading to spont endometrial breakdown
  2. 85% due to anovulatory state
  3. Most common in adolescents & perimenopausal women

Diagnosis

  1. Excessive prolonged vaginal bleeding in absence of organic pathology on clinical exam

Treatment

  1. NSAIDs
  2. Progesterone
  3. Combined OCPs
  4. High-dose estrogen prn
  5. Endometrial biopsy for all women >35 years with DUB

Disposition

  1. Admit for hemodynamic instability
  2. D/C stable pt with gyne F/U
Treatment Summary
Irregular, unpredictable bleeding
NO cramps,
Normal Pelvic exam, (-) US
(-) Beta-HCG
- Most often result of ANOVULATION
< 35 yr > 35 yr
Mild Moderate Severe
Endometrial Biopsy
FeSO4 (-) Active bleed (+) Active bleed Usually only in Adolescent within 2yr of mearche
(-) Hyperplasia WITH-OUT Atypia

(+) Hyperplasia, Complex WITH atypia


Progestrin
+
FeSO4


High-dose Estrogen
+/-
Progestin

Cyclic Progestin


Total Vaginal OR abdominal Hysterectomy
 


Fails


Works


Endometrial Ablation
OR
Hysterectomy