Disorders Emory University月经失调埃默里大学课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * Menstrual Disorders Oguchi A. Nwosu M.D. Assistant Profressor Emory Family Medicine Dept. 6/28/07 Menstrual Cycle Definitions Menorrhagia Excessive (80ml) uterine bleeding Prolonged (7days) regular DUB Abnormal Bleeding, no obvious organic cause usually anovulatory Oligomenorrhea Uterine bleeding occurring at intervals between 35 days and 6 months Amenorrhea No menses x at least 6 months Metrorragia, Menometrorrhagia, Polymenorrhea Ovulatory vs Anovulatory cycles Anovulatory Oligo or Amenorrhea +/- Menorrhagia Ovulatory Regular menstrual cycles (plus premenstrual symptoms such as dysmenorrhea and mastalgia DUB -Defn: Excessively heavy, prolonged or frequent bleeding of uterine origin that is not due to pregnancy, pelvic or systemic disease -Diagnosis of exclusion - Anovulatory -Usually extremes of reproductive life and in pts with PCOS DUB pathophysiology Disturbance in the HPO axis thus changes in length of menstrual cycle No progesterone withdrawal from an estrogen-primed endometrium Endometrium builds up with erratic bleeding as it breaks down. 16year old with daily heavy vaginal bleeding with clots, no cramps 5ft 7in, 105ibs, normal sec. sex xristics, pelvic normal Menarche 14, 2 periods last year, heavy lasts 2 weeks, virginal. I month hx of daily heavy vag bleeding with clots, 8 to 10 pads x day No associated symptoms Picture of teenager DUB management HCG, CBC, TSH ? Coagulation workup Ensure pap smear UTD if appropriate 35 or Ca risk factors, tamoxifen use – sample endometrium DUB management I/V or I/M conjugated estrogen therapy acute DUB--How ?!!!. Usually followed by OCP or progestin Cyclic progestins for 10 to 12 days each cycle, consider mirena IUD OCP D and C – old school, no longer recommended. Menorrhagia -Heavy vaginal bleeding that is not DUB -Usually secondary to distortion of uterine cavity- heavy with or without prolongati