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Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding

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Published by boorai^_^
This is an outline of the article "putting a stop to dysfunctional bleeding" by Ayers and Montgomery, from the January Issue of Nursing 2009.
This is an outline of the article "putting a stop to dysfunctional bleeding" by Ayers and Montgomery, from the January Issue of Nursing 2009.

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Published by: boorai^_^ on Jan 26, 2010
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11/19/2012

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Title: Putting a Stop to Dysfunctional Uterine BleedingAuthors: Denise McEnroe Ayes, RN, MSN, and Mariann Montgomery, RN, MSNJournal: Nursing 2009 (January)Summary
Normal Menstruation
Occurs every 21 – 35 days
Lasts 2-7 days
30 – 80 mL of menstrual blood is lost in each cycle
Most of that loss occurs during the first 3 days.
Dysfunctional Uterine Bleeding
Refers to abnormal bleeding related to changes in hormones directlyaffecting the menstrual cycle in the absence of any identified organic,systemic or structural disease.
It may occur with or without ovulation.
It occurs when a normal cycle is disrupted.
Abnormal Bleeding
Is uterine bleeding that differs in quantity, duration or frequency froma woman’s usual pattern.
Examples of abnormal bleeding:
Spotting between menstrual periods
Postmenopausal bleeding
Bleeding 1 year or more after the last menstrual period
Risk Factors of Dysfunctional Uterine Bleeding include:
Age under 20 or over 40
Overweight
Extreme weight loss or gain
Excessive exercise
High stress levels
Polycystic ovarian syndrome
Signs and Symptoms
Bleeding more heavily during one period and lightly the next
Spotting between periods
Shorter or longer intervals between periods
Bleeding for less than 2 days or more than 7 days
Examples of dysfunctional uterine bleeding
Menorrhagia
Amount of more than 80 mL and duration of more than 7 days
Polymenorrhea
Menstrual cycle of less than 21 days
Oligomenorrhea
Menstrual cycle lasting longer than 35 days
Metrorrhagia
Bleeding at irregular but frequent intervals
Menometrorrhagia
 
Prolonged or excessive bleeding at irregular or unpredictableintervals
Common Reasons for Abnormal Bleeding
Pregnancy
Pregnancy – related conditions such as miscarriage
Genital tract infections
Uterine fibroids
Endometrial cancer
Medications and herbal medicine
Blood dyscrasia
Thyroid disorders
Liver or kidney disease
Stress
Comparison of the Two Types of Dysfunctional Uterine Bleeding
Anovulatory Ovulatory
Common at the beginning or end of reproductive lifeOccurs during the peak of thereproductive yearsEstrogen is continually secreted andthe corpus luteum fails to produceprogesteroneAssociated with prolongedprogesterone secretion or inadequateprostaglandin releaseIrregular and possibly heavy bleedingHeavy but predictable bleedingNo menstrual and premenstrual signsand symptomsMenstrual and premenstrual signsand symptoms manifestDirectly linked to endometrialhyperplasia or cancerMay coexist with tumors or polyps
Assessment
Obstetric and Gynecologic History
Investigate whether she has any vaginal discharge, abdominalpain, or pain during intercourse (dyspareunia) or urination(dysuria)
Explore whether she has a clotting or bleeding disorder, chronicliver disease, renal disease, or endocrine disease
Ask about a family history of cancer, endocrine disorders orbleeding diseases than could be associated with abnormaluterine bleeding
Ask if she’s taking any over-the-counter or prescription drugs orif she uses herbal remedies
Explore diet and exercise patterns
Find out if she is under any unusual stress
Hemodynamic Status
Take baseline vital signs
Assess orthostatic BP
Ask if she ever feels light-headed, fatigued, short of breath ordizzy
These can signal anemia related to blood loss.
Physical assessment
Inspect patient’s skin
Note color and any signs of bleeding disorders, includingbruising and petechiae
 
Check for clinical or lab evidence of hyperandrogenism
Acne, hirsutism or abdominal striae
Examine her thyroid gland
For enlargement
Check her abdomen
For tenderness, rigidity and masses
Record her height and weight
Calculate her body mass index
Tests
Pelvic Examination
Bimanual pelvic examination
Assessment for ovarian and uterine masses and signs of pelvic inflammatory disease.
Specimens will be taken to screen for cervical cancer and forNeisseria gonorrhoeae and Chlamydia trachomatis even whenbleeding is present
The urethra, vagina, cervix and uterus will be examined forlesions.
The endometrium will be evaluated for polyps.
The rectal area should be assessed and a fecal occult blood testperformed to determine is the gastrointestinal tract is the sourceof bleeding.
The American College of Obstetricians and Gynecologistsrecommends endometrial evaluation, including biopsy for womenover age 35 and those at high risk for endometrial cancer.
Lab work
All women of childbearing potential should have a pregnancy testand a complete blood cell count.
Additional blood work:
Platelet count
Coagulation studies
Levels of ferritin and hormones such as:
Thyroid – stimulating hormone
Progesterone
Testosterone
Prolactin
Imaging studies
Pelvic ultrasound
To rule out tumors, cysts and polyps
Transvaginal ultrasound
Helps evaluate structural abnormalities such as theposition and size of fibroid tumors
Determines endometrial thickness
Sonohysterography
May aid in diagnosis if uterine abnormalities are detected
involves infusing saline into the endometrial cavity duringa pelvic or transvaginal ultrasound examination
Treatment
Goals
Treating any underlying cause
Controlling excessive bleeding

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