1. ‫الطالب‬ ‫أعداد‬
:
‫زهير‬ ‫محمد‬
‫عجاوي‬
‫حسن‬ ‫فاطمة‬
‫قنبر‬
‫المشرف‬ ‫األستاذ‬
:
‫م‬
.
‫م‬
.
‫عباس‬ ‫فاضل‬ ‫أمال‬
Dysfunctional Uterine
& Vaginal bleeding

2. INTRODUCTION
Dysfunctional Uterine Bleeding
• Abnormal uterine bleeding is the umbrella term used to
describe any deviation from normal menstruation or
from a normal menstrual cycle pattern.
• The key characteristics are regularity, frequency,
heaviness of flow, and duration of flow, but each of
these may exhibit considerable variability.

3. Cont….
• Dysfunctional uterine bleeding (DUB) : is
a disorder that occurs most frequently in
women at the beginning and end of their
reproductive years.
• irregular, abnormal bleeding that occurs
with no identifiable anatomic pathology, it
affects up to 50% of woman.
• It is frequently associated with anovulatory
cycles, common in first year after menarche
and later when women approach
menopause.

4. Pathophysiology
• it is related to a hormone disturbance, With
anovulation, estrogen levels rise as usual in
the early phase of the menstrual cycle.
• In the absence of ovulation, a corpus
luteum never forms and progesterone is
not produced.
• The endometrium moves into a
hyperproliferative state, ultimately
outgrowing its estrogen supply.

5. Cont….
• This leads to irregular sloughing of the
endometrium and excessive bleeding, it
may cases sever to moderate anemai.
• DUB is similar to several other types of
uterine bleeding
 Some terms in the next page that differs
from DUB (Dysfunctional Uterine Bleeding).

6. Cont….
• Important terms :
1- Menorrhagia : long, heavy periods.
2- Oligomenorrhea :bleeding more than
35 days.
3- Metrorrhagia : (bleeding between periods).
4- Menometrorrhagia : (bleeding occurs at
irregular intervals with heavy flow lasting
more than 7 days).
5- Polymenorrhea : (too frequent periods).

7. Etiology
Adenomyosis Pregnancy
Hormonal imbalance Fibroid tumors
Endometrial polyps or cancer Endometriosis
Intrauterine systems (IUS) Hypothyroidism
Steroid therapy Morbid obesity
Polycystic ovary syndrome Blood dyscrasias/clotting
disorder.

8. Commonly Sign and symptoms
Obesity , diabetes infertility
mood swings hot flashes
vaginal tenderness acne
variable menstrual flow ranging from scanty to profuse
vaginal bleeding between periods, irregular menstrual
cycles (usually less than 28 days between cycles)
Signs of polycystic ovary syndrome might be present

9. Nursing Assessment
history should be taken to differentiate between DUB
and other conditions that might cause vaginal
bleeding.
1-pregnancy and pregnancy-related conditions:
 abruption placentae, ectopic, pregnancy, abortion,
placenta Previa
In cases of medical emergencies, a comprehensive
assessment of the cause of bleeding must be made
so that we can take appropriate measures through
medical advice, and in the case of severe bleeding,
a blood transfusion may be given.

10. Cont….
2-Regular conditions such as:
Cushing's disease, blood dyscrasias, liver disease,
kidney disease, thyroid disease
3-Reproductive system diseases such as infections,
tumors or trauma
Evaluation of clinical manifestations of DUB
Measurement of orthostatic blood pressure and
orthostatic pulse. A decrease in pressure or pulse
rate may occur with anemia.

11. Cont….
After assessing the client's condition, you must...
1-Educate the woman about normal menstrual cycles
and the possible reasons for her abnormal pattern.
2-Inform the woman about treatment options.
3-Do not simply encourage the woman to “live with
it.”
4-support and encourge woman to follow up if there
is any sign of irrgular period or any abonormal or
continous bleeding.

12. Diagnosis tests:
1-CBC to detect anemia.
2-Prothrombin time to detect blood dyscrasias.
3-Pregnancy test to rule out a spontaneous abortion
or ectopic pregnancy.
4-Thyroid-stimulating hormone level to screen for
hypothyroidism.
5-Transvaginal ultrasound to measure endometrium.
6-Pelvic ultrasound to view any structural
abnormalities.
7-Endometrial biopsy to check for
intrauterine pathology.
8-D&C for diagnostic evaluation.

13. Therapeutic Management
Treatment of DUB depends on the cause of the
bleeding and the age of the client.
When known, the underlying cause of the disorder is
treated.
Otherwise, the goal of treatment is to normalize the
bleeding, correct the anemia, prevent or diagnose
early cancer, and restore quality of life.

14. Drug Treatment
1-Estrogens: cause vasospasm of the uterine arteries
to decrease bleeding.
2-Progestins: used to stabilize an estrogen-primed
endometrium.
3-Oral contraceptives: regulate the cycle and
suppress the endometrium.
4-NSAIDs: inhibit prostaglandins in ovulatory
menstrual cycles
5-Progesterone-releasing IUSs: suppress endometrial
growth .
6-Androgens: create a high-androgen/low-estrogen
environment that inhibits endometrial growth.
7-Iron : replenish iron stores lost during heavy
Bleeding.

15. Surgery Treatment
surgical intervention might include:
1_ dilation and curettage (D&C).
2_ endometrial ablation.
3_ hysterectomy (Endometrial ablation is an
alternative to hysterectomy).
Techniques used for ablation include:
laser, electro surgery excision procedure, freezing,
heated fluid infusion thermal balloon ablation.

16. Cont….
Most women will have reduced menstrual flow
following endometrial ablation, and up to half will stop
having periods.
Hysterectomy should be considered a last resort for
DUB when blood loss impedes health.

17. Endometrial Ablation
hysterectomy D&C

18. Refernes
Susan,R.( 2013
&,nrobwen ,ytinretam fo laitnesse .)
sretloW.noitide driht. gnisruN htlaeh s'nemow
anihC.reulK.
 Davidson, M & London, M & Ladewig, P .(2012)
OLDS’ Maternal-Newborn Nursing & Women’s Health
Across the lifespan.9th Edition.