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

* * * * * * * * * * * * * * * * * * * 胆道疾病病人护理化工企业本质安全理论实践及方法内科护理学呼吸系统总论概论脾胃病常见症状及治疗经验偏瘫截瘫康复训练手册偏执性精神障碍品管圈实践 胆道疾病病人护理化工企业本质安全理论实践及方法内科护理学呼吸系统总论概论脾胃病常见症状及治疗经验偏瘫截瘫康复训练手册偏执性精神障碍品管圈实践 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. Men