LU 11 Abnormal Uterine Bleeding / Menstrual Disorders

What is abnormal uterine bleeding (AUB) ?

any uterine bleeding that differs in regularity, frequency, volume & duration.

What is intermenstrual bleeding (IMB) ?

• bleeding between clearly defined cycles

What is heavy menstrual bleeding (HMB) ?

• excessive menstrual blood loss, >80mls

What is the meaning of these terms ?

• metrorrhagia

• polymenorrhea

• oligomenorrhea

• amenorrhea

• post-coital bleed

• metrorrhagia : irregular intervals, bleeding betweeen cycles

• polymenorrhea : frequent bleeding with shortened cycle

• oligomenorrhea : bleeding less frequent (interval > 35 days)

• amenorrhea : absence of menstruation

• dysmenorrhea : painful menstruation

• post-coital bleed : bleeding following sexual intercourse

What causes menstrual disorders ?

• structural

• pregnancy associated

• hormonal and endocrine

• hematologic and coagulation disorders

What are the classification of bleeding pattern and causes based on PALM-COEIN classification ?

What causes abnormal uterine bleeding ?

• pregnancy (the leading cause of missed periods)

• perimenopause

• stress (stress hormone such as cortisol, interfere with ovulation)

• polycystic ovary syndrome (PCOS)

• fibroids (noncancerous growths in the wall of uterus)

• Iatrogenic causes (medication used such as contraception)

What are the types of amenorrhea ?

• physiological amenorrhea : i) during pregnancy, and lactation ii) after menopause

• pathological amenorrhea : i) primary amenorrhea ii) secondary amenorrhea

What is primary amenorrhea and its causes ?

• menstruation absence until 14 years old in the presence of secondary sexual characteristics

• causes (atieology) : i) hormonal disorders ii) ovarian failure iii) overweight/ underweight iv) medications such as antidepression

What is secondary amenorrhea and its causes ?

• fails to menstruate during reproductive years in the absence of pregnancy

• causes : similar to primary

What is menorrhagia and its causes ?

• regular cycle with excessive bleeding, >80mls

• can lead to anemia

• causes : uterine fibroids, ovarian tumour, thyroid disorders, blood disorders

What are the management for menorrhagia ?

• treat the cause of menorrhagia

• treat anemia : blood transfusion

• hormone therapy such as oral estrogen]

• NSAID such as mefenamic acid during menses

What are the management for AUB ?

• medication (hormonal therapy or haemostatic agents)

• surgical procedures (myomectomy, hysterectomy)

What are the nursing considerations for AUB ?

• encourage the woman to express her feelings about her symptoms

• provide information about therapeutic options

• teaching the importance of adequate balance nutrition and weight control

• discourage excessive workouts

• teach the woman to keep a menstrual calendar to record the amount of bleeding episodes