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KMID : 0381219710030050358
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Journal of RIMSK
1971 Volume.3 No. 5 p.358 ~ p.365
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DYSFUNCTIONAL UTERINE BLEEDING
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Abstract
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Dysfunctional uterine bleeding may be defined as abnormal bleeding from the uterus unassociated `% with organic changes, such as tumor inflammation or pregnancy. Although apt to occur at the extremes of the reproductive life, dysfunctional bleeding may appear at any age and it is one of the most frequent gynecological complaints.
It has been thought for many years, that the action of estrogen to suppress the formation and secretion of anterior pituitary gonadotrophic hormones is a direct action of this on anterior pituitary gland. However, the discovery of the relationship between certain midbrain nuclei and the secretion of anterior pituitary gonadotrophic hormones has led to speculation about, and re -investigation of this theory. This relationship has provided a clue to the mechanism of the effect of the emotions on the menstrual cycle an area that still presents many clinical problems.
In the past 30 years, much has been learnt by an intensive study of relationships between the specific sex hormones and pituitary gland and endometrium, and many potent drugs were synthesized. Yet, many areas are still unknown.
The diagnosis of dysfunctional uterine bleeding can be made with certainty only after a careful bimanual examination and curettage. Even though a rectal examination may be sufficient to exclude gross pelvic pathology, investigations related to the diagnosis must include the efforts to rule out not only the pelvic disease but also blood dyscrasias and other non-gynecological pathology which may influence uterine bleeding. When the diagnosis of dysfunctional uterine bleeding is established, it is important to distinguish whether it is ovulatory or anovulatory especially for the management.
In the face of so many gaps in our knowledge as to the etiology of the dysfunctional uterine bleeding and as to the effect of specific sex hormones on the pituitary gland and endometrium, it is no wonder that the management of this disease is empirical.
The newer synthetic progestational-like compounds have much more greater biological effect than progesterone itself and are used with benefits in the treatment of dysfunctional uterine bleeding.
Curettage is utilized not only as a diagnostic but also a therapeutic measure and in many in stances, it is followed by a remission of abnormal bleeding pattern.
The effect of hormonal treatment and curettage on the dysfunctional uterine bleeding is encouraging.
However, in some instances, no effect is obtained, and the trouble recurs at frequent intervals in spite of repeated attempts to control it.
In such instances, when conservative treatment has been unsuccessful and the bleeding interfere seriously with the patient´s physical and socio-economic condition, hysterectomy is justified, The hormonal control of this disease serves its greatest purpose in the younger age group and surgical means of treatments are more widely employed after the age of 35 years, by which, time , o t patients have had their desired family. As general measures, adequate rest, diet and exercise are important, especially in the pubes girl, and also good patient-doctor relationship is perhaps the most important tool in the management of dysfunctional uterine bleeding.
Finally, it is stressed that progesterone is not a hen ostatic drug but it exerts its action 0111%, on the withdrawal bleeding, thus producing a chemical curettage.
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