> Abnormal uterine bleeding, causes and treatment

Loss of blood from the uterus. This type of heavy bleeding, irregular è associated with an impairment of the hypothalamic-pituitary-ovarian and occurs more frequently in adolescents and in women in perimenopause

The menstrual cycle occurs becauseé from the hypothalamus, the structure of the brain in halfà between a brain structure proper and an endocrine gland, the start of the commands to the pituitary gland, the endocrine gland located in the brain and that controls through protein hormones of all the endocrine glands of the body (thyroid, ovaries, adrenal glands, etc), that during their activity; they produce hormones derived from the structure of the cholesterol, and allow the normal functioning of the human body.

When the axis works correctly after about two weeks from the menstrual period, after a period of activity; estrogenic (female hormones più classics), induced by the pituitary gland, but performed from the ovary, the follicle (the cistarella that contains the egg, and that must not be confused, as often happens, with a ovarian cyst) is mature and is released from the egg following another stimulus hormone in the pituitary gland.

The follicle, then it deflates and becomes an organelle (the corpus luteum) that secretes progesterone (the hormone più related to pregnancy).

This alternation of estrogen and progesterone is a prelude or a pregnancy or a menstruation normal. The mucous membrane of the inside of the uterus, in fact (endometrium), is stimulated in the first 14 days, and changed in the next 14, così you can sfaldare without problems during the period.

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At the beginning and at the end of the reproductive life in the axis or not it still works well or not works più good, and in both cases, owing to lack of ovulation, the endometrium is poorly prepared to menstruation, and the bleeding are plentiful.

in Addition, always with the same reason of not yet or not più often estrogen are struggling to climb up, and then the menstruation does not può the end, and is prolonged in time.

This bleeding is known with the acronym AUB-O, with a new system of classification proposed in 2011 by the International Federation of Gynecology and Obstetrics and later adopted by the association of the united states.


The American College of Obstetricians and Gynecologists has issued the updated guidelines for the treatment of abnormal uterine bleeding caused by ovulatory dysfunction. The new guidelines were published in the July issue of the journal Obstetrics and Gynecology.

The group concluded that, after a diagnostic procedure that has excluded a structural pathology and endometrial, (ultrasound, pelvic and trans vaginal, in the first place, and possibly a hysteroscopy, especially in adult women), medical therapy is the first-line treatment of choice for bleeding associated with ovulatory dysfunction.

The recommendations are:


  • the surgery should only be considered if medical therapy fails, or is not; tolerated by the patient, or is contraindicated. Contraindications include significant injury intracavitarie.
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  • endometrial ablation should not be a primary therapy becauseé può make it difficult or impossible to use other common methods for monitoring the endometrium.

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  • because of its effectiveness, therapy progestogen with the intrauterine device levonorgestrel must be considered to be valid for all età. Other therapies only progestiniche, include acetate oral medroxyprogesterone, megestrol acetate, norethindrone acetate and medroxyprogesterone acetate depot. The combined contraceptives containing both estrogen and progesterone are also effective.
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  • the teen, up to the age of 18 years, the combination of low-dose hormonal contraceptives (20 – 35 mcg of ethinyl estradiol) is the treatment of choice.
  • The women, aged 19 to 39 years of age generally respond well to therapy combined oral contraceptive with low-dose hormone or therapy progestogen. If there is a heavy menstrual flow, or if the woman is hemodynamically unstable, estrogen therapy, high-dose può be useful.
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  • From the 40 years of età to menopause, the medical treatment can be made by treatment with cyclic progestin,  low doses of oral contraceptives, from the device, thentrauterino of levonorgestrel, or from hormone therapy cyclic. In addition to treating the problem of bleeding, these treatments can relieve the symptoms perimenopause as hot flashes, night sweats, and l’atrophy vaginal.
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  • A medical therapy failed indicates the needà to perform additional tests, such as, for example, the MRI, or hysteroscopy.
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  • If a biopsy endometrial is necessary to diagnose the cancer or endometrial hyperplasia, a hysteroscopy is preferred compared to the curettage becauseé è procedure  less invasive, more secure, and less expensive. However, the isteroscopie can produce a smaller number of samples and consequently there are più probability; of not being able to diagnose the pathologies of uterine, including a malignant disease. Should be carried out by expert hands.
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  • In the case of a family completed, the women who have failed medical therapy, may be considered as a candidate to thehysterectomy without preservation of the cervix.

by Lisa Canitano, gynecologist


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