Cases Of Dysfunctional Uterine Bleeding Research Articles

Endometrial Histopathology in Abnormal Uterine Bleeding and Its Relation With Thyroid Profile and Endometrial Thickness.

Abnormal uterine bleeding (AUB) is a common complaint in postmenopausal and perimenopausal women, caused by a range of disorders, including structural and systemic diseases. The evaluation of endometrial thickness (ET) via radiological methods, followed by a histopathological examination of the endometrium, is useful for proper diagnosis. Among systemic diseases, thyroid dysfunction, specifically hypothyroidism and hyperthyroidism, contribute significantly to AUB cases. This descriptive cross-sectional study was conducted at Sri Aurobindo Medical College, Indore, Madhya Pradesh, India, over a period of 16 months, from May 2021 to September 2022. Patients presenting with abnormal uterine bleeding and undergoing thyroid function tests (TFTs), ultrasonography, and endometrial biopsy/hysterectomy at the gynecological outpatient department were included. Hospital records were used to obtain clinical details and investigation results. Endometrial thickness and thyroid status were recorded, and descriptive statistics were used to analyze the collected data. This study included 150 patients with abnormal uterine bleeding, with a mean age of 44 years and 80.6% of patients in the premenopausal age group. A total of 48% of patients had a deranged thyroid profile, with hypothyroidism being more common (91.6%). Structural causes of AUB were identified in 81.3% of cases, with adenomyosis (33.65%), concomitant adenomyosis and leiomyoma (31.5%), and leiomyoma (14.8%) being the most common. Endometrial polyps (4.6%) and endometrial carcinoma (0.6%) were also observed and were consistent with the final histopathology. The remaining 18 patients had no structural causes and were categorized as cases of dysfunctional uterine bleeding (DUB). Increased ET was more commonly observed in postmenopausal patients (4.3%) compared to premenopausal patients (0.7%) among those with AUB, while the reverse was true for patients with DUB. Increased ET was commonly associated with hypothyroidism in both groups. Histopathological examination of endometrial biopsies/hysterectomy specimens revealed additional findings in some patients, including hyperplasia of the endometrium with (0.7%) and without atypia (4%), leading to a more accurate diagnosis. AUB is a prevalent condition affecting women in both pre-menopausal and postmenopausal stages, frequently caused by structural anomalies. However, thyroid dysfunction, especially hypothyroidism, is also a significant contributing factor. As such, thyroid function tests (TFTs) are an effective and economical means of identifying potential underlying causes of AUB. Hypothyroidism is frequently associated with increased endometrial thickness, and histopathological examination remains the gold standard for determining the precise cause of AUB.

Study on Thyroid Dysfunction in Patients of Dysfunctional Uterine Bleeding

Aim: The purpose of the study was to detect thyroid dysfunction in women who had abnormal uterine bleeding
 Study Design: Menorrhagia was the most common type of bleeding (36%). Thyroid dysfunction was discovered in 32% of the patients (Subclinical hypothyroidism in 17%, Hyper thyroid is 11% and hyperthyroidism in 4 % of cases).
 The researchers looked at 100 cases of Dysfunctional Uterine Bleeding that were clinically identified at Sree Balaji Medical College and Hospital between March 2014 and August 2016. The patients in this study ranged in age from under 20 to 45 years old. The number of instances with DUB who were between the ages of 31 and 40 is 38 %.
 Methodology: The parity of the patients ranged from unmarried to 0-5, with the parity 2 group accounting for 37% of all DUB patients and the following assessments were made.
 Results: Thyroid dysfunction was most common in cases of polymenorrhagia (42.8%), menorrhagia (33.3%), polymenorrhea (28.5%), and oligomenorrhea. (26%). Thyroid dysfunction was most common in the age group 31-40 years, accounting for 77.5% of the population. In 17 % of cases, the primary thyroid malfunction was subclinical hypothyroidism. 3% of hyperthyroid patients were also oligomenorrhocic. The most prevalent thyroid disorder in metrorrhagic patients was subclinical hypothyroidism.

Comparative Study of Desogestrel- Containing Oral Contraceptive and Levonorgestrel- Containing Oral Contraceptive in Dysfunctional Uterine Bleeding

Dysfunctional uterine bleeding is a type of abnormal uterine bleeding where vaginal bleeding occurs outside of the menstrual cycle in the absence of any known pelvic pathology. Dysfunctional uterine bleeding can be treated safely with hormone therapy. Combined oral contraceptives help in increased menstrual cycle regularity and decreased blood loss. In this study, a reliable drug for the dysfunctional uterine bleeding with maximum effectiveness and minimal side effects were assessed. This study was conducted on 120 cases of dysfunctional uterine bleeding. Patients who were diagnosed with dysfunctional uterine bleeding were randomly assigned into two groups. Group D and group L included patients who were given Ethinyl estradiol 0.02mg + desogestrel 0.15mg and Ethinyl estradiol 0.03mg + levonorgestrel 0.15mg respectively for the four consecutive 28- day cycles. Menstrual blood loss was assessed using the pictorial blood assessment chart (PBAC) score on 2nd and 4th months of recruitment. Side effects such as weight gain, acne and headache were assessed in both groups. This study shows 56.68% reduction in mean PBAC score in 2 months in desogestrel group whereas only 44.96% reduction in levonorgestrel group and 79.87% reduction in mean PBAC score in desogestrel group in 4 months whereas only 74.46% reduction in levonorgestrel group. Side effects like weight gain, acne and headache were more prominent in the levonorgestrel group than desogestrel group. Desogestrel containing combined oral contraceptive can be a useful and safe treatment for dysfunctional uterine bleeding.

A STUDY OF 70 CASES OF DUB

Background: Abnormal uterine bleeding (AUB) is a phenomenon which refers to menstrual bleeding of abnormal frequency, duration or quantity. It is a common gynaecological complaint caused by wide variety of organic or non-organic causes. The objective of the study was to determine the incidence of dysfunctional uterine bleeding with respect to aetiopathology, demographic variables, treatment options and other medical disorders.
 Methods: A retrospective study of randomly selected 70 cases of dysfunctional uterine bleeding admitted during October 2006 to September 2007, in the Dept. of Obstetrics and Gynaecology, in a tertiary care hospital named SSG Hospital at Vadodara. Only cases of AUB due to non-structural causes were included. Demographic details of each patient were recorded and analysed. Patients were evaluated with menstrual history, physical examination, laboratory tests and histological examinations. Patients were followed up from 3 to 8 months.
 Results: Most common age group presenting with DUB was 40–50 years and mostly belonged to low socioeconomic status. Most of the women were multiparous. Polymenorrhagia and menorrhagia was most common presentation. Size of uterus is normal in 44 patients. Dilatation and curratage was having the cure rate of 65.6% .Maximum number of patients (85%) was treated surgically and 15% got medical treatment.
 Conclusions: Dysfuntional uterine bleeding (DUB) now termed as Abnormal uterine bleeding (AUB) is a common gynaecological manifestation allied with considerable morbidity and significantly affects the patient's family, personal and social life. Perimenopausal women’s health and quality of life can be maintained and improved through preventive care, life style modification, early diagnosis of risk factor and appropriate treatment.
 
 Keywords
 
 Menorrhagia, Dysfunctional uterine bleeding,Abnormal uterine bleeding Perimenopausal women, Endometrium

Evaluation of pattern of angiogenesis in various menstrual disorders in different district in Gujarat, India.

Backgound: Menstrual disturbance is one of the commonest gynecological problems. Majority of these women have dysfunctional uterine bleeding (DUB), the rest being associated with leiomyomas, carcinomas, adenomyosis, endometrial polyps, hyperplasia and oral contraceptive uses. Aims: To study of alteration in blood vessels morphology in various menstrual disorders have significant role in prognosis and in various anti-angiogenic therapies. Methods : A Cross-sectional study done at Anand, Surendranagar and Junagadh district from October 2011 to October 2016. 1867 endometrial specimens were studied to document the changes in blood vessels in various phases of menstrual cycle, menstrual disturbances and in unexplained infertility. 761 cases were taken as control and 1106 cases as study group which included cases of dysfunctional uterine bleeding (DUB), endometrial polyps, fibroids, adenomyosis, infertility, atrophic endometrium, endometrial hyperplasia, pill endometrium and carcinomas. Using light microscopy, the vascular morphology was studied. Statistical analyses were performed using the IBM SPSS (Statistical package for the Social Sciences v15.0) and Microsoft Excel 2007 software. Results: The blood vessels were concentrated more in basal layer in the proliferative phase and in functional layer in the secretory phase. Cases of complex hyperplasia and pill endometrium had significantly higher vessel concentration. Congestion and dilatation of blood vessels were significantly higher in cases of DUB. Conclusions: The present study showed a positive correlation between endometrial angiogenesis and menstrual disorders. The alteration in blood vessel morphology has significant role in prognosis and in various anti-angiogenic therapies. DOI: 10.21276/APALM.1180

Clinical observation of Dysfunctional uterine bleeding uterine fibroids

Objective To discuss characteristics and clinical effect of dysfunctional uterine bleeding combined with uterine fibroids.Methods Among 106 cases of dysfunctional uterine bleeding combined with uterine fibroids in our hospital,we divided them into groups as follows:52 cases as intramural fibroids intramural group,28 cases as subserosal fibroicds combined group,26 cases as submucosal fibroids of mucosa group.Results ① There were some differences in pre-treatment average menstrual cycles and hormone in patients of each group,but the difference was not significant.② But after treatment the related average menstrual hormone indexes in serous group were significantly better than those of the intramural related groups,showing statistical differences,P＜ 0.05.Conclusion Dysfunctional uterine bleeding combined with uterine fibroids.may increase the clinical symptoms,especially effects to menstrual cycle and menstrual bleeding. Key words: Dysfunctional uterine bleeding; Uterine fibroids

Morphometric evaluation of endometrial blood vessels

Five hundred endometrial specimens were studied to document the changes in blood vessels in various phases of menstrual cycle, menstrual disturbances and in unexplained infertility. Sixty-three cases were taken as control and 437 cases as study group which included cases of dysfunctional uterine bleeding (DUB), endometrial polyps, fibroids, adenomyosis, infertility and atrophic endometrium. Using light microscopy, the vascular morphology was studied. The blood vessels were concentrated more in basal layer in the proliferative phase and in functional layer in the secretory phase. Cases of complex hyperplasia and pill endometrium had significantly higher vessel concentration. Congestion and dilatation of blood vessels were significantly higher in cases of DUB. The present study showed a positive correlation between endometrial angiogenesis and menstrual disorders. The alteration in blood vessel morphology has significant role in prognosis and in various anti-angiogenic therapies.

Changing the route of hysterectomy: The results of a policy of attempting the vaginal approach in all cases of dysfunctional uterine bleeding

Objective To assess the effectiveness of a policy of performing a vaginal hysterectomy for as many cases of dysfunctional uterine bleeding without uterine prolapse as possible between 1997 and 2003. Study design The study was prospective, with retrospective analysis of data. Setting Warwick Hospital. Population Eighty-seven women in a district hospital serving a population of 270,000 in South Warwickshire. Methods During 1997 and 2003, an effort was made to perform as many hysterectomies vaginally as possible, with oophorectomy where necessary, in women with dysfunctional uterine bleeding in the absence of prolapse. The trends of the three different operations, total abdominal hysterectomy, sub-total abdominal hysterectomy and vaginal hysterectomy over the 7-year period were analysed. Main outcome measures The ability to undertake surgery successfully, complications rates, length of hospital stay and changes in surgical practice. Results Over this 7-year period, it has proved possible to change the emphasis from abdominal to vaginal hysterectomy for dysfunctional uterine bleeding. In 1997, the most common operation for dysfunctional uterine bleeding (72.7%) was subtotal hysterectomy ± bilateral salpingo-oophorectomy, followed by (27.3%) total abdominal hysterectomy ± bilateral salpingo-oophorectomy. No cases were undertaken vaginally. By 2003, however, the trend had completely reversed, with the only procedure undertaken being vaginal hysterectomy ± bilateral salpingo-oophorectomy. There is no evidence that such an approach increases the complication rate, and the recovery rate from surgery is improved with a tendency towards earlier discharge in the vaginal surgery group. Conclusion The vaginal approach is possible for an average gynaecologist working in a district general hospital, with no additional complications and an improved recovery rate for patients.

Case report. role of saline infusion sonohysterography (SIS) in the diagnosis of abnormal uterine bleeding (AUB) in a patient with uterine diverticulum

Objective: To describe an unusual cause of AUB in a 38-year-old patient secondary to a uterine diverticulum occurring post-cesarean section. AUB is common in women in their reproductive years. Most cases of dysfunctional uterine bleeding are associated with anovulation. Other causes for intermenstrual AUB in non-pregnant women in the reproductive age group include uterine fibroids, endometrial polyps, endometritis, endometrial hyperplasia, and endometrial cancer. Uterine filling defects at the site of previous cesarean section has been described at SIS. Occasionally, these patients present with AUB.

Plasma Cells in Chronic Endometritis are Easily Identified When Stained with Syndecan-1

Background: Chronic endometritis has been observed in 3–10% of women with irregular uterine bleeding who undergo endometrial biopsy. The diagnosis of chronic endometritis rests on the recognition of plasma cells in endometrial tissue that may show a prominent spindle cell stromal component, and is frequently difficult to date. Syndecan-1 is a cell-surface proteoglycan that is expressed on the cell surface of plasma cells. Design: Eighteen endometrial curettage cases with the diagnosis of chronic endometritis and 25 endometrial curettage cases of dysfunctional uterine bleeding, in females under the age of thirty-five in whom no other histopathologic changes were noted, were reviewed for the presence of plasma cells. Sections were then stained with syndecan-1. Results: All of the chronic endometritis cases showed easily visible syndecan-1 staining of plasma cell membranes. None of the cases of dysfunctional uterine bleeding showed presence of plasma cells in either the hematoxylin and eosin stained or syndecan-1 stained sections. Conclusions: In cases of suspected chronic endometritis in which no plasma cells can be found on hematoxylin and eosin stained slides, syndecan-1 may be an effective adjunct in the identification of plasma cells and thus aid in the diagnosis of chronic endometritis.

Tenoxicam Versus Lynestrenol-Ethinyl Estradiol Treatment of Dysfunctional Uterine Bleeding Cases During Adolescence

BackgroundThe purpose of this study was to compare the effectiveness of tenoxicam versus lynestrenol-ethinyl estradiol (L-EE) in the treatment of severe cases of dysfunctional uterine bleeding (DUB) during adolescence. MethodsForty-eight patients with objective DUB completed a randomized comparative trial of treatment with tenoxicam (20mg daily, n = 23) or L-EE (1 tablet containing 0.05mg+2.5mg, respectively, 3 times daily, n = 25). Treatment was given during menorrhagia until bleeding ceased. Mean age of the patients was 13.74±2.1 years (range, 11–18 years). ResultsA significantly higher level of hematocrit (35.9% v 32.6%, t = 2.1, P = 0.0217) and hemoglobin (11.5 v 10.4 g%, t = 1.7, P = 0.0495), and significantly less hospitalization (5.75 v 8.33 days, t = 2.45, P = 0.0106) was seen in the tenoxicam group in comparison to L-EE group after completion of the treatment. Three patients were submitted to curettage and seven to transfusion in the group receiving L-EE, but no patients in die tenoxicam group required these procedures. ConclusionsTenoxicam is considered an effective medication for the management of DUB during adolescence.

10 - The Pathology of Dysfunctional Uterine Bleeding

The mechanism of dysfunctional uterine bleeding remains unknown. Recent studies suggest that the majority of cases of dysfunctional uterine bleeding are due to local endometrial, or myometrial, dysfunction. Changes in the pattern of production of prostaglandins PGE2, PGF2α, prostacyclin and thromboxane and increased fibrinolytic activity in the endometrium have been implicated in this disorder. Successful treatment of excessive menstrual bleeding with the prostaglandin synthetase inhibitor mefenamic acid and the fibrinolytic inhibitors epsilon amino caproic acid and tranexamic acid further substantiates the role of prostaglandins and fibrinolysis in pathological menstruation. The relationship between uterine mast cells, heparin-like activity and menstrual bleeding still needs to be elucidated. Further studies are required to improve our understanding of the pathogenesis of dysfunctional uterine bleeding, so that advances can be made in a specific treatment to restore normal menstrual function.