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Abnormal Uterine Bleeding

Normal Endometrial/Ovarian Cycle

The lining of the uterus (endometrium) responds to hormones made in the ovary. The pituitary gland at the base of the brain secretes a hormone called follicle stimulating hormone (FSH) which causes the egg follicles in the ovary to make estrogen. Estrogen causes the endometrium to thicken. When ovulation occurs, a second hormone (progesterone) is secreted by the ovary. This causes the lining of the uterus to become spongy. The corpus luteum, which makes the progesterone, lasts for fourteen days. When the progesterone and estrogen levels fall, the endometrium sheds in a menstrual period.

Dysfunctional Uterine Bleeding (DUB)

Is generally used to cover all forms of abnormal bleeding for which an organic cause cannot be found. DUB can be of two types:

  • Ovulatory: is the commonest form is generally associated with emotional upsets, post delivery, environmental changes, etc.
  • Anovulatory: If ovulation does not occur, the ovary will continue making estrogen, causing the endometrium to keep thickening. This often leads to a late menstrual period followed by irregular bleeding and spotting. This can also result in endometrial polyps, or in extreme long-standing cases, cancer of the lining of the uterus. Longstanding lack of ovulation is treated with progesterone on a regular basis, which causes the endometrium to shed regularly. Birth control pills may often accomplish the same goal. It is usually possible to induce ovulation, but this is reserved for women attempting to become pregnant.

Any stress, such as traveling or a new job can interfere with ovulation. Fortunately this will usually be temporary, and rarely requires treatment.