CASE : ABNORMAL UTERINE BLEEDING

HISTORY :-

1)    AGE

2)    OBSTETRIC HISTORY pertaining to abortions, ectopic, gestational trophoblastic disease, last child birth, any complication causing endometritis.

3)    MENSTRUAL HISTORY – excessive bleeding, content ( clots or POCs), amount, cydical / acyclical, post – coital or intermenstrual

4)    H/O D&C or instrumentation

5)    H/O Hormonal Contraception or irregular use of hormonal preparations, IUCDs

6)    H/O sexually transmitted diseases

7)    H/O bleeding disorders, aspirin or any anticoagulant use

8)    H/O abnormal weight gain, cold or heat intolerance, S&S of diabetes, hirsutism (excessive hair growth), glactorrhoea

EXAMINATION :-

1)    Appearance, obese/excessively cachetic, weight, height

2)    Enlargement of thyroid, petechiae or ecchymosis on skin

3)    Discharge from breasts, hair distribution

4)    Secondary sexual characterstics

5)    Any mass or lump in abdomen, hepatosplenomegaly

6)    Any abnormal discharge, growth or ulcer in per speculum examination

INVESTIGATIONS :-

1)    CBC with differential count and platelet count

2)    Coagulation profile, APTT where required

3)    Blood Grouping and RH typing

4)    Urine albumin, sugar and microscopy

5)    Blood sugar – fasting  and psot-prandial

6)    Liver function tests

7)    Pap’s smear

8)    Endomaterial sampling or Hysteroscopy ( particularly in > 40 year age group)

9)    Thyroid profile, prolocation (wherever indicated)

10) Ultrasonography – transvaginal

DIFFERENTIAL DIAGNOSIS:-

1)    Pregnancy complications

2)    Anovulation associated

3)    Submucous fibroids

4)    Endometrial Polyps

5)    Medication related

6)    Endometrial hyperplasia

7)    Endometrial cancer

8)    Infection associated

9)    Coagulation abnormalities

10)  Mullerian abnormalities

11) IUD complications

12) Adenomyosis

MANAGEMENT :-

1)    Hormonal – Combined pills, progestogens, danazol, GnRH Agonists, Mirena

2)    Tranexamic acid, mefenamic acid

3)    D & C, Hysteroscopy

4)    Conservative Surgery – TCRE, Endometrial ablation by Various methods ( LASER, thermal, radiofrequency)

5)    Hysteroscopy – abdominal, non-descent vaginal, laparoscopic

6)    Treatment of basic pathology