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To manage patients with dysfunctional uterine bleeding (DUB) according to endometrial thickness.
A retrospective chart review of 49 patients who reported 8 or more days of bleeding was performed. They were then divided into three groups based on endometrial thickness (mm): less than 6, 6-11, and greater than 11. These three groups were treated with...
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Citations
... More precisely the term 'AUB' refers to abnormal uterine bleeding which results from an ovarian endocrinopathy and most commonly anovulation. 1 It includes all the varieties of menstrual disturbance except amenorrhea. Although, there is no close relationship exists between the clinical variety of bleeding and the underlying pathology. ...
There are so many concerns and worries about menstruation. With the use of advance method of contraception, women are experiencing more menstrual related problems. Now a days, menstrual related complaints are more common in gynaec clinic. So, we had conducted this study to document the sociodemographic and clinical profile among the attendees of gynaec clinic with menstrual related problem.
Observational cross-sectional study carried out in western part of India with 100 patients after their written informed consent. Data were collected on pre-designed semi structured questionnaire which consist of sociodemographic and clinical questions. All data were entered in MS excel spreadsheet and analyzed with the help of SPSS V.20.
Current study reported 8% of new Gynaec attendees had problem of abnormal uterine bleeding. Majority of patients were belonging to age group 21 years to 40 years (83%) and most of the patients were multipara (75%). Commonest complains among patients were menorrhagia (80%). Most of the patients were reported haemoglobin of less than 12 mg/dl.
: Abnormal uterine bleeding is a distressing problem for women in their reproductive age groups especially in 21 years to 40 years.
... The term 'Dysfunctional uterine bleeding (DUB) refers to a disorder of excessive uterine bleeding affecting women that is not due to pregnancy or any recognizable uterine or systemic diseases [1]. The underlying pathophysiology is believed to be secondary to anovulation or oligoovulation and is often referred to as anovulatory bleeding [2]. Exclusion of anatomic pathology and medical illness is important before applying this classification.1It ...
... Variations in menstrual flow and timing often occur at the extremes of reproductive age because of the prevalence of anovulatory cycles. Menarche is typically followed by longer cycles that eventually decrease in length and become more regular as the hypothalamicpituitary-gonadal axis matures [2]. As menopause approaches, however, ovulation occurs less often, which leads to increased variability of the cycle length. ...
Background: Post tubal ligation syndrome has been a topic of debate and the association of Dysfunctional uterine bleeding (DUB) has been identified as a long-term complication. In refractory cases, hysterectomy can be considered a treatment option for managing the post-ligation syndrome due to prolonged menstrual complaints. But very few studies summarize the fact in our country's context. Considering of epidemiological data, the study was designed to assess the incidence of hysterectomy for DUB with post-tubal ligation. Methods: The hospital-based cross-sectional type of. Women suffering from DUB and having a history of post tubal ligation were included in the study. After selecting the patients, informed written consent was taken from the subjects. All patients were subjected to a detailed history, clinical examination, and relevant investigation. In necessary cases, hysterectomy was done as a treatment option. Data were collected using a semi-structured questionnaire designed for the study by the researcher. Data analysis and presentation were made by statistical software SPSS 23. Results: Total 100 patients with DUB were included in this study. The mean age was 40.9±6.28 SD (years), range: 25-54 years. The majority of patients (52%) belonged to the age group (41-50 years). About 59% came from rural areas. The mean parity was 3.43±1.34. The incidence of hysterectomy among DUB patients with a previous history of tubal ligation was 25%. The mean duration of tubal ligation was 13.4±6.3 years. The usual presentation per vaginal bleeding pattern at presentation was menorrhagia (47%), followed in second and third by metrorrhagia (20%) and postmenopausal bleeding (17%). Besides, 78% of patients also complained of tiredness, and 12% complained of pelvic pain. And Mean duration of symptoms was 13.44 months. Conclusion: About one-fourth of the tubal ligation patients underwent a hysterectomy in their subsequent life, and usually presented with menorrhagia. However, further studies are needed to finalize the incidence rate.
... 2 However, there is insufficient data regarding their dose, duration and effectiveness in cases of acute uterine bleeding and effective bleeding control might often take several months changing from one treatment regimen to another, leading to frustration in care-givers and anxiety on patients' behalf. 3 Impact of dysfunctional uterine bleeding involves physical, psychological and social factors, with women becoming susceptible to iron deficiency anemia needing hospitalization and blood transfusion leading to absence from work. Irregular and unpredictable nature of their menstruation also disturbs their daily activities, making them self-conscious and suffers from mood changes, significantly reducing their quality of life. ...
... To improve the management of acute uterine bleeding in DUB, Muneyyirci-Delale et al, tried to tailor the treatments of DUB to endometrial thickness instead of solely on clinical presentation. 3 They reasoned that thin endometrium is a result of denuded endometrium secondary to prolonged bleeding and estrogen might stimulate uniform endometrial growth and promptly stop shedding whereas bleeding caused by endometrial hyperplasia could be effectively stopped with progestogens by reversing the hyperplasia process. ...
... According to Muneyyirci-Delale et al, mechanisms of uterine bleeding differed in DUB according to different thickness of endometrium. 3 In thin endometrium, continued bleeding is due to the denuded endometrium with blood vessels mounts producing small trickles of bleeding with patients complaining of continuous spotting menstruation. In increased endometrial thickness, bleeding is due to the shedding of the thickened endometrium. ...
Background: Dysfunctional uterine bleeding is a common presentation to both general practitioner and gynaecologists which can have a significant effect on a woman’s quality of life. The aim of this study is to assess the effectiveness of treating dysfunctional uterine bleeding according to endometrial thickness.Methods: This study was a hospital based prospective study undertaken in gynecology outpatient clinic of Central Women’s Hospital, Mandalay, Myanmar for one-year period (2016). A total of 60 patients were recruited and divided into 3 groups based on endometrial thickness and offered targeted hormonal treatments. At the end of the one-month treatment, patients were asked to return for a follow-up visit and from their menstrual diaries, the number of bleeding days and bleeding scores were assessed and calculated.Results: Among sixty women with dysfunctional uterine bleeding, 55% of patients had endometrial thickness less than 6 mm, 25% had endometrial thickness 6-11 mm, with 20% of patients having endometrial thickness more than 11 mm. After one month of study period, treatment was found to be effective in 86.6% of the patients according to bleeding days and in 70% of the patients according to bleeding score.Conclusions: In women presenting with dysfunctional uterine bleeding, increased endometrial thickness was found to be associated with increased BMI. In the treatment of dysfunctional uterine bleeding, when the endometrial thickness of the patient was assessed and hormonal treatment was given according to the endometrial thickness, treatment was proven to be effective.
... [31] Previous studies established the efficacy of COC in the treatment of DUB. [16,17,32] In contrast to norethisterone, COC pills contain both estrogen and progestogen. It is given for 3 weeks, and then, it is stopped for a week. ...
Background: A significant percentage of women in India suffer from dysfunctional uterine bleeding (DUB), which has a negative impact on physical and social life. Norethisterone and low-dose combined oral contraceptive (COC) pills are used in the treatment of DUB. Aim: The aim of this study was to compare the efficacy and safety of norethisterone and low-dose COC pills in reduction of blood loss in DUB. Materials and Methods: A prospective randomized interventional study was conducted with patients with DUB. Pretreatment pictorial blood loss assessment chart (PBAC) and hemoglobin in blood were obtained from patients. Then, Group I (n = 50) and Group II (n = 50) patients were provided treatment with norethisterone and low-dose COC pills, respectively. Posttreatment PBAC and hemoglobin level in blood was obtained after 6 months of treatment. Improvements in PBAC and hemoglobin level (difference between posttest and pretest value) were compared by unpaired t-test with α = 0.05. Results: Mean age of Group I and Group II patients was 28.62 ± 9.84 and 28.42 ± 10.08 years, respectively. Improvement in PBAC score in patients treated with norethisterone versus low-dose COC pill was −98.62 ± 7.82 versus −96.44 ± 8.74 (P = 0.19). Improvement in hemoglobin level in patients treated with norethisterone versus low-dose COC pill was 2.75 ± 1.06 gm/dL versus 2.71 ± 0.86 gm/dL (P = 0.84). Conclusion: Norethisterone and low-dose COC pills were found to be equally efficacious in reducing bleeding in DUB. Hence, any one of the drugs can be used in the treatment of DUB according to patients' profile. However, considering the side effects, low-dose COC pills may be a better choice.
... The results of this study demonstrated a significant differences between the amount of menstrual bleeding before and after treatment with Megestrol (P>0.001), as the bleeding was reduced after treatment. Muneyyirci-Delale study (12) conducted in New York, revealed that treatment with megestrol decreases the mean endometrial thickness to 14 mm and also reduces the number of bleeding days from 54 days to 3 days. Williams (13) who evaluated the impact of megestrol on 21 patients with menorrhagia also observed that 18 patients recovered after treatment. ...
Background and aim
Abnormal uterine bleeding is one of the most common debilitating menstrual problems. The first therapeutic strategy for abnormal uterine bleeding is drug treatment. This study was, therefore, designed to determine the efficacy of megestrol, medroxyprogesterone, GnRh agonist, Levonorgestrol IUD and endometrial ablation on bleeding and also to evaluate the side effects of each methods in patients with menorrhagia who were admitted to the Shahid Sadoughi clinic of Yazd University of Medical Sciences.
Methods and Materials
Based on an analytical study with consideration of patients’ medical history, 89 patients with age range of 25-50 years old were included. Each patient, under gynecologist supervision, received one of treatments for three month. The evaluation of patients bleeding in response to treatment were performed using a check list filled by patients and the results were compared before and after treatment. Medroxyprogesterone acetate, megestrol, GnRh agonist (Triptorelin embonate), Levonorgestrol IUD and endometrial ablation was used for patients as their characteristics. Each treatment was conducted for a period of 3 months. Megestrol 40 mg per day on an ongoing basis, medroxyprogesterone from 15th day of menstruation for 10 nights and Diphereline 3.75 mm (manufactured by Aria Health) were administered every 28 days. Mean of bleeding before and after treatment and complications of conservative therapy were evaluated. Statistical analysis of the data were performed using paired t test and Wilcoxon tests on spss-19 software.
Result
Mean of age was 41.2 (25-50). Megestrol treatment with a frequency of 27% (24 patients) and endometrial ablation with a frequency of 20.2% (18 patients) were the most used therapy in this study. All of these ways of conservative treatment can decrease bleeding significantly. The complications of these methods of treatment were not significantly different. (p=0.37).Satisfaction of women after 2-3 months of treatment were increasing because spotting is common in the first months of therapy.
Conclusion
The results of this study indicate that all five methods are good enough to treat menorrhagia. All these methods can replace hysterectomy, especially in this age range in which preserve fertility is of particular importance, and patients can also be protected from hysterectomy, a heavy surgery, and surgery and post surgery complications.
... DUB is the major cause of heavy menstrual bleeding and impacts on women's health both medically and socially causing problems such as iron deficiency anaemia, reduced quality of life, chronic illness, social phobia and are associated with increased healthcare costs & financial burdens [7] . The initial management of DUB is medical treatment; and surgical procedures are restricted to those cases in which medical treatment prove ineffective [7,8] . The medical treatment of DUB includes antifibrinolytics, NSAID'S, COCs, progestins and Gn RH agonists; [9,10] . ...
... (Table 3) Hence, an attempt has been made for the first time to assess the endometrial thickness based on ultrasound in medical treatment of DUB. Further while evaluating the patients during the study, one of the retrospective finding noted was that 10 patients in test and 13 in control groups had PCOD on pelvic scan at baseline, while post treatment repeat scan was normal in 5 and 6 patients in test and control groups respectively; which indicates that DUB is frequently associated with PCOD [8] . This effect is attributed to medicinal properties of asgand which consists of steroidal lactones and alkaloids that serve as an important hormone precursor and even it acts as gonodotropic due to its phytoestrogens [25] . ...
Back ground & objectives: Dysfunctional uterine bleeding (DUB) is a common debilitating problem amongst women in all age groups and accounts for 20% of gynecology office visits. The aim of the study was to evaluate the efficacy of Unani formulations in the management of dysfunctional uterine bleeding. Methods: A standard controlled randomized single blind study was carried out at. Patients (n=40) of reproductive age group with dysfunctional uterine bleeding were randomly allocated to test (n=20) and control (n=20) groups. In test group, Unani formulations (safoof habis and majoon muqawwi rehm sada), each in a dose of 6 gm twice daily during an active bleeding phase and interval respectively; while in control group, standard drug (norethisterone acetate-5mg) three times daily during an active bleeding phase followed by 5mg once daily for 21 days. The above interventions were administered orally for three consecutive cycles. Primary outcome measures were to assess the effect of test drugs on menstrual regulation and pictorial blood assessment chart (PBAC) score. Secondary outcome measures were changes in endometrial thickness and hormonal profile. Results were analyzed using appropriate test. Results: Menstrual regulation was achieved in 58.8% patients in test and 63.2% in control groups (P= 1.000); improvement in PBAC score was observed in 100% patients in both the groups (P = 1.000). No significant changes were observed in endometrial thickness and hormonal profile in either group. Conclusion: The effect of Unani formulations was comparable with that of control drug; hence it can be used as an effective alternative in the management of dysfunctional uterine bleeding.
... There is significant reduction in duration and severity of bleeding by hormonal treatment. Estrogen component stimulate uniform endometrial growth and promptly stops bleeding, while progesterone component stabilizes endometrium by converting it into pseudodecidua [4]. ...
Introduction: Endometrium is mucosal layer of uterus. Throughout the reproductive age, endometrium undergoes cyclical changes during each lunar month to prepare uterus for implantation. Dysfunctional uterine bleeding (DUB) is the most common cause of abnormal vaginal bleeding (AUB) during a womans reproductive years. It affects womens health both medically and socially. Aim & Objective: To decide cut of limit of Endometrial thickness (ET) by ultrasonography (USG) for the treatment of DUB patients in premenopausal women. Method: A total of 60 patients with irregular menstrual bleeding of DUB attending Department of Obstetric and Gynecology in M G M Medical College and Hospital were selected. ET was noted by USG. Result: In younger age group most of patients showed good response to medical line of treatment, while premenopausal women needed surgical line of treatment. Conclusion: ET in younger age group is in the normal range (<8mm) as compared to moderate ET (8-11mm) in perimenopausal women. In perimenopausal age, the preferred line of treatment will be either D&C or hysterectomy, when ET is >8 mm.
... In several studies, use of COCs has been found to decrease the risk of endometrial carcinoma by approximately 50%, and this protective effect seems to persist for decades after their cessation [55]. Although COCs likely prevent or reverse EH in some patients, few data are available to support this possibility [56]. ...
Endometrial hyperplasia (EH), with or without atypia, is a common gynecologic diagnosis and a known precursor of endometrial carcinoma, the most common gynecologic malignancy. During the reproductive years, the risk of EH is increased by conditions associated with intermittent or absent ovulation, in particular, polycystic ovary syndrome. After menopause when ovulation has ceased, EH is more common in women with conditions that increase levels of circulating estrogen such as obesity or estrogen replacement therapy. Women with EH are at increased risk for both concurrent and subsequent endometrial cancer. The risk of coexisting cancer in women with a diagnosis of EH at endometrial sampling is due to limitations in both endometrial sampling and the diagnostic reproducibility among pathologists. These diagnostic uncertainties add to the complexity of managing EH. This review offers a rational approach to prevention, diagnosis, and treatment of EH, including hormone therapy and conservative surgical methods.
Objective:
This study aimed to investigate the curative effect of motherwort combined with ethinylestradiol-cyproterone acetate (EE/CPA) on dysfunctional uterine bleeding (DUB).
Methods:
Atotal of 68 patients with DUB were divided into a single medication group (treated with EE/CPA) and a combination medication group(treated with motherwort and EE/CPA). The clinical efficacy, uterine hemodynamic parameters, sex hormone levels, coagulation index levels, blood routine test levels, and adverse reactions of patients were evaluated.
Results:
After three months of treatment, total treatment response rate of the combination medication group was significantly higher than that of the single medication group. Decreased uterine volume, endometrial thickness and resistance index (RI), increased pulsatility index(PI), average flow rate, and uterine artery blood flow, as well asreduced follicle-stimulating hormone (FSH), luteinizing hormone (LH),estradiol (E2), progesterone (P), activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen (FIB), thrombin time(TT), platelet count (PLT), red blood cell (RBC), and hemoglobin (Hb)levels were witnessed in patients of the two groups. In thecombination medication group, there exhibited reduced uterine volume, endometrial thickness and RI, elevated PI, average flow rate, and uterine artery blood flow, reduced P, E2, FSH, LH, aPTT, PT, FIB, TT,PLT, RBC, and Hb levels in comparison to the single medication group.
Conclusion:
The combination of motherwort and EE/CPA is clinically effective in the treatment of DUB.
It has been suggested that impaired venous drainage and endometrial vascular ectasia (EMVE), secondary to increased intramural pressure, explains abnormal bleeding in fibroid uteri. Striking EMVE with extravasated red blood cells (ecchymosis) has also been seen in uteri with grossly obvious myometrial hyperplasia (MMH), suggesting that increased intramural pressure can cause EMVE in the absence of fibroids. EMVE with MMH may explain the century old association of clinically enlarged uteri with abnormal bleeding, and this same mechanism may be operative in myopathic uteri with grossly obvious adenomyosis.
EMVE with associated thrombosis, ecchymosis, and/or stromal breakdown is commonly seen in random sections of hysterectomies for bleeding. EMVE may also be associated with endothelial hyperplasia, consistent with a reaction to endothelial injury due to impaired venous drainage. This further supports the theory that EMVE bleeds when thrombosis occurs, due to Virchow's Triad (stasis, endothelial injury, and hypercoagulability). EMVE may be “the lesion for which surgery was performed” in hysterectomies with otherwise unexplained bleeding.
