Womens Health W3R2 assignment

 

 

           

Women’s Health W3R2

 

 

 

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Women’s Health W3R2

            Abnormal uterine bleeding (AUB) is a general term used to describe menstrual cycle irregularities involving duration, volume, regularity, and frequency of flow outside of pregnancy (Kolhe, 2018). Studies show that up to a third of women globally will experience AUB in their lifetime with irregularities commonly reported at menarche and perimenopause.

Epidemiology

            The prevalence of AUB among women of reproductive age globally is estimated to be from 3% to 30% with higher incidences reported around menarche and perimenopause (Kaunitz, 2019). Most women however normally avoid seeking treatment for the symptoms of AUB, hence making it had to determine the exact prevalence.

Morbidity and Mortality

The morbidity of AUB is associated with the amount of lost blood during menstruation that can occasionally be severe enough to cause hemorrhagic shock (Kaunitz, 2019). Excessive uterine bleeding is also associated with several adverse effects such as anemia and iron deficiency, increased cost of healthcare, and reduced quality of life.

Pathophysiology

            Abnormal uterine bleeding usually results from any derangement in the uterine structure such as hyperplasia, malignancy, adenomyosis, polyps, or leiomyoma (Narayan & Beran, 2020). It can also result from derangement to the clotting pathways either iatrogenically or coagulopathies or when the hypothalamic-pituitary-ovarian axis has been disrupted hence affecting menstruation land leading to AUB.

 

 

Subjective and Objective Presentation

            In the assessment of AUB among women, the subjective data should capture the patient’s menstrual history for postcoital and intermenstrual bleeding, sexual and reproductive history, family history, and associated symptoms such as pain, discharge, and weight loss, and bladder symptoms among others (Kolhe, 2018). The objective data should look for signs of pallor, endocrine disorders, coagulopathies, and pelvic masses.

Differential Diagnosis

Any form of bleeding from the genitourinary gastrointestinal tract or genitourinary tract can mimic AUB. Such conditions include cancer, endometrial hyperplasia, submucous myomas, polyps, endometritis, intrauterine device, and cervical disease (Narayan & Beran, 2020).

Clinical Management

            Abnormal uterine bleeding is normally managed symptomatically. Medications recommended for heavy menstrual bleeding include levonorgestrel-releasing intrauterine system, continuous oral progestins, combined oral contraceptives, and tranexamic acid (Kolhe, 2018). Most national clinical practice guidelines recommend hormonal therapy as the first line for AUB.

 

 

References

Kaunitz, A. M. (2019). Abnormal uterine bleeding in reproductive-age women. JAMA, 321(21), 2126-2127. doi:10.1001/jama.2019.5248

Kolhe, S. (2018). Management of abnormal uterine bleeding–focus on ambulatory hysteroscopy. International journal of women’s health, 10, 127. DOI: 

Narayan, R., & Beran, B. D. (2020). Abnormal Uterine Bleeding. In Sex-and Gender-Based Women’s Health (pp. 99-116). Springer, Cham. https://doi.org/10.1007/978-3-030-50695-7_7