Dysfunctional Uterine Bleeding During Adolescence

Abstract

Dysfunctional uterine bleeding (DUB) is an abnormal uterine bleeding (AUB) in the absence of organic cause. It is usually a painless, excessive, and irregular endometrial bleeding that may be prolonged, and it is not attributable to any underlying structural or systemic disease. The etiology of DUB arises out of continuing maturation of the hypothalamus, such that the eventual establishment of normal pulsatile gonadotropin release leads to normal menstrual cycle control. The European Society of Human Reproduction and Embryology (ESHRE) defined DUB as excessive bleeding (excessively heavy, prolonged, or frequent) of uterine origin, which is not due to a pelvic disease, complications of pregnancy, or systemic disease. According to ESHRE, DUB can be either ovulatory or anovulatory [1,2].Figure 2.1 shows the incidence of DUB in relation to the age of the patients and the seasonal distribution.DUB is usually seen during adolescence. In about 95 % of cases DUB is due to the late maturation of the hypothalamic-pituitary-ovarian axis. Anovulation is considered the most common cause. However, other causes as pregnancy complications, coagulation disorders, systemic diseases, and anatomical lesions of the uterus should be excluded. The pathophysiology of the disease is related to the lack of maturation of the positive feedback, which results in anovulation, excess estrogen secretion, abnormal endometrial hyperplasia, and profuse bleeding, leading to endometrium apoptosis. Endometrium sampling shows proliferation, hyperplasia, and lack of progestagenic effect [3][4][5].As endometrium is a known source of prostaglandin (PG) and especially of PGF 2a and PGE 2 production, the alteration of PGF 2a (vasoconstrictor) and PGE 2 (vasodilator) ratio have been also considered as a cause of the disease. DUB patients presented with anovulation exhibit a decreased availability of arachidonic acid, the precursor of PG synthesis. The PGF2a/ PGE 2 ratio is found decreased,

Masalah ginekologi pasien remaja di RSUP Sanglah Denpasar pada April 2016 – Maret 2017

“…Seperti pada dysmenorrhea, anovulation terjadi akibat ketidak matangan dari positif feedback yang juga dapat menyebabkan abnormal endometrial hyperplasia, profuse bleeding, dan dapat menyebakan apoptosis dari endometrium, karena hal ini kebanyakan dari kasus ini tejadi 1-3 tahun setelah menarche. 8 Usia menarche yang lebih lama dapat menurunkan resiko kanker ovarium dengan mengurangi jumlah ovulasi dalam hidupnya. Sedangkan…”

Overview of Abnormal Uterine Bleeding in Adolescents: Diagnosis and Management

“…The absence of a sufficient luteinizing hormone (LH) response that corresponds to the mid-cycle increase of estrogen due to a general immaturation of the HPO axis is considered to be the cause of anovulatory DUB. Thus, ovulation does not occur, and the ovarian follicles undergo atresia (12).…”

“…It is difficult to discern from the history whether the cycles are ovulatory or anovulatory. However, almost all cases of DUB in adolescents are known to originate from anovulatory cycles (12,17). A late first menarche especially increases the possibility of the cycles being anovulatory, as it indicates that gynaecological maturation will also be delayed (6,18).…”

“…Complaints of lower abdominal pain should suggest pelvic inflammatory disease (6,12). Moreover, other possible causes of AUB (such as weight change, hirsutism and acne), chronic disorders and drug use (i.e.…”

Congress Report from 2nd Society of Endometriosis and Uterine Disorders Congress, 12-14 May 2016, Barcelona, Spain

“…Focusing on adolescence, the AUB includes: oligomenorrhea, dysfunctional uterine bleeding (DUB) and amenorrhea. Creatsas (26) identified several clinical situations during adolescence: oligomenorrhea is related to the polycystic ovarian syndrome. DUB is a painless, excessive and irregular bleeding not attributable to any structural or systemic disease (in about 95% is due to the late maturation of the hypothalamic-pituitary-ovarian axis).…”