Abnormal Virginal Bleeding
Abnormal Vaginal Bleeding
Generally, unexpected bleeding than is not normal menstrual period, abnormal heavy period, can be great cause for alarm for any woman
Summary of Normal Menstrual Cycle
1 of menstrual bleeding = day 1 of cycle. Bleeding about 3-5 days. Cycle = 28 days +/- 7 days. the period occurs in 3 stages: menses, proliferative, and secretory.
Ovarian cycle- occurs in two phases: Follicular and luteal
New endometrial lining renewed in preparation for implantation of embryo. Plasma concentrations of estradiol, progesterone and LH at lowest point. FSH ↑ 2 days before bleeding starts and helps in maturation of another ovarian follicle. Due to FSH granulosa cells surrounding oocyte begin secreting estradiol. As estradiol ↑ there is negative feedback (↓) on FSH and positive feedback (↑) on LH
Marks end of follicular phase. By day 11 to 13 of Menstrual Cycle an LH surge occurs resulting in ovulation w/in 30-36 hours. The LH surge causes the expulsion of oocyte from follicle and follicle become the corpus luteum which secretes progesterone until end of cycle. As LH surges FSH rises. Prostaglandins in follicle essential to release of oocyte. “Mittelschmerz” = twinge some women feel at time of ovulation.
marked by change in sex steroid hormone secretion from estradiol to progesterone. Progesterone secretion ↑ 24 hours before ovulation and peaks 3-4 days after ovulation. If fertilization does not occur progesterone ↓. Corpus luteum has life span of 13-14 days unless oocyte fertilized then lasts 6-7 weeks due to ↑ hCG
Menses, Proliverative, and Secretory
destruction of functional zone of endometrium caused by constriction of arteries, integrity of endometrium epithelium restored. Concomitant enlargement of primary and secondary follicles in ovary. Developing follicles secrete estrogens that sustain and stimulate proliferation of tissue. endometrial glands enlarge, accelerate secretion stimulating the growth and maintenance of functional endometrial zone. Occurs under the combined stimulatory effects of progestins and estrogens from the corpus luteum. The phase begins at the time of ovulation and persists as long as corpus luteum remains in tact.
summary of management of AUB
- directed toward the underlying etiology.
- Once structural abnormalities have been excluded, the management of anovulatory bleeding is aimed at controlling bleeding and preventing recurrence.
- Involves high-dose estrogen to promote rapid endometrial growth, clotting, and healing of denuded epithelial surfaces.
- Estrogen administration is followed by progesterone to prevent subsequent bleeding.
- Hysterectomy is reserved for patients whose bleeding does not respond to the previous measures or whose frustration with persistent bleeding necessitates definitive treatment