Metropathia haemorrhagic

Also known as cystic glandular hyperplasia or Schroeder's disease.
It is specialised from of DUB.
In the condition the endometrium is thick and one or the other ovary contains cystic follicle.
It is most prevalent in women over 40yr and max between 40 to 45 yrs.
It may prevalent in over below 20 yrs.
Parity is not related to its incidence.
Symptoms
Most common complaint is amenorrhoea followed by continuous vaginal bleeding last for many weeks.
Bleeding is always painless since it is anovulatory.
Typical menstrual history
Type-1 in 50% cases continue vaginal bleeding is preceded by amenorrhoea of about 8 to 10 weeks
Types-2 In some patient bleeding follow normal pattern and occurs at the time of expected
Type-3  bleeding may be preceded by menorrhagia.
Differential diagnosis
Ectopic he station
Abortion
Gestational trophoblastic disease
Fibroid uterus
Endometrial cancer
Thyroid abnormalities
PID , Endometriosis
Emdometrial TB
PCOS
Treatment
 General
Anti-fibrinolytic agent-Tranexa 500 mg twice or TDS
NSAIDS
Ethamsylate 250 to 500 mg TDS oral/IV
GnRH agonists
Hormonal Method
1)Progestins 
   Tab.Nonethisterone (NE) 20-30mg/day 
2)Cyclical therapy  
    OCP is given from 5th to 25 th day for 3 consecutive cycles
     In ovular bleeding where patients wants pregnancy or in cases of irregular shedding or ripening dydrogesterone 10 mg per day from 16th to 25th day.
    MPA 10 mg 5th to 25 th day or NE 5mg 5th day to 25 th day for consecutive cycles.
DMPA 150 mg IM every 3 months
Surgical Management
Hysterectomy....

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