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-K.MONICA

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Diagnosis of DUB depends on the process of exclusion

of organic causes for menorrhagia.

It is based on

1. History

2. Examination

3. Investigations

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HISTORY1. Age, parity and fertility of the patient

2. Uterine bleeding onset,duration,amount,pattern,character,cyclical

features.

MENSTRUAL CALENDAR can be maintained.

It is a day to day record of amount of blood loss for 2-3 months

Useful when pattern and amount ofblood loss are uncertain.

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3. Antecedent cause IUCD, recent delivery/abortion, drug

intake, sterilisation operation.

4. Any symptoms suggestive of bleeding disorders orhypothyroidism.

CLINICAL EXAMINATION

1.Degree of anaemia

2.Associated thyroid problems

3.Abdomen and bimanual pelvic examination

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INVESTIGATIONS1. Assessment of amount of menstrual blood loss by

y Direct method - weighing napkins before and after use

y Indirect method - amount of clot passagedegree of anaemia

2. Complete haemogram

Hb%, coagulation profile, blood grouping and typing.

3. Thyroid profile

4. Hormonal profile

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5. ULTRASOUND

y Transvaginal US preferred over transabdominal.

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USE:

y Exclude organic causes of abnormal bleeding

y Endometrial thickness and texture accurately measured.

thickness>12mm risk of disease and is an indication for biopsy

thickness

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6. DILATATION OF CERVIX

AND CURETTAGE

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y Consider the age group

Peri-menopausal mandatory without delay

Reproductive abnormal USG and biopsy

- failed medical therapy

Pubertal LAST RESORT

- severe persistent bleeding- non-responsive to medical therapy

CONTRAINDICATION:y Any infection

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USE:

Esentially DIAGNOSTIC but also THERAPEUTIC

only 60% diagnosed 30-40% cured

Excludes intrauterine - removes intrauterine path

-removes structurally

diseased fragile endometrium

Functional state of

endometrium det. Restores normal

haemostasis

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HISTOPATHOLOGICAL PICTURE OF

ENDOMETRIUMy Normal endometrium - 54%

y Endometrial hyperplasia - 31%

yIrregular shedding - 6%

y Irregular ripening - 3%

y Atrophic endometrium - 3%

COMPLICATIONS:y Haemorrhage

y Infection

y Uterine perforation

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DILATATION AND CURETTAGE

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7. HYSTEROSCOPY

Endoscopic technique of directly visualizing interior of

uterine cavity.

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USESANDADVANTAGE:

yIdentification of intrauterine pathology even small lesionsidentified.

y Identification of endometrial atrophy and bleeding from rupturedvenules.

y HYSTEROSCOPY GUIDED BIOPSY Goldstandard investigation of choice.

DISADVANTAGE:

y Expensive

y Needs skill and experience

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8. UTERINE ASPIRATION

CYTOLOGYVibra aspirator, Gravlees jet washer, Isaacs aspirator &Pipelleaspirator.

ADVANTAGE:

y Very simple OPprocedure

y Avoids anaesthesia

DISADVANTAGE:

y Less diagnostic

y

Not curative

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9. SONOHYSTEROGRAPHYy Involves transvaginal ultrasound

y Injection of sterile saline improves visualization.

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10. MRI

11. PELVIC ANGIOGRAPHYANDVENOGRAPHY; COLOURDOPPLER

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