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K NAVANEETHARANI UNIT OG
DYSFUNCTIONAL UTERINE BLEEDING
Management at Pubertal Age Group
• MAJOR• MAJOR
MINOR MINOR
Immature hypothalamo-pituitary axis• excess/unopposed estrogen • absent progesterone in anovulatory cycles
o coagulation disorderso blood dyscrasiasohypothyroidism
ETIOLOGY
FACTORS DETERMINING THE CHOICE OF TREATMENT
◦Age
◦Parity
◦Histopathological changes in Endometrium
◦Need for contraception
◦Availability of treatment option
3
2
1Early control of excessive bleeding
Normalizing cyclical rhythms
Prevention of recurrence
TREATMENT
OBJECTIVES
Management
MILD PUBERTAL MENORRHAGIA
◦Reassurance
◦Maintenance of menstrual calendar, pictorial bleeding assessment chart & assessment of menstrual blood loss
◦Iron & Vitamin Supplementation
◦Periodic re-evaluation
MILD (..contd)• No Specific treatment required• Normal menstrual pattern occurs spontaneously
within 1 or 2 years
SEVERE PUBERTAL MENORRHAGIA
o ADMISSION OF THE PATIENTo Blood Transfusiono RULE OUT
Hypothyroidism-thyroid profile
Bleeding diathesis - FBC, platelet count, bleeding time, PTT,vwf antigen
oTo Achieve HemostasisoHigh dose progestogeno Norethisterone acetate
o 1st 48hrs 5-10mg tdso Next 2 weeks 5-10mg bdo Next 1 week 5-10mg odo Then stop the drug
oTo Regularise Menstrual CyclesoCyclical progestogen for 6 months or longer
oRe-evaluation upto 12 months or longer if necessary
OCP-20-30 microgram tabs
mefenemic acid 500 mg tds for 6 days
OTHER DRUGS
tranexemic acid 500-1000 mg 8 hourly
GnRH-leuprolide -3.75 mg im monthly for 6 months
• DILATATION AND CURETTAGE (D&C)
– Last resort
– To rule out Tuberculous Endometritis (4% of cases)