Dysfunctional uterine bleeding is irregular bleeding from the uterus. It is usually due to hormonal disturbances. It can be classified as ovulatory or anovulatory, depending on whether ovulation is occurring or not.
OVULATORY DUB:
10% of cases occur in women who are ovulating. It may represent a possible endocrine dysfunction. Mid-cycle bleeding may indicate a transient estrogen decline, while late-cycle bleeding may indicate progesterone deficiency.
ANOVULATORY DUB:
About 90% of DUB events occur when ovulation is not occurring (Anovulatory DUB). Anovulatory menstrual cycles are common at the extremes of reproductive age, such as early puberty and perimenopause (period around menopause). In such cases, women do not properly develop and release a mature egg. As a result, estrogen is produced continuously, causing an overgrowth of the uterus lining. The period is delayed in such cases, and when it occurs menstruation can be very heavy and prolonged.
Causes:
The aetiology can be psychological stress, weight (obesity, anorexia, or a rapid change), exercise, endocrinopathy, neoplasm, drugs, or it may be otherwise idiopathic.
Assessment of anovulatory DUB should always start with a good medical history and physical examination. Laboratory assessment of haemoglobin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, T4, thyroid stimulating hormone (TSH), pregnancy (by βhCG), and androgen profile should also happen. More extensive testing might include an ultrasound and endometrial sampling
Symptoms
Symptoms of dysfunctional uterine bleeding may include:
• Bleeding or spotting from the vagina between periods
• Periods that occur less than 28 days apart (more common) or more than 35 days apart
• Time between periods changes each month
• Heavier bleeding (such as passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 - 3 hours in a row)
• Bleeding lasts for more days than normal or for more than 7 days
Other symptoms caused by changes in hormone levels may include:
• Excessive growth of body hair in a male pattern (hirsutism)
• Hot flashes
• Mood swings
• Tenderness and dryness of the vagina
A woman may feel tired or have fatigue if she is loses too much blood over time. This is a symptom of anaemia.
Complications
• Infertility (inability to get pregnant)
• Severe anaemia due to a lot of blood loss over time
• Increased risk for endometrial cancer
Diagnosis
The health care provider will do a pelvic examination and may perform a Pap smear. Tests that may be done include:
• Complete blood count
• FSH,LH,malehormone,prolactin level,progesterone level,TSH
• Biopsy
• USG
Homoeopathic treatment
Young women within a few years of their first period are often not treated unless symptoms are very severe, such as heavy blood loss causing anaemia. We can save many patients from unnecessary hysterectomy by properly selected medicines. A detailed case taking is essential to know the constitutional remedy. The acute remedy will check the bleeding which has to be controlled and the deep acting constitutional and miasmatic remedy will prevent the recurrence. A regular estimation of Hb level, blood pressure, USG, and if necessary endometrial biopsy would ensure the physician and the patient, of the progress and prognosis.
Self tips:
• Keep track about menstrual history or record no of pads you use throughout your periods.
• Avoid aspirin intake as it interferes in blood clotting leads to more blood loss.
• Eat right. Add up sufficient iron supplements in your diet.
• Chill out. Putting you under too much of stress adds to your physical and mental complaints.
• Rest up if bleeding is heavy.
Case :- Leela (52) , came with the complaints of irregular menstruation since 1 year , with hot flushes, severe sudden sweating, anger and irritability before the menses. The complaints reduced once the menses appeared. Her sleep was disturbed and anger increased. Mood swings were common. She was prescribed Lachesis based on these symptoms. Her symptoms reduced slowly and on continual medication she started improving.
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