Dysfunctional Uterine Bleeding

Abstract

Dysfunctional uterine bleeding (DUB) is a frequent gynecological problem during adolescence and the most frequent cause of urgent admission to the hospital over this period of life. In about 95% of cases it is caused by the late maturation of the hypothalamic-pituitary-ovarian axis (HPO), leading to anovulatory cycles. These adolescents lack the E2 positive feedback on LH. Thus, the continuous production of estrogen with endometrial stimulation is the basic cause of dysfunctional uterine bleeding. The initial step in the evaluation of DUB includes detailed clinical history, followed by complete physical examination. Laboratory tests should include coagulation profile, complete blood count with platelet evaluation, and sometimes a serum pregnancy test. The treatment of DUB is related to the severity of symptomatology with the objective of stopping bleeding and preventing recurrences. Modern hormonal and other medical therapies enable physicians to treat DUB effectively, regardless of the cause. Surgical treatment, such as dilatation and curettage, is rarely indicated in the adolescent patient. The importance of continued follow-up in DUB cases should be underlined, until stabilization of ovulatory menstrual cycles.

Diagnóstico y tratamiento del sangrado menstrual excesivo en la adolescencia (actualizado en febrero del 2013)

“…Las 2 principales líneas de tratamiento médico no hormonal para el SMA asociado a ciclos ovulatorios, cuya efectividad ha sido demostrada en ensayos aleatorizados 1,15,16 , son los antiinflamatorios no esteroideos (AINE) y los antifibrinolíticos.…”

Contraception in Adolescence

“…In some European countries it is used by 50% of women and is considered an appropriate contraceptive method for adolescents. Apart from the protection against an unplanned pregnancy, other advantages of the use of the pill during adolescence are the decrease of menorrhagia 24 (which is very important when anemia coexists), reduction of benign breast disease, lowering the severity of endometriosis, suppression of ovarian functional cysts, decrease of ovarian and endometrial cancer, 25 and reduction of the incidence of ectopic pregnancy. Other important positive effects of hormonal contraception are the relief of dysmenorrhea, 26 the regulation of menstruation, and the inhibition of rheumatoid arthritis progression from mild to severe.…”

Dysfunctional Uterine Bleeding During Adolescence

“…Tranexamic acid, a synthetic derivative of the amino acid lysine, exerts an antifibrinolytic effect through reversible blockade on plasminogen. Other therapies, such as the use of high doses of progestogens given peros or parenterally, gonadotropin-releasing hormone (Gn-RH) agonists, with add-back therapy, as well as levonorgestrel-impregnated intrauterine devices, are rarely used for the management of DUB during adolescence [6,17,18].…”

“…Those patients with ovulatory DUB have an increased bioavailability of arachidonic acid that alters the PG ratios [3,6].…”

“…The use of nonsteroid anti-inflammatory medications may reduce the bleeding through the inhibition of prostaglandin synthase [6,16]. Severe cases need hospitalization.…”