Dysfunctional uterine bleeding

Refers to an abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable structural or organic disease.

Usually due to hormonal disturbances: reduced levels of progesterone cause menorrhagia and increased levels of tissue plasminogen activator (TPA) that leads to more fibrinolysis.

Diagnosis must be made by exclusion, since organic pathology must first be ruled out.

Can be classified as ovulatory or anovulatory, depending on whether ovulation is occurring or not.

It is usually a menstrual disorder, although abnormal bleeding from the uterus is possible outside of menstruation.

The term abnormal uterine bleeding is pref2242ed in today’s medicine.

10% of cases of abnormal uterine bleeding occur in women who are ovulating, but progesterone secretion is prolonged because estrogen levels are low.

Prolonged progesterone secretion causes irregular shedding of the uterine lining and break-through bleeding.

Mid-cycle bleeding may indicate a transient estrogen decline, while late-cycle bleeding may indicate progesterone deficiency.

About 90% of dysfunctional uterine bleeding events occur when ovulation is not occurring, and is ref2242ed to as anovulatory dysfunctional uterine bleeding.

Anovulatory menstrual cycles are common at the extremes of reproductive age, such as early puberty and perimenopause.

In dysfunctional uterine bleeding such cases, women do not properly develop and release a mature egg.

When this happens, the corpus luteum, a mound of tissue that produces progesterone, does not form.

As a result, estrogen is produced continuously, causing an overgrowth of the uterus lining.

In such cases the period is delayed and when it occurs menstruation can be very heavy and prolonged.

Sometimes anovulatory dysfunctional uterine bleeding is due to a delay in the full maturation of the reproductive system in teenagers.

The etiology can be psychological stress, obesity, anorexia, or a rapid change in weight, exercise, endocrinopathy, neoplasm, drugs, or it may be otherwise idiopathic.

Assessment of anovulatory DUB includes: medical history and physical examination, laboratory assessment of hemoglobin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, T4, thyroid stimulating hormone (TSH), pregnancy (by βhCG), androgen profile and may include a pelvic ultrasound and endometrial sampling.,

Agent of choice is progesterone.

Management consists of reassurance, though mid-cycle estrogen and late-cycle progestin can be used for mid- and late-cycle bleeding respectively.

Non-specific hormonal therapy such as combined high-dose estrogen and high-dose progestin can be given.

The goal of therapy should be to stop bleeding, replace lost iron to avoid anemia, and prevent future bleeding.

A hysterectomy may be performed in some cases.

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