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Pathology - Dysfunctional Uterine Bleeding
Dysfunctional uterine bleeding ( DUB) is identified clinically following meticulous history and physical examination and appropriate laboratory test. DUB is caused by hormonal abnormalities in the hypothalamic–pituitary axis in the absence of obvious anatomical or biological disease. Most typically, DUB is related with anovulatory conditions occurring at the extremes of reproductive age, such as early puberty and perimenopause. In certain cases, women do not correctly develop and release a mature egg. Without appropriate ovulation, a corpus luteum does not form and progesterone levels are lowered, producing practically constant estrogen production and subsequent thickening of the uterine lining. Menstruation is sometimes delayed; when it occurs, it can be heavy and lengthy. This condition has been connected with psychological stress, fast weight gain or loss, other endocrinopathies, neoplasms, and medication use. Mechanisms of DUB are generally unknown and often, no specific cause is recognized. Laboratory assessment includes blood hemoglobin level; LH, FSH, prolactin, and TSH levels; evaluation for pregnancy; and androgen profile, if clinically needed. Evaluation of endometrial thickness using pelvic ultrasonography may be indicated in some cases. Symptoms of weariness mentioned in the patient in the vignette above may be attributed to anemia/low hemoglobin from repeated excessive blood loss during protracted menses. The term used to describe severe menstrual bleeding is menorrhagia. Metrorrhagia is used to characterize frequent (more often than every 28 days) bleeding or bleeding in between menstrual cycles.
Dysfunctional uterine bleeding ( DUB) is identified clinically following meticulous history and physical examination and appropriate laboratory test. DUB is caused by hormonal abnormalities in the hypothalamic–pituitary axis in the absence of obvious anatomical or biological disease. Most typically, DUB is related with anovulatory conditions occurring at the extremes of reproductive age, such as early puberty and perimenopause. In certain cases, women do not correctly develop and release a mature egg. Without appropriate ovulation, a corpus luteum does not form and progesterone levels are lowered, producing practically constant estrogen production and subsequent thickening of the uterine lining. Menstruation is sometimes delayed; when it occurs, it can be heavy and lengthy. This condition has been connected with psychological stress, fast weight gain or loss, other endocrinopathies, neoplasms, and medication use. Mechanisms of DUB are generally unknown and often, no specific cause is recognized. Laboratory assessment includes blood hemoglobin level; LH, FSH, prolactin, and TSH levels; evaluation for pregnancy; and androgen profile, if clinically needed. Evaluation of endometrial thickness using pelvic ultrasonography may be indicated in some cases. Symptoms of weariness mentioned in the patient in the vignette above may be attributed to anemia/low hemoglobin from repeated excessive blood loss during protracted menses. The term used to describe severe menstrual bleeding is menorrhagia. Metrorrhagia is used to characterize frequent (more often than every 28 days) bleeding or bleeding in between menstrual cycles.
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