Chapter 109 Dysfunctional Uterine Bleeding
INTRODUCTION
Description: Dysfunctional uterine bleeding is irregular or intermenstrual bleeding with no clinically identifiable underlying cause.
Predominant Age: Reproductive, greatest in adolescents and patients experiencing climacteric changes.
ETIOLOGY AND PATHOGENESIS
Causes: Anovulatory patients—chemotherapy, chronic illness, climacteric changes, endometrial carcinoma, endometrial hyperplasia, hormonal contraception (oral, injectable, intrauterine), iatrogenic (anticoagulation, hormone replacement), idiopathic, medications (anticholinergic agents, monamine oxidase inhibitors, morphine, phenothiazines, reserpine), nutritional disruption (anorexia, bulimia, excess physical activity), obesity, pituitary–hypothalamic–ovarian axis immaturity, pituitary tumor, polycystic ovary syndrome, stress, systemic disease (hepatic, renal, thyroid). Ovulatory patients—anatomic lesions (adenomyosis, cervical neoplasia, cervical polyps, endometrial carcinoma, endometrial polyps, leiomyomata, sarcoma), bleeding at ovulation, coagulopathies (natural or iatrogenic), endometritis, fallopian tube disease (infection, tumor), foreign body (IUCD, pessary, tampon), idiopathic, ingested substances (estrogens, ginseng), leukemia, luteal phase dysfunction, pelvic inflammatory disease (including tuberculosis), pregnancy related (abortion, ectopic, hydatidiform mole, retained products of conception), repeated trauma, systemic disease (hepatic, renal, thyroid).
