29 Jul Abnormal Uterine Bleeding Dysfunctional Uterine Bleeding

• Abnormal uterine bleeding (AUB): Dysfunctional uterine bleeding.
• Irregularity of the vaginal bleeding pattern in a woman between the ages of 10-50 years of age. Most
commonly seen in teenagers not yet developed a regulatory ovulatory pattern and in older women approaching
menopause: anovulatory bleeding.
• Women who are excessively overweight, or with polycystic ovarian syndrome: more predisposed.
• A possible cause: clinical evidence of hyperthyroidism or hypothyroidism, galactorrhea (elevated prolactin
levels).
• Presence of bruising and heavy bleeding with wounds: bleeding disorder as an underlying cause for the
vaginal bleeding.
• Absence of any identifiable pelvic condition, pregnancy-related bleeding, or other medical condition.
• Bleeding Variable: may be frequent or infrequent, heavy or light, or prolonged or brief.
• The extremes of age are when this type of bleeding is likely to happen. It. Women who are
• One classic finding: typical premenstrual symptoms of cramping, breast tenderness, bloating, and back pain
are absent with this type of bleeding.
• Pelvic examination: universally normal with no evidence of fibroids, ovarian abnormalities, uterine
enlargement, or adnexal masses.
• Cycles are anovulatory: no progesterone because of no corpus luteum.
• Estrogen level remains high: endometrium thickens more: proliferative tissue that bleeds according to day-
to-day changes in estrogen levels: bleeding occurring when the estrogen level drops.
• Menopausal age: wider fluctuations in estrogen levels. Ovarian follicles secrete less estradiol: shedding
of the endometrial lining when the estrogen level is not high enough to support the proliferating
endometrial lining.
• In adolescents, failure to have a normal luteinizing hormone (LH) surge in response to elevated estrogen
levels midcycle: No ovulation and no progesterone-secreting corpus luteum. Estrogen level is elevated, and
the progesterone level is low: friable and proliferative endometrium: breakthrough and bleed without a
predictable pattern.
• Surgical intervention with a dilatation and curettage: if medical treatment fails.
• Endometrial ablation should not be considered a first-line treatment.
• First line treatment: progesterone to turn the proliferative endometrium into secretory endometrium: won’t
slough off and bleed. Ex: progestin-containing intrauterine device and birth control pills containing
progestins.
• First-line treatment: teen patients: low-dose ethinyl estradiol and progestin birth control pill. High
dose estrogen: flow extremely heavy.
• Hysterectomy: second-line treatment: women who no longer wish to have any pregnancies and who fail
oral/medical treatment.
• An endometrial ablation procedure: second-line treatment in older women.
• Biopsy to make sure there isn’t endometrial atypia should be performed before an ablation procedure or
hysterectomy.
• About 1-2 percent with prolonged unopposed estrogen: endometrial atypia: later endometrial carcinoma.
• Chronic iron loss and iron-deficiency anemia: in teens make: vulnerable to having secondary iron-deficiency
anemia.
• About 20 percent of teens have an underlying bleeding disorder: not diagnosed in childhood.