(3) In women 20 to 40 years of age, the primary common cause of nonstructural uterine bleeding is ovulatory dysfunction, most often caused by PCOS or anovulatory bleeding
Differential diagnosis of heavy menstrual bleeding in adolescents Endocrine causes Infections Anovulatory bleeding
Cervicitis PCOS Adenomyosis Thyroid disease Disorders of the uterus Other Myoma Bleeding disorders Intrauterine device von Willebrand disease Polyps Platelet dysfunction Cancer Thrombocytopenia Medications Clotting factor deficiency Depot medroxyprogesterone Pregnancy Anticoagulants Abortion Trauma Ectopic pregnancy Foreign body Gestational trophoblastic disease Hemorrhagic ovarian cysts PCOS: polycystic ovary syndrome Table 3.
ACOG practice bulletin: management of anovulatory bleeding
. Int J Gynaecol Obstet 2001;72(3):263-71.
In anovulatory bleeding
with stable patient, PG synthetase inhibitors such as mefenamic acid and antifibrinolytic drugs tranexamic acid were used as the first-line therapy for control of blood loss.
In women between age 40 years to menopause, AUB is much more of a concern, and it is often due to anovulatory bleeding
In younger women, consider a biopsy if they've had a "long history" of untreated anovulatory bleeding
, which could be 2 years or 5 years, she suggested.
Because of OC underutilization, Dr Burkman said, many perimenopausal women rely on sterilization as their only option for dealing with contraception, Unfortunately, these women miss out on "the significant benefits that OCs have in managing some of their reproductive health or medical problems." The noncontraceptive benefits of OCs that are of increasing concern as women age include prevention of osteoporotic bone loss as well as immediate quality-of-life issues such as control of anovulatory bleeding
and relief of primary dysmenorrhea and heavy flow or menorrhagia.
Although less common than anovulatory bleeding
, ovulatory DUB may also occur.
She is in the perimenarchal stage of her reproductive life cycle, when anovulatory bleeding
was more common in above 40 age group.
(2) In addition to a pregnancy test, consider testing for thyroid dysfunction and obtaining serum prolactin levels for women presenting with anovulatory bleeding
. (3) If anemia is suspected, a hematocrit or hemogram is indicated.
We have observed in majority of cases the cause is dysfunctional anovulatory bleeding
secondary to anovulation; endocrine disorders and bleeding diathesis were the other common causes.