Dysfunctional uterine bleeding

Definition

• • Iirregular uterine bleeding that occurs in the absence of pathology or medical illness

  • Diagnosis of exclusion

Risk Factors

Differential diagnosis

• • Pregnancy

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