Abnormal Uterine Bleeding.ppt

Abnormal Uterine Bleeding Peter J. Chen, M.D. Clinical Assistant Professor Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania What is normal uterine bleeding? Age of patient Frequency Duration Flow What is normal uterine bleeding? Frequency of menses 21 days (0.5%) to 35 days (0.9%) Age 25, 40% are between 25 and 28 days Age 25-35, 60% are between 25 and 28 days Teens and women over 40’s cycles may be longer apart Munster K et al, Br J Obstet Gynaecology What is normal uterine bleeding? Duration of menses 2 days to 8 days Usually 4-6 days Hallberg L et al, Acta Obstet Gynecology Scandinavica What is normal uterine bleeding? Flow/amount of menses Normal volume of menstrual blood loss is 30 cc Hallberg L et al, Acta Obstet Gynecology Scandinavica Traditional terminologies Menorrhagia Regular intervals, excessive menstrual blood loss amount 80mL Metrorrhagia Irregular intervals, excessive flow and duration Oligomenorrhea Interval longer than 35 days Polymenorrhea Interval less than 21 days Cohen BJB et al, Obstetrical and Gynecologic Survey Differential diagnosis Pregnancy related complications ectopic, inevitable Differential diagnosis Disease of the cervix Polyp, ectropian, dysplasia, invasive cancer Differential diagnosis Disease of the uterus Infection: endometritis Endometrial polyp, adenomyosis, hyperplasia, adenocarcinoma Fibroids One third of patients with symptoms Correlation between the severity of the bleeding and the area of endometrial surface Sehgal N, et al American Journal of Surgery Histologic abnormalities of the endometrium, ranging from atrophy to hyperplasia Deligdish, et al Journal of Clinical Pathology Endometrial venule ectasia Faulkner RL American J of Obstetrics and Gynecology; Farrer-Brown G, et al Journal of Obstetrics and Gynaecology Br Common W Differential diagnosis Disease of the ovary Germ cell tumors Choriocarcinomas Embryonal carcinoma Sex cord-stromal tumors Gra