Abnormal Uterine Bleeding

Etiologi
Polyps
• Clinical Features:
1. Bleeding
1. Pre << post menopausal
2. Irregular menstrual bleeding
3. Excessive menstrual bleeding
4. Post coital  cervical polyps
2. Infertility
• Diagnostic : TVUS
Polyps
• Tatalaksana
• Younger women, wish to preserve fertility : Hysteroscopic
polypectomy  PA
• Multiple endometrial polyps, not desirous of continued fertility :
hysteroscopic polypectomy  PA  Clear + LNG- IUS
 Adenomyosis
• Risk factor:
• Age : 40-50
• Multiparity
• Prior uterine surgery
• Smoking
• Ectopic pregnancy
• Clinical features:
1. HMB
2. IMB
3. Pelvic pain
• Diagnostic : TVUS, MRI, Biopsi endometrium
Treatment AUB-A
• Preserve fertility, no immediate conception : LNG-IUS
• Resistant to LNG-IUS : GnRH agonist
• No fertility : Long term GnRH agonist
• Symptomatic : NSAID, As Tranex, Hormonal  Pil KB
COC, danazol, progesterone
• Definitif: histerektomi, uterine artery embolization /
ligation
Leiomyoma
• Clinical features
1. HMB
2. IMB
3. Abdominal mass
4. Pain, pressure
5. Infertility
• Diagnostic: USG (A/V), MRI
Treatment AUB-L
• Grade 2-6 :
• Preserve fertility : TA, COC, NSAID, LNG-IUS (not trying to
conceive for at least 1 year)
• Myomectomy (open or laparoscopic)
• Grade 0-1
• <4cm : hysteroscopic resection
• >4cm : abdominal myomectomy
• Above 40 years old : hysterectomy, <4cm boleh coba LNG-
IUS
Malignancy
• Clinical features:
1. Family history, prolonged hyper-estrogenic state
2. Abdominal mass
3. Vaginal bleeding
1. AUB
2. Post Coital Bleeding
• Diagnostic:
• USG, MRI, Biopsy
• CA 125, HE 4, Beta HCG, AFP
• Treatment :
• Symptomatic : NSAID, As. Tranex
• Definitive : Surgery, kemo, radiasi
 • Mostly adolescent
Coagulopathy • Most common: VWD,
Factor IX, X deficiency
• Treatment:
• TA
• Antifibrinolytics
• desmopressin,
• Hormones: IV estrogens,
LNG IUS DnC,
endometrial balloon
tamponade
Ovulatory
• Etiologies: PCOS, hyperprolactine, thyroid, stress, anorexia
• Clinical features
• Non cyclic
• Irregular, prolonged, heavy menstruation
• Most common during menarche and perimenopausal
• Diagnostic :
• TVUS, MRI
• TSH, prolactin, progesterone, total and free testosterone, FSH, LH
• Tx
• 13 to 18 years : OCP
• 18–39-year : Pil KB campuran, progestin, LNG-IUS
• 40 to menopause: progestin, LNG-IUS
Endometrial
• Diagnosis tong sampah, no prove of C O I
• Clinical feature
• Inter-menstrual spotting, prolonged
• Vaginal discharge
• Normal uterus sign
• Fluid in endometrial cavity
• Treatment : As. Tranex, NSAID, hormonal
 Iatrogenic
• History of KB, medication,
pemakaian AKDR
• Normal size uterus, IUD in situ
• Treatment : ganti KB, LNG-IUS
Not otherwise classified
• Diagnosis tong sampah
• Riw trauma
• AVM
• Symptoms: Heavy menstrual bleeding
• Confirm diagnosis with full gynecology workup: speculum, bimanual,
USG (both abdominal and vaginal)
• Full lab work
• MRI
• Tx: As. Tranex, NSAID, hormonal
• AVM  uterine artery embolization
Management of AUB
• TTV  Perhatikan tanda hypovolemia  resusitasi, tatalaksana shock
• Stop perdarahan  As. Traneksamat + Vit K
• Cek lab  CBC, panel koagulasi
• Rujuk Sp OG