Dysfunctional uterine bleeding : clinical and pathologic study
Uterine bleeding is a physiologic monthly event occuring during the reproductive period of the nonpregnant woman. As with any other physiologic event, normal women gave different menstrual patterns, and at times it is difficult to define when normality ends and abnormality begins(Scommegna and Dmowski, 1973).
The problem of abnormal uterine bleeding is one which is encountered frequentely. In general, such bleeding results from benign or malignant neoplasms, endometrial dysfunctions secondary to hormonal discrepancies or to infection, the complications of pregnancy and certain constitutional disease(Sluder and Lock, 1951).
Dysfunctional uterine bleeding is an all-inclusive terms its diagnosis usually depends on the exclusion of local or systemic organic causes. The term dysfunctional refers to alterations in the physiologic mechanisms controlling a multitude of cyclic events in the women's reproductive function. These mechanisms
are primarily neuroendocrine in nature.
It may occur in an evulatory cycle(Nedoss, 1971), although it is more commonly associated with an anovulatory one. It is usually caused by alteration in the secretion of estrogen and progesterone by the ovary. Various endocrine disorders may interfere with the hypothalamic-pituitary axis and may result in dysfunctional uterine bleeding. Organic lesions must be ruled out prier to diagnosis and treatment of dysfunctional uterine bleeding.
In this regard uterine curettage plays a prominent role both diagnostically and therapeutically.
Materials and Methods :
93 endometrial cases of dysfunctional uterine bleeding obtained by curettage, biopsy. or hysterectomy and 169 cases of endometrial hyperplasia including 37 cases of dysfunctional uterine bleeding during 3 years (1971-1973) were reviewed.
Results and Summary :
1. Age distribution of dysfunctional uterine bleeding (93 cases) was localized mainly in 30-50 years. Mean age was 43.0 years.
2. Clinical duration of about one half of the dysfunctional uterine bleeding were within one month and the mean was about 6.5 months.
3. Dusfunctional uterine bleeding patients were largely multigravida and the mean showed 4-5 times of pregnancy and delivery.
4. Among variable bleeding patterns, menorrhagia with intermenstrual bleeding was most frequent(18 cases) another 18 patients showed postmenopausal bleeding.
5. Histologic findings of endometrium were proliferative phase, 41 cases, hyperplasia 37 cases, and secretory phase, 10 cases in order of frequency.
6. Ovarian findings of 12 cases of dysfunctional uterine bleeding showed 7 cases of corpus luteum and 5 cases of follicle cysts and cystic follicles.
7. 18 cases of follow up study in dysfunctional uterine bleeding showed 12 cases of recurrent bleeding within 3 years.