n CME : Your SA Journal of CPD - Menstrual disturbances : main topic

Volume 22, Issue 2
  • ISSN : 0256-2170



The major cause of abnormal uterine bleeding is dysfunctional uterine bleeding (DUB). <br>In sexually active women presenting with menstrual aberrations, pregnancy complications must be excluded. <br>Simple explanation and reassurance should be given to adolescents with DUB regarding the functional and anatomical normality of the genital tract. <br>Breakthrough bleeding and spotting occur in 25% of women during the first 3 months of the oral contraceptive pill, but improves with ongoing use. <br>The progestogen-only pill should be taken at the same time every day as a variability of 2 - 3 hours can cause menstrual disturbances. <br>Endometrial cancer and hyperplasia are the two most important conditions that need to be excluded in perimenopausal women with abnormal uterine bleeding and a normal cervical smear. <br>Tranexamic acid and prostaglandin synthetase inhibitors reduce menstrual loss by 35 - 55%. <br>Hysteroscopy and biopsy is preferable to dilatation and curretage (D & C) as the latter is a blind procedure that samples less than 50% of the endometrium in 60% of patients and misses up to 10% of endometrial pathology and 15% of endometrial cancers.

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