Dysfunctional bleeding

Question 1

What is abnormal uterine bleeding?

Answer 1

Abnormal uterine bleeding includes all forms of bleeding disturbances regardless of cause.

Question 2

What is dysfunctional uterine bleeding / idiopathic uterine bleeding?

Answer 2

A diagnosis of exclusion in the absence of organic disease.

Usually implies disturbance in the hormonal regulation of the endometrium or the local endometrial function.

Question 3

What is primary amenorrhea?

Answer 3

No menstruation has started at 16 years of age.

Question 4

What is secondary amenorrhea?

Answer 4

No menstruation for 6 months.

Question 5

What is oligomenorrhea?

Answer 5

Menstrual cycle lasting from 38 days and up to 6 months.

Question 6

What is the normal length of a menstrual cycle?

Answer 6

24-38 days.

Question 7

What is menorrhagia?

Answer 7

Heavy uterine bleeding / voluminous uterine bleeding.

Question 8

What is metrorrhagia?

Answer 8

Absence of a normal cyclic menstrual pattern.

Question 9

What is post-menopausal bleeding?

Answer 9

Bleeding minimum one year after last period (menopause).

Question 10

What is menometrorrhagia?

Answer 10

Voluminous uterine bleeding without a normal cyclic menstrual pattern.

Question 11

What types of causes can lead to abnormal uterine bleeding?

Answer 11

Ovarian failure (primary - ovary, secondary - pituitary, tertiary - hypothalamus).
Organic causes, such as tumors, infection, inflammation or pregnancy.
Systemic causes, such as thyroid, adrenal, renal, and coagulation disorders.
Side effects of medication.
Idiopathic / dysfunctional.

Question 12

What can results of total and partial ovarian failure be?

Answer 12

Total ovarian failure causes amenorrhea.
Partial ovarian failure cases oligomenorrhea or menometrorrhagia. (Variable production of hormones usually results in anovulation with irregular, long
and heavy periods or oligomenorrhea. Partial ovarian failure is a common problem during menarche and before menopause.)

Question 13

What is the most common type of ovarian failure? What are common causes of this kind of ovarian failure?

Answer 13

Tertiary ovarian failure is the most common type. Causes of this type of failure can be delayed puberty, anorexia, extensive sport/training or emotional.

Question 14

What are causes of secondary ovarian failure?

Answer 14

Often tumors in or at pituitary gland, such as prolactinomas. (Prolactin inhibits secretion of FSH and LH as it decreases release of GnRH.) Other causes includes Sheehan syndrome (which is necrosis of the pituitary gland post-partum).

Question 15

What are causes of primary ovarian failure?

Answer 15

Menopause.
Gonadal dysgenesia (46XX,45X0,46XY).
Resistant ovary syndrome – can be temporary.
Climacterium praecox – Menopause before 40 years.

Question 16

What are organic genital causes of abnormal uterine bleeding?

Answer 16

Erythroplakia
Asherman`s syndrome (acquired condition with scar tissue - adhesions - in the uterus.)
Congenital anomalies of uterus and /or vagina.
Polyps (and fibroids) in cervix/corpus uteri.
Myoma uteri.
Infections.
IUD.
Pregnancy/abortion (as well as ectopic pregnancy).
Tumors.

Question 17

What are common symptoms of Asherman’s syndrome?

Answer 17

Amenorrhea.
Dysmenorrhea.
Infertility.

Question 18

What are some congenital anomalies causing abnormal uterine bleeding?

Answer 18

Mullerian agenesis.
Androgen insensitivity with 46XY and female phenotype. (Complete and partial.)
Hymen imperforatum.

Question 19

What are some medications can cause abnormal uterine bleeding?

Answer 19

Gestagens.
Contraceptive pills.
Anticoagulants.
Medication that induce hyperprolactinemia.

Question 20

What are common causes of abnormal bleeding in teenagers?

Answer 20

Dysfunctional (idiopathic) bleeding.
Pregnancy.
infections.

Question 21

What are common causes of abnormal bleeding in women of 20-50 years?

Answer 21

Organic diseases more common.

Infections and pregnancy.

Question 22

What are common causes of abnormal bleeding in women over 50 years (postmenopausal)?

Answer 22

Cancer (increased risk).

Question 23

How is amenorrhea/oligomenorrhea treated?

Answer 23

Congenital anomalies are treated surgically.
Ovarian failure is treated with contraceptive pill or hormone replacement therapy.
(Longstanding amenorrhea can cause osteoporosis.)

Question 24

How can metrorrhagia be treated?

Answer 24

Cyclic gestagens.
Contraceptive pills.
Surgery.

Question 25

How can menorrhagia be treated?

Answer 25

Antifibrinolytics and NSAIDS.
Hormone IUD.
Systemic gestagen treatment.
Contraceptive pills.
Surgery.

Question 26

How is postmenopausal bleedings treated if the cause is atrophic vaginal mucosa?

Answer 26

Local estrogens.