PALM COEIN theory for atyoical uterine bleeding
P- polyps
A-Adenonyosis
L- leiomyoma
M- Malignancy (cervix, endo )
Endometrial hyperplasia
( These are structural)
C- coagulopathy
O- Ovulatory dysfunction
E- endometrial causes
I- iatrogenic(IUCD, OCP)
N- not otherwise classified
(These are non structural )
MC cause of puberty menorrhgia
Anovulation>coagulopathy
Clinical features of endometrial etiology
Pathogenesis of endometrial etiology
Causes of Anovulatory AUB
Puberty
Perimenopausal females
Obese
PCOS
Androgen excess(foliiculotoxic)
Hypothyroidism
Hyperprolactemia
Cause of lacatational amenorrhea
Increase in prolactin
(- feedback on GNRH)
What can be a common cause of intermenstrual bleeding
Polyp
Instrument used for endometrial biopsy in India
Karman’s cannula
What history is taken in AUB
Examination done in AUB
Investigations done in AUB
Investigation algorithm in AUB in reproductive age female
Investigatory algorithm in perimenopausal age in AUB
Step 1 is UPT(urine pregnancy test)
Then
TVS + endometrial biopsy irrespective of USG
Age parameter of menopausal and perimenopausal females
Investigatory algorithm in post menopausal females in AUB
Drugs used in management of AUB
Tranexamic acid
OCP
Progestrone
What are actions of OCP
Stabilize endometrium which decreases bleeding
Negative feedback on LH and FSH(anovulation)
How are OCP given in AUB
DOC for regularizing cycle
What are indications of OCPs in various bleeding/endometrial thickness
Role of progestrone in AUB
Supports endometrium
If given continuously causes endometrial atrophy
Blood loss decreased
Amemorrhea
Protect endometrium against proliferative effects of E
How is progestrone supplementation given in AUB
Continuously for 3-6 mnths without break
(Endometrial atrophy)
How is progestrone given in Anovulatory DUB
Cyclical
D14 to D25
What is mirenai
IUCD progesterone
Causes endometrial atrophy
When is mirena given
Minimum days for which mirena used to have a protective effect against endometrial proliferation
12days/month
Indications of blood transfusion in AUB
What are surgical management of AUB
What is done in
Which surgery is not done in endometrial hyperplasia
Endometrial ablation
What is endometrial ablation
Last changed2 months ago
