DYSFUNCTIONAL UTERINE BLEEDING

Management at Pubertal Age Group

K NAVANEETHARAN
I UNIT OG
 ETIOLOGY

• MAJOR

Immature hypothalamo-pituitary axis

• excess/unopposed estrogen
• absent progesterone in
anovulatory cycles

MINOR

o coagulation disorders
o blood dyscrasias
ohypothyroidism
FACTORS DETERMINING THE CHOICE OF
TREATMENT

◦ Age

◦ Parity

◦ Histopathological changes in Endometrium

◦ Need for contraception

◦ Availability of treatment option

TREATMENT
OBJECTIVES

3
Prevention of
2 recurrence
Normalizing cyclical rhythms
1
Early control of excessive bleeding
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 PATIENT

o Blood Transfusion
o RULE OUT

Hypothyroidism-thyroid profile

Bleeding diathesis - FBC, platelet count, bleeding time, PTT,vwf

antigen
oTo Achieve Hemostasis
o High dose progestogen
o Norethisterone acetate
o 1st 48hrs 5-10mg tds
o Next 2 weeks 5-10mg bd
o Next 1 week 5-10mg od
o Then stop the drug

oTo Regularise Menstrual Cycles

o Cyclical progestogen for 6 months or longer

oRe-evaluation upto 12 months or longer if necessary

 OTHER DRUGS

OCP-20-30 microgram tabs

tranexemic acid 500-1000 mg 8 hourly

mefenemic acid 500 mg tds for 6 days

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)