Dysfunctional uterine bleeding

Uterine bleeding during puberty (juvenile uterine bleeding, dysfunctional uterine bleeding, heavy menstruation during puberty) is a bloody discharge from the uterus that differs from natural menstruation and occurs during the first 3 years after menarche as a result of a discord in the activity of the reproductive system.

ICD-10 code

N92.2 Heavy menstruation during puberty.

Epidemiology of dysfunctional uterine bleeding

Dysfunctional uterine bleeding during puberty (DUB) in the structure of gynecological diseases in childhood and adolescence ranges from 10.0 to 37.3%. Over 50% of all visits to a gynecologist by adolescent girls are due to uterine bleeding during puberty. Almost 95% of all vaginal bleeding during puberty is due to uterine bleeding during puberty. Most often, uterine bleeding occurs in adolescent girls during the first 3 years after menarche.

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What causes dysfunctional uterine bleeding?

Dysfunctional uterine bleeding in puberty is a multifactorial disease that occurs as a result of excessive or unbalanced interaction of random factors and individual reactivity of the organism. The most common risk factors for the occurrence of uterine bleeding in puberty are acute psychogenic or prolonged psychological stress, unfavorable environmental conditions in the place of residence, hypovitaminosis, alimentary deficiency, obesity, underweight, etc. The leading and most likely provoking role belongs to various types of psychological stress, acute psychological trauma and constant readiness for stress reactions (up to 70%). It is more correct to regard these unfavorable factors not as causal, but as phenomena that provoke bleeding.

What are the symptoms of dysfunctional uterine bleeding?

The symptoms of dysfunctional uterine bleeding during puberty are quite heterogeneous. Certain typical symptoms depend on the level (central or peripheral) at which the disturbances in coordinated activity (self-regulation) occurred.

If it is impossible to recognize the type of uterine bleeding during puberty (hypo-, normo- or hyperestrogenic), and there is no correlation between clinical and laboratory data, we can talk about atypical forms of uterine bleeding during puberty.

How is dysfunctional uterine bleeding diagnosed?

Dysfunctional uterine bleeding during puberty is diagnosed based on clinical criteria:

• duration of vaginal bleeding less than 2 days or more than 7 days against the background of shortening (less than 21-24 days) or lengthening (more than 35 days) of the menstrual cycle;
• blood loss of more than 80 ml or subjectively more pronounced compared to normal menstruation;
• the presence of intermenstrual or postcoital bleeding;
• absence of structural pathology of the endometrium;
• confirmation of an anovulatory menstrual cycle during the period of uterine bleeding (the level of progesterone in venous blood on the 21st-25th day of the menstrual cycle is less than 9.5 nmol/l, monophasic basal temperature, absence of a preovulatory follicle according to echography).
  

Screening for dysfunctional uterine bleeding

It is advisable to screen for the disease using psychological testing among healthy female patients, especially students studying at a high educational level (grammar schools, lyceums, vocational classes, institutes, universities), especially excellent students. The risk group for the development of uterine bleeding in the pubertal period should include adolescent girls with deviations in physical and sexual development, early menarche, heavy menstruation with menarche.

How is dysfunctional uterine bleeding treated?

Dysfunctional uterine bleeding in puberty is treated in several stages. In patients with uterine bleeding, it is advisable to use plasminogen to plasmin inhibitors (tranexamic or aminocaproic acid) at the first stage of treatment. The intensity of bleeding is reduced by reducing the fibrinolytic activity of blood plasma. Tranexamic acid is prescribed orally at a dose of 4-5 g during the first hour of therapy, then 1 g every hour until bleeding stops completely. Intravenous administration of 4-5 g of the drug during the first hour is possible, then drip administration of 1 g per hour for 8 hours. The total daily dose should not exceed 30 g. With high doses, the risk of developing intravascular coagulation syndrome increases, and with the simultaneous use of estrogens, the probability of thromboembolic complications is high. It is possible to use the drug in a dose of 1 g 4 times a day from the 1st to the 4th day of menstruation, which reduces the volume of blood loss by 50%.

How to prevent dysfunctional uterine bleeding?

Patients with uterine bleeding during puberty require constant dynamic monitoring once a month until the menstrual cycle stabilizes, then the frequency of control examinations can be limited to once every 3-6 months. Ultrasound of the pelvic organs should be performed at least once every 6-12 months; electroencephalography - after 3-6 months. All patients should be trained in the rules of maintaining a menstrual calendar and assessing the intensity of bleeding, which will allow assessing the effectiveness of the treatment.

Patients should be informed about the advisability of correcting and maintaining optimal body weight (both in cases of deficiency and excess body weight), and normalizing work and rest patterns.

What is the prognosis for dysfunctional uterine bleeding?

Most adolescent girls respond favorably to drug treatment of dysfunctional uterine bleeding, and within the first year they develop full ovulatory menstrual cycles and normal menses. Dysfunctional uterine bleeding has a different prognosis, which depends on the presence of pathology of the hemostasis system or systemic chronic diseases and depends on the degree of compensation of existing disorders. Girls who remain overweight and have recurrent uterine bleeding during puberty at the age of 15-19 years should be included in the risk group for endometrial cancer.