Menstrual

Cycle
Physiology
Muhsin Anis - 30101507507
Menarche
▪ Menarche (onset of
first menses) is a
late event in
puberty (preceded
by growth spurt,
breast development,
and pubic hair
growth)

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Uterine Cycle
▪ Series of cyclic changes that the uterine endometrium goes
through each month in response to ovarian hormones in the
blood
▪ Days 1-5: Menstrual phase – uterus sheds all but the deepest part
of the endometrium
▪ Days 6-14: Proliferative (preovulatory) phase – endometrium
rebuilds itself
▪ Days 15-28: Secretory (postovulatory) phase – endometrium
prepares for implantation of the embryo

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 Menses
Kinking and spasm spiral arteries
Progesteron of spiral arteries, constrict one last
↓ necrosis of time then suddenly
endometrial cells relax
Fertilization

Endometrium Sudden rush of

Digestion of
deprived from blood  weaken
functional
hormonal capillary bed 
layer
support, sloughing of
release of functional layer
uterine PG2

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Abnormal
Uterine
Bleeding
Definitions
AUB has been used to standardize nomenclature
▪ Menorrhagia: Menses >7 days or >80mL
▪ Metrorrhagia: Intermenstrual bleeding
▪ Hypomenorrhea: Diminished flow or shortening of
menses
▪ Oligomenorhhea: Cycles with longer intervals (>35 days)
Other terms may include postcoital bleeding, withdrawal
bleeding, and breakthrough bleeding
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Classification

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History Taking
▪ How much?
▪ How long?
▪ Regular/irregular intervals?
▪ Personal/family history of bleeding?

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Physical
Examination
▪ Signs of acute blood loss  General Status
(hypovolemia, anemia)
▪ Pelvic examination  to make sure bleeding is not of
other source within the genitourinary system
□ Bimanual
□ Speculum examination

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Laboratory Testing and
Imaging

▪ Lab tests 
▪ USG
▪ Endometrial sampling
□ 1st line for AUB ≥
45years
□ AUB < 45 years with
failed therapy
(persistent AUB)
□ Can be done by
curettage or biopsy
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Treatment
▪ Depends on clinical stability, suspected etiology,
desire for future fertility, and underlying medical
problem
▪ Main objective of acute AUB treatment:
□ Control current episode of heavy bleeding
□ Reduce menstrual blood loss in subsequent
cycles
▪ Medical therapy is most preferred

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Medical Therapy
▪ 1st line  hormonal management
▪ Treatment include IV conjugated equine estrogen
(CEE), combined Oral Contraceptives (OCs), oral
progestins
▪ An RCT of 34 women with AUB given IV CEE showed
72% success rates (bleeding stopped) compared
with placebo (38%)

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Thanks
!

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