Introduction
Dysfunctional uterine bleeding is the most common abnormality of a woman’s menstrual cycle. Ordinarily the first day of the period would be 28 days (26 to 30 range) apart. In more than 70% of cases there has not been an ovulation in the ovary (no egg release) in that cycle that causes a dysfunctional bleeding. More than 50 % happen in women that are older than 45 years, 20% in adolescents.
As there is a persistent ovarian follicle where estrogen is produced when ovulation does not occur, the lining of the uterus grows more than usual. This leads to a heavy menstrual period that might be late or irregular (on and off). Women with such conditions as polycystic ovary disease (PCOD) or endometriosis often have dysfunctional uterine bleeding.
Treatment
Treatment might be quite different depending on the age of the woman, the underlying disease process and the severity of bleeding. If the bleeding is mild to moderate the physician might decide to use the birth control pill for the bleeding. The effect often sets in within 12 to 24 hours. This will also regulate the periods.
Should this fail to stop the bleeding, a D&C (dilatation of the cervical canal and curretage of the uterus) is usually done. This method has the advantage that it stops the bleeding reliably and it provides the physician with lining material from the uterine cavity, which can be sent to the pathologist for analysis. The downside is the risks of the anesthetic, of uterine perforation and uterine infection as there is an internal wound in the uterus for a few days. If there is an anovulatory period (meaning no egg was released) and the woman would like to get pregnant, then clomiphene citrate (brand name: Clomid) can be given or else human chorionic gonadotropin. Usually these specialized treatments are given and supervised by a gynecologist/obstetrician. If obesity is present a dietary plan to reduce sugar and starch consumption will help to shed some weight and will normalize blood insulin levels. In cases of polycystic ovaries, where often there is also syndrome of insulin resistance present at the same time, treatment of insulin resistance will help balance the female hormones and thyroid dysfunction. Every case needs to be investigated by the specialist on its own merit.
References:
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 235.
2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby, Inc.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 245.
5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.
6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.
7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B. Saunders Company
8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B. Saunders Company
9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.
10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B. Saunders Company
11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.
12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B. Saunders Company
13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.
14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.
15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc.
16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams & Wilkins
17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC
18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.
19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.
20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.
21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.
22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.
23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.
24. Horner NK et al. J Am Diet Assoc Nov-2000; 100(11): 1368-1380.
25. Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. On page 253 and 254 he describes how progesterone can be used as a cream to treat fibroids.
