Beruflich Dokumente
Kultur Dokumente
MANAGEMENT OF ABNORMAL
UTERINE BLEEDING IN
PREMENOPAUSAL WOMEN
By :
Siti Arfiah Meisari
16710127
Pembimbing :
D r Yu s u f N a w i r S p . O G
Abnormal uterine bleeding occurs in
9 to 14 percent of women between
menarche and menopause, significantly impacting quality
of life and imposing
financial burden
INTRODUCTION
AUB frequently co-exists with fibroids, but the relationship
between the two remains incompletely understood and in
many women the identification of fibroids may be incidental to
a menstrual bleeding complaint.
Based on WHO 2011
18 millions
women from 50% in 20% in
3,5 billlion perimenopa adolescence
women in use period
the world
A NORMAL CYCLE
and withdrawal
bleeding occurs
13 to 15 days
postovulation.
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Differential Diagnosis and Evaluation of Abnormal Uterine Bleeding
Anovulatory Ovulatory
Irregular, often infrequent Periods Regular intervals (every 24 to 35 days) with
Characteristics progesterone-deficient/ estrogen-dominant state . excessive bleeding or duration greater than
Flow ranges from absent or minimal to seven days . Less than 1 percent of
excessive , 14 percent of women with recurrent women develop cancer or hyperplasia if they
have no more than one risk factor for
anovulatory cycles develop cancer or hyperplasia
endometrial cancer
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6
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Anovulatory Bleeding
ACOG recommends endometrial tissue assessment to rule
At extremes of the reproductive years, irregular cycles out cancer in adolescents and in women younger than
resulting from anovulation can occur. Following menarche, 35 years with prolonged unopposed estrogen stimulation,
the immature hypothalamic-pituitary-ovarian axis may women 35 years or older with suspected anovulatory
result in anovulatory cycles for two to three years bleeding, and women unresponsive to medical therapy
During the rest of the reproductive years, however, recurrent ACOG recommends treatment
irregular cycles may be caused by anovulation and are with combination oral contraceptives or cyclic
considered abnormal progestin
Evaluation
history, physical examination to look After the initiation of treatment, endometrial biopsy
for obesity and hirsutism (manifestations of polycystic should be repeated in three to six months to assure
ovary syndrome) resolution of the hyperplasia
a pregnancy test, and measurement of thyroid-
stimulating hormone
and prolactin levels
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A N O V U L AT O R Y
BLEEDING
Evaluation
Pregnancy test
Complete blood count,
Measurement of thyroid-stimulating hormone level.
Tr e a t m e n t
Hormonal Therapies. Progestins
Nonhormonal Therapies. (NSAIDs)
Surgery
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OVULATORY
BLEEDING
A N O V U L AT O V U L
AT O R Y
BLEEDINGORY
BLEEDING
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Perdarahan uterus abnormal dengan anovulasi dilakukan evaluasi awal yaitu riwayat penyakit,
pemeriksaan fisik untuk mencari obesitas dan hirsutisme (manifestasi sindrom ovarium
polikistik), tes kehamilan, dan pengukuran tingkat hormon perangsang tiroid dan tingkat
prolaktin. ACOG merekomendasikan penilaian jaringan endometrium untuk menyingkirkan
kanker.
Dan untuk terapi, ACOG merekomendasikan pengobatan dengan kombinasi kontrasepsi oral
atau progestin siklik. Terapi progestin dan kontrasepsi oral menginduksi pendarahan
penarikan rutin, mengurangi risiko hiperplasia atau kanker, dan memperbaiki pendarahan
menstruasi terkait lainnya
Untuk terapi menggunakan terapi hormonal, terapi non hormonal seperti NSAID, dan
operasi.
T h a n k Yo u
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