Terminology and etiology classification M Tohidi 2 Physiology

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Terminology and etiology classification

Terminology and etiology classification

M. Tohidi 2

M. Tohidi 2

Physiology and epidemiology of Menstrual Cycle Dr. Samira Behboudi Research Assistant Professor Reproductive Endocrinology

Physiology and epidemiology of Menstrual Cycle Dr. Samira Behboudi Research Assistant Professor Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Winter, 2018

overview 1. Physiology of the normal menstrual cycle 2. Terminology of Abnormal uterine bleeding

overview 1. Physiology of the normal menstrual cycle 2. Terminology of Abnormal uterine bleeding 3. Epidemiology of Abnormal uterine bleeding

Learning Objectives 1. Understand the physiology and biology aspects of normal menstruation 2. Explain

Learning Objectives 1. Understand the physiology and biology aspects of normal menstruation 2. Explain the different definition of abnormal uterine bleeding 3. Understand the epidemiology of Abnormal uterine bleeding, worldwide and Iranian prevalence

Importance

Importance

INTRODUCTION The normal menstrual cycle is a tightly coordinated cycle of stimulatory and inhibitory

INTRODUCTION The normal menstrual cycle is a tightly coordinated cycle of stimulatory and inhibitory effects that results in the release of a single mature oocyte from a pool of hundreds of thousands of primordial oocytes. A variety of factors contribute to the regulation of this process, including hormones and paracrine and autocrine factors that are still being identified.

PHASES AND DURATION OF THE MENSTRUAL CYCLE

PHASES AND DURATION OF THE MENSTRUAL CYCLE

Ovarian cycle

Ovarian cycle

Uterine cycle

Uterine cycle

during menstruation: 2 -4 mm early proliferative phase (day 6 -14): 5 -7 mm

during menstruation: 2 -4 mm early proliferative phase (day 6 -14): 5 -7 mm late proliferative / preovulatory phase: up to 11 mm secretory phase: 7 -16 mm

Hormonal changes

Hormonal changes

Abnormal uterine bleeding (AUB) wide range of poorly defined terminology used to describe AUB

Abnormal uterine bleeding (AUB) wide range of poorly defined terminology used to describe AUB symptoms and etiologies! Difficulties in interpreting the scientific and clinical literature

Terminology and etiology classification l l Concerns about the confusing nature of AUB terminology

Terminology and etiology classification l l Concerns about the confusing nature of AUB terminology Formation of international workshop in Washington, DC in 2005 – l l workshop addressed the most obvious and confusing issues regarding AUB terminology, definitions, and classifications International Federation of Gynecology and Obstetrics via a Menstrual Disorders Working Group (FIGO MDWG) standing committee of FIGO, the FIGO Menstrual Disorders Committee (MDC) Since 2012

e b d l u o h ts a h t s e i

e b d l u o h ts a h t s e i g lo o in T m r e s i d d r ca

DEFINITIONS OF UTERINE BLEEDING l Evidence-based approach to develop parameters of normal menstrual bleeding

DEFINITIONS OF UTERINE BLEEDING l Evidence-based approach to develop parameters of normal menstrual bleeding based upon published population data and using medians and confidence intervals. Anything outside these limits was regarded as AUB.

Normal menstruation is defined as: l l Frequency – 24 to 38 days. Regularity

Normal menstruation is defined as: l l Frequency – 24 to 38 days. Regularity – Variation ≤ 7 to 9 days. No more than seven to nine days difference between the shortest to longest cycles; cycle length is the number of days from the first day of one menstrual cycle to the first day of the next. For some young girls who have occasional or frequent long cycles, typically, but not always, the cycle length evolves spontaneously to fit norms. For others, such an evolution may not occur. Duration – ≤ 8 days. Up to eight days; duration is the number of days of bleeding in a single menstrual period. There are no specific clinical entities that are associated with reduced duration below four days with the exception of amenorrhea. Volume – Clinical definition is subjective and defined as a volume that does not interfere with a woman's physical, social, emotional, and/or material quality of life. Research definition is ≤ 80 m. L vaginal "blood" loss per cycle.

Normal menstruation parameters

Normal menstruation parameters

Abnormal uterine bleeding l Acute abnormal uterine bleeding : An episode of uterine bleeding

Abnormal uterine bleeding l Acute abnormal uterine bleeding : An episode of uterine bleeding in a woman of reproductive age, who is not pregnant, that is of sufficient quantity to require immediate intervention to prevent further blood loss l Chronic abnormal uterine bleeding Bleeding from the uterine body (or corpus), that is abnormal in frequency, regularity, duration, and/or volume, and has been present for at least the majority of the past six months

Normal and abnormal uterine bleeding patterns in reproductive-age women

Normal and abnormal uterine bleeding patterns in reproductive-age women

 Abnormal uterine bleeding prevalence l Abnormal uterine bleeding (AUB) is common! l The

Abnormal uterine bleeding prevalence l Abnormal uterine bleeding (AUB) is common! l The importance of AUB relates to its major impact on women’s quality of life, sexual life, productivity, and utilization of healthcare services

l Overall, 4506 women responded, of whom 1225 (27. 2%) had experienced two or

l Overall, 4506 women responded, of whom 1225 (27. 2%) had experienced two or more predefined HMB symptoms within the previous year. Of these women, 564 (46. 0%) had never consulted a physician. – – Unusual levels of tiredness, fatigue, or exhaustion affecting daily life Breathlessness or shortness of breath affecting physical activity

Iran

Iran

AUB Frequency Regularity Duration Frequent: <24 days 10. 6 % Irregular: > 7 -9

AUB Frequency Regularity Duration Frequent: <24 days 10. 6 % Irregular: > 7 -9 days 8. 4% Prolonged: > 8 days 10. 4% Infrequent: >38 days 13. 2% Volume Light: < 5 cc 0. 8% Heavy: > 80 cc 15. 2% Absent 2. 2 % Intermenstrual bleeding: 4. 3%

l This was a population-based study conducted among women (n=941) aged 18 -45 years

l This was a population-based study conducted among women (n=941) aged 18 -45 years old. The participants were selected from four provinces using quota stratified cluster sampling. l Almost one out of every four Iranian women in the reproductive age suffered from at least one menstrual disorder. l The most common menstrual disorders in Iranian women was HMB (20. 3%).

Take home message… l l l The basic biology of the menstrual cycle is

Take home message… l l l The basic biology of the menstrual cycle is a complex, coordinated sequence of events involving the hypothalamus, anterior pituitary, ovary, and endometrium Menstruation should be considered as vital sign Abnormal uterine bleeding (AUB) is one of the common disorders among The most common AUB are HMB and infrequent UB. Previous terminologies should be discard and new well defined terminology must used worldwide.