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1. Abnormal Uterine Bleeding Dr Atthulyaa Mangal S Final Year Postgraduate, GMKMCH, Salem

2. Mrs X, 45 yr old . R esiding at Omalur, Salem H ome maker Belonging to socio economic class III P4L4, Previous 4 Normal Vaginal Deliveries, Bilateral tubectomy done 20 years back, came with complaints of heavy menstrual bleeding - For past 8 months

3. History Of Presenting Illness Patient was apparently normal 8 months back , following which she complains of heavy menstrual bleeding. Regular cycles, with increased duration of flow, 10 to 15 days/30 days cycle Changes 6 pads/day, every 4 hours, associated with passage of clots . Associated with pain during menstruation - starting 2 days prior to menstruation and continuing during menstrual cycle. Radiating to low back and thigh; Spasmodic in nature; Gets relieved with analgesics No h/o intermenstrual bleeding/ post coital bleeding No h/o dyspareunia

4. No h/o vaginal discharge No h/o weight gain, cold intolerance, hair loss No h/o easy bruising/ epistaxis/ bleeding gums and delayed wound healing No h/o abdominal distension or any pressure symptoms No h/o fever, loss of weight and loss of appetite No h/o breathlessness or palpitations No h/o any drug/ hormonal pill intake/ IUCD usage

5. Menstrual History Attained menarche at 1 3yrs of age Previously she had regular cycles, 5/30 days cycle, Moderate flow, change d 3 pads/day, not a/w clots/ dysmenorrhoea LMP 07.07.2025 Her cycles have been abnormal for the past 8 months Regular cycles, with increased duration of flow, 10 to 15 days/30 days cycle Changes 6 pads/day, every 4 hours, associated with passage of clots and dysmenorrhoea

6. MARITAL HISTORY – Married since 27yrs OBSTETRIC HISTORY – P4L4 G1 - 26 years, Girl, Alive and healthy, Full Term Normal Vaginal delivery at local GH, Birth weight – unknown. Postpartum uneventful. G2 - 24 years, Girl, Alive and healthy, Full Term Normal Vaginal delivery at local GH, Birth weight – unknown. Postpartum uneventful. G3 - 22 years, Girl, Alive and healthy, Full Term Normal Vaginal delivery at local GH, Birth weight – unknown. Postpartum uneventful. G4 - 20 years, Boy, Alive and healthy, Full Term Normal Vaginal delivery at local GH, Birth weight – unknown. Postpartum uneventful. No h/o contraceptive usage between pregnancies Sterilisation done 20 yrs back

7. PAST HISTORY Not a k/c/o diabetes/ hypertension/ asthma/ thyroid disorders/ TB/ epilepsy and heart disease. No h/o surgeries in the past History of hospital admission at local GH for anemia 1 month back, transfused 3 PRBC for Hb of 6g/dL

8. PERSONAL HISTORY Mixed diet, Normal Bowel and bladder habits, Adequate sleep and appetite , No substance use. FAMILY HISTORY No h/o similar complaints in the family members. No h/o bleeding /coagulation disorders in the family members No h/o cancers in the family members.

9. General examination Patient well built and well nourished Ht 160 cm, Wt – 72 kg, BMI 28.1 On examination- Pallor + No cyanosis/ clubbing/ pedal edema / icterus or generalized lymphadenopathy Breast - No discharge and No mass felt on examination Thyroid - Not enlarged Spine - Normal clinically

10. VITALS BP - 120/80 mmhg PR - 84/min RR - 18/min

11. Systemic Examination CVS – S1,S2 heard, No murmurs RS – Normal vesicular breath sounds heard, No added sounds. CNS – No Focal Neurological Deficits

12. Per Abdomen Examination INSPECTION Umbilicus in normal position Abdomen symmetrical All quadrants moves equally with respiration No obvious mass/ swelling visible. Sub - umblical transverse scar 2 cm noted and healthy, puerperal sterilisation scar No dilated veins/ sinus/ visible pulsation

13. PALPATION Soft, Not tense/tender No organomegaly . PERCUSSION No fluid thrill / shifting dullness . Normal resonant bowel sounds percussed. AUSCULTATION Normal Bowel sounds heard

14. EXTERNAL GENITALIA appears normal PER SPECULUM EXAMINATION Cervix appears healthy No polyp or growth No abnormal discharge per vaginum BIMANUAL PELVIC EXAMINATION Cervix pointing downward, Uterus anteverted, Uterus 10-12 wks of gravid uterine size, Uniformly enlarged, Mobile, Tender + Fornices free and no forniceal tenderness / fullness. PER RECTAL EXAMINATION Rectal mucosa free. No nodularity felt.

15. SUMMARY A case of Mrs. X, 45 years of age, multiparous, sterilized lady, presents with complaints of heavy menstrual bleeding for 8 months whose previous cycles were regular with no history of preceding amenorrhea. On examination, pallor+, with vitals stable. Speculum examination reveals a healthy cervix and vagina. Bimanual examination reveals a uterus- 10-12 weeks of gravid uterine size, Uniformly enlarged, mobile, tender, with no adnexal mass palpable.

16. DIAGNOSIS 45 years of age, multiparous, sterilized, and peri-menopausal lady with AUB for further evaluation. The possible differentials include: AUB – A AUB – L AUB – O

17. THANK YOU