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Irregular Menstruation in Young Girls, Dysfunctional Uterine Bleeding
Definition and Frequency
Abnormal uterine bleedings that are not related to an organic cause (such as myoma, intrauterine polyp etc.) are called dysfunctional uterine bleeding. Its frequency throughout the life of a woman is %20. %20 of these cases occur in adolescence, %30 in reproductive ages, %50 in perimenopausal period (close to the menopause). %90 of dysfunctional uterine bleedings is anovulatory, meaning it is seen that there is no ovulation.
Why does Irregular Menstruation Occur in Young Girls? Basic Physiopathology
The condition we called dysfunctional uterine bleeding, shortly DUB, is used for referring to bleedings that result from uterus and caused by hormonal irregularity. In the life cycle of a woman, these irregular bleedings occur at the beginning of reproductive ages and at the end, while menstruation begins and ends.
The cause of irregular menstruation in young woman is that the relation between the brain and ovaries is beginning to be maintained which is obligatory for a menstrual cycle during reproductive ages. Menstruation occurs when young girl comes to upper points of physiological development. In order to have menstruation, the hormones called FSH and LH must be secreted from hypophysis and the ovaries must respond to that. Estrogen is secreted in the ovaries when ovum begins to develop as a response to FSH. Subsequently, ovulation occurs. The formation called corpus luteum which is formed after ovulation begins to secrete progesterone and as a result of the balance between estrogen and progesterone endometrium begins falling off. Thus, girls have menstruation. This hormonal dance I told simply here is repeated every months in perfect harmony. However, just as in everything occurrence of such synchronization gets loud. During the period for harmony between ovaries and GnRH/FSH/LH which are secreted from upper centers, endometrium tissue falls off without ovulation with the effect of estrogen. Because of the fact that there is no ovulation, progesterone hormone and its stabilizing effect for intrauterine tissue is not present. This condition causes the estrogen to be excessive and causes irregular menstruation. Here, you can see general mechanism of dysfunctional uterine bleedings
How is it treated?
Treatment of patients gets shaped according to hemoglobin levels, meaning blood values. If patient’s hemoglobin is above 11 gr/dlt but she has irregular bleedings, patient and family is consulted. It is emphasized that this is a temporary period. If hemoglobin level is between 9 and 11 gr/dlt patient may be followed with oral contraceptives for 3 months. However, if bleedings increasingly continue when the drug is quitted, hematology consultation is required.
You may see the slides of the speech regarding the subject prepared by Prof. Dr. Süleyman Engin Akhan in ADSAD symposium by clicking the link: Irregular Uterine Bleeding in Young Girls (DUB)
In most of the patients, hmg level is normal and especially the family is very concerned with irregular bleeding. The aim is that the first option for maintaining continuance of the harmony process I detailed above MUST NOT BE DRUGS. ORAL CONTRACEPTIVES AND SIMILAR DRUGS SHOULD ONLY BE USED IN PATIENTS WITH LOW BLOOD LEVELS. IF IRREGULAR BLEEDINGS AFFECT GIRL’S PSYCHOLOGY, FOR EXAMPLE IF THERE IN AN IMPORTANT EVENT SUCH AS AN EXAM, THESE DRUGS CAN BE USED SHORTLY.
Problematic ones are the cases that consult the gynecologists with commonly in a pre-shock clinic. Although in the literature which is commonly from USA, use of conjugate estrogen is advised which can be used in parenteral way, these drugs are not present in our country. Patients must be hospitalized. Vascular access must be opened, urine excretion must be followed. Consultation of pediatric hematology is wanted and regarding tests are ordered. In management of these patients, we use 6×1 or 8×1 oral contraceptives (oral contraceptives must not include low levels. 30 mgr. ethynil estradiol must be included) depending on the severity of the bleeding in our clinic. OCS is used for 3 months with 7 day intervals. After these three months, patient may be followed or OCS treatment may be continued for another three months.
In the adolescents presented with irregular menstruation, possible pregnancy and its complication must be checked. The tests that will be ordered are in respect: Pregnancy test, full blood count, bleeding duration, peripheral smear and commonly pediatric hematology consultation. The most important reason for ordering hematology consultation is that in the cases presenting with DUC, congenital blood disease is found out in %3-20. This rate is %22 in our own series.