Dysfunctional Uterine Bleeding And Its Management Strategy

摘要

Dysfunctional uterine bleeding (DUB) is a diagnosis of exclusion. An adequate examination of the abdomen and the pelvis and uterine curettage, hysteroscopy or at least an endometrial biopsy is essential to exclude organic disease of the uterus. It occurs most frequently at the extremes of menstrual life, but it can develop at any intervening time. The objectives of treatment are to control the acute bleeding, avert future episodes, and prevent a serious long-term consequence of anovulation, endometrial cancer. The mainstay of treatment has been medical therapy although surgical intervention is required in some cases. If the bleeding is severe and / or recurrent or the medical treatment fails, re-evaluation is needed. Adolescent DUB is due to immaturity of the hypothalamus and pituitary and menstrual cycles may be anovulatory. In teenage girls organic disease is rare and DUB usually gets resolved spontaneously. That's why they are treated expectantly and curettage is often delayed. In the middle years of reproductive life (20-39yrs), benign organic disease is common, and curettage is usually performed to exclude complications of pregnancy and other disease. Conservative therapy is usually indicated, though hysterectomy may be indicated if bleeding is severe or recurrent and patient has completed her family. Perimenopausal DUB is due to the decreased number of ovarian follicles and their increased resistance to gonadotrophin stimulation, there is a possibility of malignancy. So, these women should always be investigated by curettage or hysteroscopy without delay. Although conservative therapy may be tried as a temporizing measure, hysterectomy is often indicated. Introduction Disturbances in the pattern of menstruation are a common clinical presentation. Dysfunctional uterine bleeding is defined as abnormal and excessive endometrial bleeding without structural pathology.1 It has also been defined as heavy and / or irregular menstruation in the absence of recognizable pelvic pathology, pregnancy or general bleeding disorders. 2 It commonly occurs at the extremes of reproductive life, when anovulatory DUB is common. During these periods, it is secondary to an estrogen withdrawal. It can have its origin in an endocrine imbalance or can occur in normal menstrual cycles (ovulatory DUB).The social and economic cost of DUB is considerable. About one third of the hysterectomies are carried out for menstrual disturbances alone.3 In this article, the clinical management of DUB is re-viewed. The current approach to the treatment of DUB will be discussed.Since the diagnosis of DUB rests on excluding the pathologic causes, it is important to know the differential diagnosis of DUB. Upto 40 % of women with DUB will eventually end up with some other diagnosis if intensively investigated.4 Psychiatric morbidity is also associated with DUB. Community studies have shown that women who score highly on psychiatric scores are more likely to complain of menstrual disturbances.5, 6 DUB includes any condition of abnormal uterine bleeding in the absence of pregnancy, neoplasm, infection or other intra uterine lesions. Such bleeding is most often the result of endocrinologic dysfunction that inhibits normal ovulation.