复旦大学上海医学院妇产科学系2009级六年制妇产科学课件 Dysfunctional Uterine Bleeding.ppt

Dysfunctional Uterine Bleeding Introduction DUB is defined as ABNORMAL uterine bleeding absence of demonstrable structural?or organic?pathology. It is usually with hormonal disturbances due to hypothalamic-pituitary-ovarian axis (HPOA) dysregulation. Diagnosis must be made by exclusion. DUB occurs most often shortly after menarche and at the end of the reproductive years. 20% of cases are adolescents 50% of cases in perimenopausal years Introduction Heavy menses, prolonged menses, or frequent irregular bleeding are the most common complaints. Up to 20% of women will experience irregular cycles in their lifetimes. Normal Menstrual Cycle Pathophysiology Two types: anovulatory and ovulatory Most women with DUB do not ovulate (70-80%). In theses women, there is continuous E2 production without corpus luteum formation and progesterone production. Adolescent: 20% Perimenopausal years: 50% Ovulatory DUB occurs most commonly at the reproductive age. 20-30% of DUB Incidence in these patients may be as high as 10% Anovulatory DUBEtiology Psychological?stress Body weight (obesity,?anorexia, or a rapid change) Endocrine: In perimenopausal women, the mean length of the cycle is shorter compared to younger women. Shortened follicular phase Diminished capacity of follicles to secrete Estradiol? Neoplasm, Drugs It may be otherwise?idiopathic. Endometrial Hyperplasia Chronic anovulatory, persistently elevated estrogen levels, uninterrupted by progesterone Proliferative Disorder: earliest pathology Simple Hyperplasia: 1% will develop EM cancer Complex Hyperplasia: 3% Atypical Hyperplasia: precarcinoma 15% will develop EM cancer In fact, 17-51% cases are associated with EM cancer Ovulatory DUB Luteal phase insufficiency Shortened menstrual interval(24-26d) Not easy to conceive baby Recurrent first-trimester abortion Irregular shedding of endometrium Prolonged involution of corpus luteum 5-6th day during menses of the menstrual cycle, the secretor