MENSTRUATION Periodic desquamation of the endometrium The
external hallmark of the menstrual cycle Just before menses the
endometrium is infiltrated with leucocytes Prostaglandins are
maximal in the endometrium just before menses Prostaglandins
constriction of the spiral arterioles ischemia & desquamation
Followed by arteriolar relaxation, bleeding & tissue
breakdown
Slide 4
NORMAL MENSTRUAL CYCLE The mean duration of the MC Mean 28 days
(only 15% of ) Range 21-35 The average duration of the MC 3-8 days
The normal estimated blood loss? Approximately 30 ml Ovulation
occurs Usually day 14 34 hrs after the onset of mid-cycle LH
surge
Slide 5
Definition of normal menstruation Regularity Frequency - Cycle
lenght Duration of menstrual flow Volume of menstrual flow
Slide 6
Describing normal uterine bleeding Regularity of menstruation
Regular Iregular Absent Frequency Frequent Normal Infrequent
Slide 7
Describing normal uterine bleeding Duration of menstrual flow
Prolonged Normal Shortened Volume of menstrual flow Heavy Normal
Light
28 Pharmacological therapy of DUB Individual Age-specific
Treatment outcome and side effects are unpredictable Side effects
are common Economic efficiency Need for surgical treatment is
often
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Estrogens CEE - 2.5 mg p.o. a 6 h. or 25 mg i.v. a 4 h. for 48
h. Progestins MPA 10 mg/d for 10-12 d. NES 10-15 mg/d 10 d. LNG-IUS
29 Pharmacological therapy of DUB
Surgical therapy of DUB - controversies Dilatation+curettage
Diagnostic procedure Endometrial - Resection/ablation Many costly
methods Many failures selhn Hysterectomy Invazive Operational risks
Expensive Suitable for women over 40 37