Download Dysfunctional uterine bleeding

DYSFUNCTIONAL
UTERINE
BLEEDING
Gem Ashby MD
OB/GYN
Cancer Support Services is committed through a
spirit of volunteerism to the care of persons with
cancer and to bring comfort and support to the
affected relatives and dependents.
DYSFUNCTIONAL UTERINE BLEEDING
DUB
• Bleeding is heavier (passing large clots, soaking
through a sanitary pad or tampon every hour for 2 - 3
hours in a row)
• Bleeding or spotting that occurs between periods
• Time between menstrual periods changes with each
cycle
• Bleeding lasts for more days than normal
CAUSES OF DUB
• GYN cancers
• Anovulation
• Fibroids
• Polyps
• Systemic illness
WORK UP FOR DUB
• History and exam
• Blood work/PAP smear
• Pelvic US
• Endometrial biopsy
• D&C, hysteroscopy
A: Cervical cancer
B: Endometrial(Uterine) cancer
C: Ovarian cancer
Which two cause DUB?
Which one has been linked to a viral
infection?
Which one is often diagnosed at a very late
stage?
CERVICAL CANCER
• Cervical cancer is the second most frequent cancer
in women in the world
• Third greatest cause of death from cancer in women
• 90% of cervical cancer is cause by HPV
• Of the estimated more than 270 000 deaths from
cervical cancer every year, more than 85% occur in
developing countries
Stats from WHO
CERVICAL CANCER AND DUB
• Early cervical cancer is frequently asymptomatic
• The most common symptoms at presentation are:
• Abnormal bleeding
• Postcoital bleeding
• Vaginal discharge that may be watery, mucoid, or purulent
and malodorous
TREATMENT OF CERVICAL
• Surgery to remove the cancer
• Radiation therapy, which uses high-dose X-rays or implants in
the vaginal cavity to kill cancer cells. It is used for certain
stages of cervical cancer. It is often used in combination with
surgery
• Chemotherapy, which uses medicines to kill cancer cells.
Chemotherapy may be used to treat advanced cervical cancer
ENDOMETRIAL CANCER
• Endometrial cancer is cancer of the lining of the uterus
ENDOMETRIAL CANCER
• Endometrial cancer is rare in women under the age of 45
• The average chance of a woman being diagnosed is about one
in 37
• This cancer is slightly more common in white women, but
black women are more likely to die from it
RISK FACTORS FOR ENDOMETRIAL
CANCER
• Being obese. Fat cells make extra estrogen, but the body doesn't
make extra progesterone to balance it out
• Taking estrogen without taking a progestin
• Polycystic ovary syndrome. This can cause you to produce too
much estrogen and not enough progesterone
• Having type 2 diabetes
• Never having been pregnant
ENDOMETRIAL CANCER AND
DUB
The most common symptoms include:
• DUB
• BLEEDING AFTER MENOPAUSE
• Pain during sex
• Pelvic pain
TREATMENTS
• Surgery to remove the uterus (and cervix), ovaries, and
fallopian tubes (hysterectomy with bilateral salpingooophorectomy)
• Surgery to remove lymph nodes
• Radiation therapy to kill cancer cells
• Progestin hormone therapy to block cancer growth
• Chemotherapy to kill cancer cells
ANOVULATION
• Anovulation is the absents of ovulation
ANOVULATION
• Polycystic ovarian syndrome
• Peri-menopause
• Thyroid dysfunction (either hyperthyroidism or
hypothyroidism)
• Extremely high levels of stress
ANOVULATION
TREATMENT
Hormonal manipulation
OCP’s
Nuvaring
Depo Provera
Nexplanon
Mirena IUD
FIBROIDS
• The most common pelvic tumor in women
• They are benign tumors arising from the
smooth muscle cells of the myometrium
• They can cause DUB, pain, voiding
dysfunction and may also have reproductive
effects (e.g, infertility, adverse pregnancy
outcomes)
FIBROID TREATMENTS
• There's no single best approach to uterine fibroid
treatment; many treatment options exist
FIBROID TREATMENTS
• Hormonal Manipulation (OCP, Nuvaring, Depo Provera,
Nexplanon, Mirena)
• Gonadotropin-releasing hormone (Gn-RH) agonists
• Medications called Gn-RH agonists (Lupron, Synarel,
others) treat fibroids by putting you into a temporary
postmenopausal state. With the decreased estrogen many
fibroids tend to shrink
FIBROID TREATMENTS
• Uterine artery embolization
• Small particles (embolic agents) are injected into the arteries
supplying the uterus, cutting off blood flow to fibroids, causing
them to shrink and die
• SHOULD NOT BE DONE if the patient wants more children !!!
FIBROID TREATMENTS
• Laparoscopic, robotic or open myomectomy
• In a myomectomy, your surgeon removes the fibroids,
leaving the uterus in place
FIBROID TREATMENTS
• Endometrial ablation and resection of submucosal fibroids
• A specialized instrument inserted into your uterus; uses
heat, microwave energy, hot water or electric current to
destroy the lining of your uterus, either ending
menstruation or reducing your menstrual flow
• Ablations DO NOT remove the fibroids
• SHOULD NOT be done if the patient wants more children
ABLATION
FIBROID TREATMENTS
HYSTERECTOMY
• Abdominal
• Vaginal
• Laparoscopic
• Robotic
FIBROID TREATMENTS
HYSTERECTOMY
• A hysterectomy is an operation to remove a woman's uterus
• Definitions:
• In a supracervial or subtotal hysterectomy, a surgeon
removes only the upper part of the uterus, keeping the
cervix in place
• A total hysterectomy removes the whole uterus and cervix
• The ovaries may also be removed -- a procedure called
oophorectomy -- or may be left in place
POLYPS
• Overgrowth of cells in the lining of the uterus (endometrium)
• Are usually noncancerous (benign), although some can be
cancerous or can eventually turn into cancer (precancerous
polyps)
POLYPS
TREATMENT FOR POLYPS
• Hormonal Manipulation (OCP, Nuvaring, Depo Provera,
Nexplanon, Mirena)
• Surgical removal: D&C hysteroscopy
• A camera is used to look inside the uterus and then the polyp is
scraped out
• An ablation can be done at the same time
AUB
Causes
Treatment
• GYN cancers
Surgery
• Anovulation
Hormonal Contraception
• Fibroids
Lupron, Surgery/UAE
• Polyps
Surgery
• Systemic illness
Treatment based on
affected organ system
THANK YOU
• Wright, Jason and Solange Wyatt. The Washington Manual Obstetrics
and Gynecology Survival Guide. Lippincott Williams and Wilkins,
2003. ISBN 0-7817-4363-X
• Bravender T, Emans SJ (June 1999). "Menstrual disorders.
Dysfunctional uterine bleeding". Pediatr. Clin. North Am. 46 (3):
545–53, viii. PMID 10384806.
• ^ "Dysfunctional Uterine Bleeding".
http://www.sh.lsuhsc.edu/fammed/OutpatientManual/DUB.htm.
Retrieved 2010-01-23.