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Dysfunctional uterine bleeding

Definition
  • Iirregular uterine bleeding that occurs in the absence of pathology or medical illness
  • Diagnosis of exclusion
Risk Factors

Differential diagnosis
Epidemiology

Aetiology
  • Disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining
  • Usually is associated with anovulatory menstrual cycles but also can present in patients with oligo-ovulation
  • Possibilities:
    • Estrogen breakthrough bleeding
    • Estrogen withdrawal bleeding
    • Oral contraceptives, progestin-only preparations, or postmenopausal steroid replacement therapy
    • Failure to mount an ovulatory luteinizing hormone (LH) surge in response to rising estradiol levels (adolescents)

Clinical features
  • Uunpredictable or episodic heavy or light bleeding despite a normal pelvic examination
    • Without moliminal symptoms
  • Nothing else!
Pathophysiology
  • Constant, noncycling estrogen levels stimulate endometrial growth
  • Proliferation without periodic shedding causes the endometrium to outgrow its blood supply
  • Tissue breaks down and sloughs from the uterus
  • Subsequent healing of the endometrium is irregular and dyssynchronous
Investigations

Management

a) conservative

b) medical

c) surgical

Prognosis
  • Single episodes of anovulatory bleeding generally carry a good prognosis

  • Increased risk for iron deficiency anemia
  • Flow can be copious enough to require hospitalization for fluid management, transfusion, or intravenous hormone therapy
  • Chronic unopposed estrogenic stimulation of the endometrial lining increases the risk of both endometrial hyperplasia and endometrial carcinoma
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