AUB & Menopause
What is AUB?
Abnormal uterine bleeding (AUB) is extremely common gynecologic complaint. It is estimated that 30% of women experience menorrhagia annually. This debilitating condition is clinically important; We report it is the indication for two thirds of hysterectomies and nearly 25% gynecologic operations. This impacts condition on public health and health care costs is significant. Because medical therapies for AUB have significant failure rates or side effects surgical treatment by hysterectomy remains a major therapeatic option for chronically symptomatic women. We review normal menstruation, the pathophysiology underlying AUB, the evaluation of AUB & current treatment modalities Reproductive capability in a young woman begins at point of menarche, which is the beginning of cyclic uterine bleeding in the anatomically and physiologically normal female. Menarche marks beginning of importance in a young woman’s physical reproductive maturation development. Attitudes toward menstruation, what is considered”normal,” and the decision to seek medical evaluation is impacted.
aub & menopause
The suggested normal limits for frequency, regularity, and duration of menstrual flow were based on the 5th and 95th percentiles for data drawn. As such, they are influenced by the prevalence of common anovulatory disorders, such as the polycystic ovary syndrome (PCOS), in a given population. Consequently, the population-based norms are wider than the generally accepted norms for menstrual frequency (24-35 days), regularity (+5 days variation), and duration (2-7 days) among ovulatory women. The normal limits of menstrual blood loss were based primarily on measurements of hemoglobin loss. It is important to note that, while heavy menstrual bleeding is officially defined by a volume measurement, it is more meaningful and clinically recommended to define heavy menstrual bleeding based upon its impact on a woman’s quality of life, with consideration to both objective and subjective measures. The expectation is that a structured menstrual history can clarify the details needed to categorize a patient’s complaint in clear and simple terms (e.g., irregular, heavy menstrual bleeding)
SOME DEFINITIONS FOR AUB
Amenorrhea-The absence of menstrual bleeding for me than 6 months.
Breakthrough bleeding-Intermenstrual bleeding that occurs despite the use of exogenous hormones.
Dysmenorrhea-Painful menstruation.
Interval bleeding-Bleeding between menstrual cycles.
Menorrhagia—Prolonged menstrual bleeding that is excessive in amount, due or both that occurs at regular intervals. Metrorrhagia—Bleeding between periods.
Oligomenorrhea-Bleeding that occurs less frequently than every 35 days.
Polymenorrhea-Bleeding that occurs more often than even 21 days.
Postmenopausal bleeding-Uterine bleeding occurring than 12 months after the last menstrual period of a menopausal woman.
PALM-COEIN-Polyp; adenomyosis; leiomyoma; malignant and hyperplasia; coagulopathy; ovulatory dysfunction endometrial; iatrogenic; and not yet classified. The ter dysfunctional uterine bleeding (DUB) is discouraged sine he implementation of this classification system
WHAT IS MENOPAUSE?
Menopause sets in when a woman reaches her 40s or 50s. It is not a disease but a natural process, marked by the end of menstruation and fertility. Throughout menopause and its transition period, the levels of progesterone and oestrogen hormones in the body fluctuate, as your ovaries try to keep up with the normal levels of hormone production.
The fluctuation is what leads to symptoms of menopause, such as vaginal atrophy/dryness, hot flashes, painful intercourse, early grade prolapse, and urinary incontinence. However, there are various treatment options to manage these symptoms.
During menopause, estrogen production slows and then stops. There are a number of changes, which occur in your body during this time. Periods become irregular and then stop. You may have hot flashes, mood swings, a deeper voice and an increase in facial hair. Vaginal dryness is another common symptom of menopause. It becomes even more common after menopause. Vaginal dryness also can occur at any age from a number of different causes. It may seem like just a minor irritation; however, it can be a major problem when it comes to your sex life. Here is everything you need to know about vaginal dryness:
WHAT CAUSES VAGINAL DRYNESS IN WOMEN?
Even though menopause is the most common cause of vaginal dryness, it can happen at any age and there are various causes of vaginal dryness as well. Here they are;
- Childbirth and Breastfeeding: Childbirth as well as breastfeeding result in lower levels of estrogen and this can lead to vaginal dryness.
- Jorgen’s Syndrome: This is an autoimmune disorder in which your immune system attacks the moisture producing cells in your body.
- Douching: Douching is a common practice done by women wherein, they wash their vagina using water and vinegar, knowing little that it can actually cause dryness.
Treatment
As mentioned earlier, vaginal dryness is caused by a lack of estrogen. Here are some of the ways that estrogen is supplied to your body;
- Vaginal Estrogen Cream: This also needs to be inserted through an applicator. It will be applied daily for the first two weeks after which, it will be applied one to three times a week.
- ThermiVa: THERMIva is a non-surgical radiofrequency treatment that can improve collagen under the surface and ultimately improves blood supply as well. It works well in treating vaginal dryness by improving lubrication.
In case you have a concern or query, you can always consult an expert & get answers to your questions!
Treatment SUmmary
- Cyclic progestin therapy is an appropriate treatment for oliogomenorrhric anovultaory women with episodic abnormal bleeding do not need contraception: choice of an estrogen – progestin contraceptive or the LNG – IUS may be preferable in those seeking contraception. Standard cyclic progestin treatments do not reliably suppress the HPO axis, will not prevent random ovulation and are not contraceptive.
- Failed medical management for presumed anovulatory bleeding suggests strongly that another pathology is causing or contributing to bleeding and signals the need for additional diagnostic evaluation.
- In women with acute heavy bleeding, imaging the trans – vaginal ultrasonography helps to guide the choice of treatment by defining the endometrial thickness and revealing structural abnormalities not otherwise suspected.
- Acute prolonged episodes of heavy anovulatory bleeding can be treated effectively with high dose estrogen – progestin therapy or with high-dose progestin alone (when estrogen is contraindicated), provided that the endometrium is normal or increased in thickness.
- Endometrial hyperlasia without cytologic atypia is an exaggerated form of persistent proliferative endometrium resulting from long term unopposed estrogen stimulation in women with chronic anovulation. With few exceptions, the lesion can be treated effectibvely with cyclic or continuous progestin therapy or by nsertion of a LNG – IUS.
- Endometrial hyperlapsia with cytologic atypia is a pre-cancerous lesion best treated surgically except in women with intent on preserving reproductive potential. Medical management of atypical endometrial hyperlapsia requires high doses and longer durations of progestin treatment or insertion of a LNG IUS, serial endometrial biopsies to monitor response, and longer term close surveillance.
