What is this Condition?

Dysfunctional uterine bleeding refers to abnormal bleeding from the endometrium (surface lining of the uterus) that occurs without recognizable organic lesions. Prognosis varies with the cause. Dysfunctional uterine bleeding is the reason for almost 25% of all gynecologic surgeries.

What Causes it?

Dysfunctional uterine bleeding usually results from an imbalance in hormonal-endometrial interactions, in which estrogen constantly stimulates the endometrium. Disorders that cause sustained high estrogen levels include polycystic ovary syndrome, obesity, immaturity of the hypothalamic-pituitary-ovarian mechanism (in sexually mature teenagers), and failure to ovulate (in women in their late 30s or early 40s).

What are its Symptoms?

Dysfunctional uterine bleeding usually causes episodes of vaginal bleeding between periods; it may also cause heavy or prolonged periods (longer than 8 days) or shorten the menstrual cycle to less than 18 days. Such bleeding is unpredictable and can cause anemia.

How is it Diagnosed?

Dilatation and curettage (D&C) and biopsy results confirm the diagnosis. Blood tests help determine the need for blood or iron replacement.

Diagnostic studies must rule out other causes of excessive vaginal bleeding, including cancer, polyps, incomplete abortion, pregnancy, and infection.

How is it Treated?

The primary treatment, high-dose estrogen-progestogen combination therapy (oral contraceptives), is designed to control endometrial growth and reestablish a normal menstrual cycle. These drugs are usually administered four times daily for 5 to 7 days, even though bleeding usually stops in 12 to 24 hours.

In women over age 35, endometrial biopsy is necessary before thE start of estrogen therapy, to rule out endometrial cancer. Progestogen therapy is a necessary alternative in some women, such as those susceptible to the side effects of estrogen (thrombophlebitis, for example).

If drug therapy is ineffective, a D&C serves as a supplementary treatment that removes a large portion of the bleeding endometrium.

Also, a D&C can help determine the original cause of hormonal imbalance and can aid in planning further therapy.

Regardless of the primary treatment, the woman may need iron replacement or transfusions of packed cells or whole blood because of anemia caused by recurrent bleeding.

What can a Woman with Dysfunctional Uterine Bleeding do?

If you have dysfunctional bleeding, follow these guidelines:

• Be sure to follow the prescribed hormonal therapy.

• Get regular checkups to determine if your treatment is effective.

Ovarian Cysts – Remedies for the Treatment ofOvarian Cysts

What is this condition?

Ovarian cysts are usually noncancerous sacs that contain fluid or semisolid material. Although these cysts are usually small and pro­duce no symptoms, they require thorough investigation to be sure they’re not cancerous. Common types of ovarian cysts include follicular cysts, lutein cysts, and those associated with polycystic ovarian disease.

Ovarian cysts can develop any time between puberty and menopause, including during pregnancy. Some lutein cysts occur infrequently during early pregnancy. The prognosis for noncancerous ovarian cysts is excellent.

What causes them?

Follicular cysts are typically small and arise from follicles that have malfunctioned during the menstrual cycle. When such cysts persist into menopause, they secrete excessive amounts of estrogen in response to the hypersecretion of follicle-stimulating hormone and luteinizing hormone that normally occurs during menopause.

Granulosa-lutein cysts, which occur within the corpus luteum, are functional, nonneoplastic enlargements of the ovaries, caused by excessive accumulation of blood during the bleeding phase of the menstrual cycle. Theca-lutein cysts are commonly bilateral and filled with clear, straw-colored fluid; they’re often associated with other types of ovarian tumors or hormone therapy.

Polycystic ovarian disease is part of the Stein-Leventhal syndrome and stems from endocrine abnormalities.

What are the symptoms?

Small ovarian cysts (such as follicular cysts) usually don’t produce symptoms unless twisting or rupture causes abdominal tenderness, distention, and rigidity. Large or multiple cysts may induce mild pelvic discomfort, low back pain, painful intercourse, or abnormal uterine bleeding secondary to a disturbed ovulatory pattern. Ovarian cysts that become twisted cause acute abdominal pain similar to that of appendicitis.

Granulosa-lutein cysts that appear early in pregnancy may grow as large as 2 to 2½ inches (5 to 6 centimeters) in diameter and produce discomfort on one side of the pelvis and, if rupture occurs, massive one-sided bleeding within the abdomen. In nonpregnant women, these cysts may cause delayed menstruation, followed by prolonged or irregular bleeding. Polycystic ovarian disease may also produce secondary absence of menstruation, diminished menstrual flow, or infertility.

How are they diagnosed?

Generally, the doctor diagnoses ovarian cysts based on the woman’s signs and symptoms. A physical exam and lab tests may also help detect certain types of cysts.

Visualization of the ovary through ultrasound, laparoscopy, or surgery (often for another condition) confirms ovarian cysts.

How are they treated?

Follicular cysts generally don’t require treatment because they tend to disappear spontaneously within 60 days. However, if they interfere with daily activities, Clomid taken orally for 5 days or progesterone given intramuscularly (also for 5 days) reestablishes the ovarian hormonal cycle and induces ovulation. Oral contraceptives may also accelerate involution of functional cysts (including both types of lutein cysts and follicular cysts).

Treatment for granulosa-lutein cysts that occur during pregnancy is symptomatic because these cysts diminish during the third trimester and rarely require surgery. Theca-lutein cysts disappear spontaneously after elimination of hydatidiform mole or choriocarcinoma, or discontinuation of human chorionic gonadotropin or Clomid therapy.

Treatment of polycystic ovarian disease may include the administration of such drugs as Clomid to induce ovulation, Depo-Provera for 10 days of every month for the woman who doesn’t want to become pregnant, or low-dose oral contraceptives for the woman who needs reliable contraception. Surgery may be necessary to remove a persistent or suspicious ovarian cyst.

What can a woman who’s had ovarian cyst surgery do?

You’ll be advised to increase your activities at home gradually­preferably over 4 to 6 weeks. Abstain from intercourse and use tampons and douches during this period.