Document Detail


Dysfunctional uterine bleeding in ovulatory women.
MedLine Citation:
PMID:  3880890     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Ovulatory dysfunctional uterine bleeding (DUB), a disease prevalent in the latter half of the reproductive years, is diagnosed when organic causes for bleeding have been excluded by clinical, laboratory, and surgical diagnostic means. Disordered prostaglandin metabolism within the endometrium explains most cases of DUB. Nonsteroidal antiinflammatory drugs, oral contraceptives, and oral progestin are effective medical alternatives for women who wish to retain their uterus or to avoid surgery. Hysterectomy is a rapid cure for DUB and is a therapy that is acceptable to many, if not most, women.
Dysfunctional uterine bleeding (DUB), menstrual bleeding not explained by organic pathology in the pelvis or systemic deseases that exacerbate bleeding, is suspected when a reproductive-aged woman has excessive menstrual flow. Ovulatory DUB is most common in parous women aged 30-45 years. Cycles are regular and predictable and menstrual flows are preceded by breas soreness, mood or energy changes, or pelvic discomfort. Hypochronic microcytic anemia may result from the amount, rapidity, and duration of bleeding. Current evidence supports the hypothesis that DUB is associated with an increased total amount of prostaglandin in the uterus. Prostacyclin appears to be a likely cause of menorrhagia because it is locally produced within the intima of vessels and is a powerful vasodilator and effective inhibitor of platelet aggregation. DUB diagnosis requires careful exclusion of organic pathology through a detailed history, complete physical examination, and a complete blood count. A beta-human chorionic gonadotrophin measurement to rule out obstetric accident, curettage, hysteroscopy, biopsy, or laparoscopic visualization may be appropriate under different conditions. Curettage, thyroid hormone administration, ergot alkaloids, vitamin and mineral preparations, and iron therapy do little to correct the basic problem. Aspirin should be avoided in the week before and on the days of flow since in analgesic doses it inhibits the platelet thromboxanes that promote platelet agggregation and local vasoconstriction. Bed rest or reduced physical activity on days of flow is also advisable. Nonsteroidal antiinflammatory drugs are effective in reducing blood loss in women with DUB. The durgs are prostaglandin synthetase inhibitors, but the biochemical modifications causing an improved bleeding pattern are not well understood. All such drugs are effective, but some women experience greater relief with 1 formulation than another. Medroxyprogesterone acetate, 10 mg dialy for 7 days before the onset of flow, reduces bleeding in some women although the mechanism of action is unclear. Oral contraceptives (OCs) containing progestins derived from 19-nortestosterone inhibit endometrial proliferation, so ther is little tissue to be shed and little local prostaglandin to stimulate bleeding. Nonsmoking women under 40 years old with DUB who desire reversible contraception are excellent candidates for OCs. Aminocaproic acid is very expensive and has annoying gastrointestinal side effects. but is cost-effective for women with chronic anemia or life threatening uterine hemorrhage who wish to avoid hysterectomy. Danazol is of little usefulness because of its expense and side effects. Hysterectomy is an acceptable therapeutic option for many women.
Authors:
R C Strickler
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Postgraduate medicine     Volume:  77     ISSN:  0032-5481     ISO Abbreviation:  Postgrad Med     Publication Date:  1985 Jan 
Date Detail:
Created Date:  1985-02-11     Completed Date:  1985-02-11     Revised Date:  2006-12-21    
Medline Journal Info:
Nlm Unique ID:  0401147     Medline TA:  Postgrad Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  235-7, 240-3, 246     Citation Subset:  AIM; IM; J    
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-Inflammatory Agents / therapeutic use
Contraceptives, Oral / therapeutic use
Diagnosis, Differential
Endometrium / metabolism
Epoprostenol / biosynthesis
Female
Humans
Hysterectomy
Menorrhagia* / diagnosis,  physiopathology,  therapy
Prostaglandin Antagonists / therapeutic use
Prostaglandins / biosynthesis
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Contraceptives, Oral; 0/Prostaglandin Antagonists; 0/Prostaglandins; 35121-78-9/Epoprostenol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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