gyn

1. Prof FOMULU Joseph Nelson

2. PLAN
1. Definition
2. Clinical types of abnormal uterine bleeding
1. Menorrhagia
2. Hypomenorrhoea
3. Metrorrhagia
4. Polymenorrhoea
5. Menometrorrhagia
6. Oligomenorrhoea
7. Contact bleeding
8. Amenorrhoea
9. Dysmenorrhoea
3. Evaluation of abnormal bleeding
1. Clinical history
2. Physical exam
3. Investigations
4. General principles of management

3. 1- Definition
• Any bleeding from uterus that differs materially from
that of the normal menstrual cycle in frequency of
occurrence, in amount or in duration of flow.
• It applies to both menstrual and non menstrual
disturbances due to
– Organic disease either benign or malignant
– Or to systemic or psychogenic origin
• Between menarche and menopause, almost every
woman experiences one or more episodes of
abnormal uterine bleeding.

4. 2- Clinical types of abnormal uterine bleeding
Menorrhagia (hypermenorrhoea)
Cyclical menstrual bleeding excessive in amount and/ or
prolonged in duration
Causes:
 Uterine fibroids
 Complication of undiagnosed pregnancy
 Adenomyosis
 Endometrial hyperplasia
 Malignant tumours
 Endometritis
 Dysfunctional bleeding

5. 2- Clinical types of abnormal uterine bleeding
Hypomenorrhoea (cryptomenorrhoea)
An abnormally small amount of menstrual flow usually
spotting
Causes:
 Cervical stenosis
 Congenital transverse vaginal membrane
 Asherman syndrome
 Endometrial tuberculosis
Polymenorrhoea
Periods occurring too frequently, usually less than 21 days
apart. Bleeding may or may not be abnormal in amount
Causes: anovulation (endocrine disorders)

6. 2- Clinical types of abnormal uterine bleeding
Metrorrhagia (intermenstrual bleeding)
Bleeding occuring at any time between menstrual
periods ranging from slight spotting to haemorragic
flow and from a single short episode to bleeding that
continues for days
Causes:
 Endometrial polyps
 Endometrial and cervical cancers
 Exogenous oestrogen administration

7. 2- Clinical types of abnormal uterine bleeding
Menometrorrhagia
Uterine bleeding totally irregular in frequency and
duration of episodes and excessive in amount.
Causes:
 Complications of pregnancy (abortion, hydatoform mole,
choriocarcinoma)
 Malignant genital tract tumours
Oligomenorrhoea
Menstrual periods that occur more than 35 days apart.
Bleeding usually decreased in amount and duration
Causes: Menopause, Anovulation, Pregnancy
complications, Oestrogen-producing tumors

8. 2- Clinical types of abnormal uterine bleeding
Contact bleeding
Self-explanatory
Causes:
 Cervicitis
 Cervical cancer
 Cervical eversion (ectropion)
 Cervical polyps
Amenorrhoea
Failure to menstruate which is:
 Physiology (before puberty, during pregnancy, puerperum and after
menopause)
 Pathological
 Primary amenorrhoea: congenital malformations, genetic disorders.
 Secondary amenorrhoea

9. 2- Clinical types of abnormal uterine bleeding
Dysmenorrhoea
Painful menstruation, the commonest gynaecological
complaint, and leading cause of absenteism
 primary dysmenorrhoea: idiopathic causes (theories)
 secondary dysmenorrhoea: organic disease (PID,
endometriosis, fibroids, ...)

10. 3- Evaluation of abnormal uterine bleeding
Clinical history
Many causes of bleeding will be strongly suggested by
history alone.
Note amount of flow, duration of cycle, duration of
periods, number of episodes, LMP, menopause and any
change in general health
Physical examination
General health condition
Glands
Abdominal masses
Size of the uterus/ovaries
Cervix

11. Evaluation of abnormal uterine bleeding
Investigations
Pap smear
Endometrial Biopsy
Hysteroscopy
D & C
Hormonal assays
Ultrasound
Laparoscopy

12. 4- General principles of management
A careful clinical history, physical and pelvic
examination are vital.
Improved diagnostic technics and treatment have
resulted in better care of patients with abnormal
uterine bleeding.

13. References
Integrated Obstetrics and Gynaecology for
postgraduates by C.J. Dewhurst, 2nd
edition by
Blackwell Scientific Publications.
Obstetrics and Gynaecology (Scientific Foundations
of) by Elliot E Philipp, Josephine Barns and Michael
Newton International Edition (3rd edition)
Principles of Gynaecology, by Sir Norman Jeffwate,
Butterworths, 4th edition.