| ID | 312 |
|---|---|
| Name | THRESHOLD BLEEDING |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation: Endometrium curettage show poorly developed proliferative phase & thin endometrium. Investigations far diagnosis of DUB: 1. Blood for- Hb%,TC, DC, ESR, BT, CT. 2. Vaginal, cervical and endometrial cytology and for detection of oestrogen and progesterone level, 3. Histopathology of the curettage from endome-trium to diagnose incomplete abortion, polyp, malignancy and endometrial hormone response. 4. Laparoscopy and culdoscopy- for diagnosing adenomyosis, pelvic adhesion or inflammation. 5. Hysterosulphingography. 6. Angiography and venography, if there is H/O thrombosis. |
| Management | |
| Introduction | |
| History | |
| Etiology | |
| Clinical Features | Clinical feature: 1. This is another anovular type of dysfunctional uterine bleeding. 2. Prolong painless bleeding occurs like metropathia hemorrhagica due to underactivity of ovarian function. |
| Preventions | |
| Treatment | Treatment of abnormal & excessive uterine bleeding: A. If bleeding is slight- 1. Reassurance. 2. Rest in bed, good diet, sedatives, and daily cold bath. 3. Observation for 3-4 months. It may spontaneously recover in most of the cases. B. If bleeding is severe- 1. Reassurance. 2. Hospitalization. 3. Rest in bed, sedation, good diet & correction of blood loss, anemia, hypovolemia. 4. For Menorrhagia: antifibrinolytic agent- Trasylol l-3gm 2-4 times daily orally. Or, Epsilon amino caproic acid (EACA) 3gm 4-6 times daily for 3-6 days in each period. 5. Hormone thearapy- i. For metropathia hemorrhagica and there shold bleeding-Progesterone alone for girls and youngs. 2 tab stat & t.d.s for 10 days. (1 tab=5mg.) ii. Oestrogen-progesterone combination-2 tabs, stat and t.d.s. for 10 days. If withdrawal bleeding after that combined pill than to be continued for 3-6 month. iii. Stilboesterol Img t.d.s. for 21 days. Progesterone 5-10mg is added for last 7 of these. iv. Synthetic progesterone (norethisterone 5-10mg daily) may be given from the 15-25th day in woman suffering from menorrhagia and epimenorrhoea. C. Surgical treatment- 1. For young patient when medical treatment fails D&C to be done and hormone therapy to be repeated. D&C should be avoided in young patients for the risk of infection or tubal block. Very rarely D&C may be needed. 2. For older patients age more than 40 years and family complete, then if not controlled by D&C- hysterectomy should be done. Cryosurgery or resection of cystic ovary may be needed for specific cases. Radiotherapy may be helpful when hysterectomy is contraindicated. |
| Complications | |
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