Dysfunctional uterine bleeding
Dysfunctional uterine bleeding is abnormal bleeding resulting from changes in the normal hormonal control of the menstruation.
- Dysfunctional uterine bleeding occurs most commonly at the beginning and end of reproductive years.
- 20% of the cases occur in adolescent girls and more than 50% occur in women older than 45.
- Dysfunctional uterine bleeding commonly results when the level of estrogen remains high.
- High levels of estrogen are not balanced by appropriate levels of progesterone and release of egg does not occur.
- As a result, the lining of the uterus thickens.
- This condition is called endometrial hyperplasia.
- The lining is then shed incompletely and irregularly, which causes bleeding.
- Bleeding is irregular, prolonged and sometimes heavy.
- This type of bleeding is common in women who have polycystic ovarian syndrome.
- Dysfunctional uterine bleeding is diagnosed when all other possible causes of vaginal bleeding have been excluded.
- The results of a blood test can help doctors estimate the extent of the blood loss.
- Tranvaginal sonography may be used to determine whether the uterine lining is thickened.
- If the risk of the cancer of the uterine lining is high, an endometrial biopsy is performed before drug treatment is stated.
- Women at risk include those who are 35 years or older, those who are substantially overweight and those who have polycystic ovarian syndrome, high blood pressure or diabetes.
- Treatment depends on woman’s age, how heavy the bleeding is whether the uterine lining is thickened and whether the woman wishes to become pregnant.
- When the uterine lining is thickened but its cells are normal, hormones may be used.
- Women who have heavy bleeding may be treated with oral contraceptives containing estrogen and progestin.
- When bleeding is very heavy, estrogen may be given intravenously until the bleeding stops.
- Sometimes progestin is given by mouth at the same time or started 2 or 3 days later.
- Bleeding usually stops in 12 to 24 hours.
- Low doses of oral contraceptives may be prescribed for at least 3 months.
- Treatment given with oral contraceptives or intravenous estrogen may be inappropriate for some women like postmenopausal women or women with significant risk factors for heart or blood vessel disease.
- These women may be given progestin alone by mouth for 10 to 14 days each month.
- For women, who wish to become pregnant, clomiphene may be given by mouth.
- If the uterine lining remains thickened or bleeding persists despite the treatment with hormones, dilation and curettage is usually needed.
- In this procedure, tissue from the uterine lining is removed by scraping.
- When the uterine lining is thickened and contains abnormal cells, particularly in women who are older than 35 years and women who don’t want to become pregnant, treatment begins with a high dose of progestin.
- If the cells continue to be abnormal after treatment, a hysterectomy is performed, because the abnormal cells may become cancerous.
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