Dysfunctional uterine bleeding (DUB) refers to abnormal endometrial bleeding without recognizable organic lesions. The prognosis varies with the cause. DUB is the indication for almost 25% of gynecologic surgical procedures.
DUB usually results from an imbalance in the hormonal-endometrial relationship, where persistent and unopposed stimulation of the endometrium by estrogen occurs. Disorders that cause sustained high estrogen levels are polycystic ovary syndrome, obesity, immaturity of the hypothalamic-pituitary-ovarian mechanism (in postpubertal teenagers), and anovulation (in women in their late 30s or early 40s).
In most cases of DUB, the endometrium shows no pathologic changes. However, in chronic unopposed estrogen stimulation (as from a hormone-producing ovarian tumor), the endometrium may show hyperplastic or malignant changes. DUB occurs in 20% of adolescents and in 40% of women older than age 40.
DUB usually occurs as metrorrhagia (episodes of vaginal bleeding between menses); it may also occur as hypermenorrhea (heavy or prolonged menses, longer than 8 days) or chronic polymenorrhea (menstrual cycle of less than 18 days). Such bleeding is unpredictable and can cause anemia.
Diagnostic studies must rule out other causes of excessive vaginal bleeding, such as organic, systemic, psychogenic, and endocrine causes, including certain cancers, polyps, incomplete abortion, pregnancy, and infection.
Hemoglobin levels and hematocrit determine the need for blood or iron replacement.
High-dose estrogen-progestogen combination therapy (hormonal contraceptives), the primary treatment, is designed to control endometrial growth and re-establish a normal cyclic pattern of menstruation. (The patient’s age and the cause of bleeding help determine the drug choice and dosage.) In patients older than age 35, endometrial biopsy is necessary before the start of estrogen therapy to rule out endometrial adenocarcinoma. Progestogen therapy is a necessary alternative in some women such as those susceptible to estrogen’s adverse effects (thrombophlebitis, for example).
If drug therapy is ineffective, D & C serves as a supplementary treatment, through removal of a large portion of the bleeding endometrium. Also, D & C can help determine the original cause of hormonal imbalance and can aid in planning further therapy. Regardless of the primary treatment, the patient may need iron replacement or transfusions of packed cells or whole blood, as indicated, because of anemia caused by recurrent bleeding.
❑ Explain the importance of adhering to the prescribed hormonal therapy. If D & C is ordered, explain this procedure and its purpose.
❑ Stress the need for regular checkups to assess the effectiveness of treatment.
Review other book chapters online related to Retroverted uterus:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
What do you think about the features of this website?
Take our user survey and have your say:
Next articles: Tools & Services:
Medical Articles:
Treatment
Special considerations
Book Source Details
More About Retroverted uterus
More Medical Textbooks Online about Retroverted uterus
Medical Books Excerpts
More About This Book:
Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
» Next page: Surveys relating to Retroverted uterus
Rate This Website
Medical Tools & Articles:
Forums & Message Boards
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2009 Health Grades Inc. All rights reserved.
