Dysfunctional Uterine Bleeding

Methods: This prospective study was conducted on women with dysfunctional uterine bleeding, who attended Gynaecology OPD at Hind Institute of Medical Sciences, between August 2015 and April 2016. After applying inclusion and exclusion criteria, 72 women diagnosed with DUB were enrolled randomly in two groups A and B. Group A was treated by Ormeloxifene and Group B patients were treated with combined oral contraceptive pills for three consecutive cycles. The efficacies of the studied drugs were compared by analyzing the mean change in the pre and post treatment PBAC score, haemoglobin level and endometrial thickness using unpaired t-test.

TRANSVAGINAL SONOGRAPHY IN DYSFUNCTIONAL UTERINE BLEEDING AND ITS CORRELATION WITH HISTOPATHOLOGY – ANJALI SINGH, SAROJ SINGH, VEENA MATHUL, KALPANA SINGH DEC 2001 . Total number of 100 cases, out of which 50 were of dysfunctional uterine bleeding and 50 of reproductive age group with normal menstrual cycle were taken for the study. All of them were subjected to transabdominal ultrasonography with full bladder technique with 3.5 MHz probe and the transvaginal sonography with empty bladder technique with 3.5 MHz intravaginal transducer and then finally to endometrial biopsy for histopathologial correlation.

BACKGROUND: Dysfunctional uterine bleeding (DUB) is one of the commonest presenting symptoms in gynaecology out-patient department. The term dysfunctional uterine bleeding is used to describe abnormal uterine bleeding for which no specific cause has been found. Endometrial biopsy could be effectively used as the first diagnostic step in DUB. This study was done to evaluate histopathology of endometrium for identifying the endometrial causes of DUB and to correlate them with various age groups MATERIALS AND METHODS: This is a prospective study, undertaken in the department of pathology of P. D. U. Medical College, Rajkot, over a period of two years from July 2010 to July 2012. 150 endometrial lesions diagnosed on histopathology were selected for the final analyses. RESULTS: The most common age group presenting with DUB was 41–50 years (40.6%). The commonest pattern in these patients was proliferative endometrium. The commonest pathology was simple cystic hyperplasia (25.3%). Other patterns identified were secretory endometrium, menstrual endometrium, Pseudodecidual changes, endometrial carcinomas. Endometrial causes of DUB and age pattern was statistically significant with P value <0.05. CONCLUSION: There is an age specific association of endometrial bleeding, with highest incidence in perimenopausal age group. The incidence of proliferative pattern was high in this study. Dilatation and curettage is helpful to exclude other organic pathology, which mimic DUB like endometrial polyp, endometritis, etc. It is useful for diagnosis, to assess therapeutic response and to know the pathological incidence of organic lesions in cases of dysfunctional uterine bleeding prior to surgery.

particularly useful in those not responding to medical management and those who are at high risk for undergoing major surgery. Transcervical resection of endometrium (T.C.R.E.) is a first generation hysteroscopic endometrial ablation technique that has gained popularity in gynaecological practice as an alternative to hysterectomy for patients presenting with dysfunctional uterine bleeding. The results so far suggest that T.C.R.E. is of comparable efficacy in producing hypomenorrhea in 80% to 90% and amenorrhoea in 25% to 50%. 2-5

12. Mrinal Kanti Kundu,Nibedita Chattopadhyay,Sajal Kumar Mondal, Manami Roy, Manas Kumar Saha,V. Aruna Kumari, Arati Biswas. Role of Thyroid Dysfunction in patients with a provisional diagnosis of Dysfunctional Uterine Bleeding. Journal of Evolution of Medical and Dental Sciences 2014;vol.3,issue 38,August 25;page:9751- 9756,DOI:10.14260/jemds/2014/3261

Conclusions: Ormeloxifene was significantly better than combined OCP in reduction of menstrual blood flow in cases of DUB. It has better compliance and marked improvement in subjective symptoms as compared to OCP. Keywords: Centchroman, Combined oral contraceptive pills, Dysfunctional uterine bleeding, Ormeloxifene, Pictorial Blood loss assessment chart, Selective estrogen receptor modulators

We have previously reported on a randomised clinical trial comparing a bipolar radio-frequency impedance- controlled endometrial ablation system and thermal balloon ablation, which are both second generation endometrial ablation devices. At one-year follow-up, amenorrhoea rates were 43% (34/83) in the bipolar group and 8% (3/43) in the balloon group (Relative Risk (RR) 0.17, 95% confidence interval (CI) 0.06–0.52). Moreover, 12 months after the start of treatment 90% of the patients in the bipolar group were satisfied with the result of the treatment versus 79% in the balloon group (RR 0.46, 95% CI 0.1–1.1). We concluded that the bipolar ablation system was more effective than balloon ablation in the treatment of dysfunctional uterine bleeding.

In present era with the changing role of women in society, occupational whereabouts and with increased stress the number and frequency of menstrual cycles have increased. The victimized patients end up with general debility and anaemia. Aacharya Sushrut says that when menstruation comes in excess amount, for prolonged period and/or even without normal period of menstruation (during menstruation in excessive amount and for prolonged period, but in intermenstrual period even scanty and for a short duration) and different from the features of normal menstrual blood or denoting the feature of specific Dosha is known as Asrigdar. Asrigdar indicates the excessive and irregularity of menses. Asrigdar can be correlated with abnormal uterine bleeding specially, dysfunctional uterine bleeding (DUB) on the basis of its description in literature. Present study is aimed at finding out a method of treatment, which will impart a permanent cure without any side effect. Vasa-Ghan is taken in present study because of its Tikta rasa, shita virya and Rakta-pitta shamak property. In the present clinical trial, the study was completed on 15 patients. Extremely significant results are shown on Intensity, Amount, Duration and Inter menstrual period, very significant results are shown on Body ache and significant result on burning sensation.

BHU, Varanasi. Newly diagnosed dysfunctional uterine bleeding from all age groups from puberty to reproductive and perimenopausal age group were eligible for the study. They were confirmed by Histopathological examination and by Trans Vaginal Scan (TVS) / Trans abdominal scan (TAS). Informed consent was taken from all patients for the study. Inclusion criteria were all women with irregular and or heavy menstrual bleeding age groups from adolescent to peri menopausal women who were willing to maintain Monthly record of vaginal bleeding and willing to come for regular follow up at 3 , 6 and 12 months. Exclusion criteria were pregnancy or desirous to become pregnant, Coagulopathy, medical disorders - liver dysfunction, heart disease, migraine, stroke, renal disease, hypo/hyperthyroidism, and lactating women in first 6 months of post-natal period, intake of hormonal contraception or any hormonal therapy received in last three months. History of hypersensitivity or allergy to Ormeloxifene was also excluded. A detailed history of demographic profile, obstetric history, any medical and surgical illness and detailed menstrual history regarding amount and duration of bleeding was taken. Subjective assessment of menstrual blood loss was done with pictorial blood loss assessment chart (PBAC). PABC score > or = 100 was considered as menstrual blood loss >/= 80 ml, was considered as diagnostic of menorrhagia (7). Patients were asked to maintain a menstrual diary and PBAC score was calculated from it on successive visits. General examination and complete Gynaecological examination was performed.

Objective: Experience of Norethisterone Tablets in the treatment of perimeno- pausal dysfunctional uterine bleeding, which in order to exchange experience with Clinician. Methods: 60 patients who were treated in our hospital during May 2015 to May 2016 have been diagnosed with perimenopausal dysfunctional uterine bleeding as the research object, and performed Diagnostic curettage on all patients. Then, randomly divided all the patients into two groups that every group has 30 cases. The patients in the experimental group were given Nore- thisterone Tablets after curettage, but the control group was given Medroxy- progesterone Acetate Tablets. Results: In the experimental group, 14 cases were cured, 11 cases were markedly effective, 3 cases were effective, and the total ef- fective rate was 93.33%. While in the control group, 5 cases were cured, 9 cases were markedly effective, 10 cases were effective, the total effective rate was 80%. The comparison showed that the total effective rate of the two groups was dif- ferent, and the difference was statistically significant ( P < 0.05). Conclusion: Norethisterone Tablets treatment of perimenopausal dysfunctional uterine bleeding has obvious curative effect, which has little side effect, and the price is low. It is worthy of wide clinical application.

Background-Dysfunctional Uterine Bleeding (DUB) is defined as abnormal uterine bleeding not caused by pelvic pathology, medications, systemic disease or pregnancy. It is a diagnosis of exclusion. Endometrial biopsy is a simple, cost effective procedure which helps in ruling out organic causes and establishing the changes in endometrium. Objectives-To analyse the endometrial histomorphological patterns in cases of DUB and to correlate with clinical presentations. Methodology-Endometrial biopsy samples fixed in 10% formalin were processed, embedded, sections cut, stained with H& E stain and hisopathological features were noted. Results- Out of 500 endometrial biopsies studied, 225 were Proliferative,69 Secretory,127 Simple hyperplasia without atypia,27 Complex hyperplasia without atypia,10 Mixed endometrium,07 disordered proliferation,07 chronic endometritits,05 Partial mole,05 luteal phase defect,05 atrophic,04 Arias stella reaction,04 inadequate,02 Endometrial adenocarcinomas, 01 endometrial stromal sarcoma and01 Endometrial polyp. Majority of patients were in the age group of 31-40 years. Most common presenting complaint was menorrhagia. Conclusion-The study helps in detecting and differentiating functional causes from organic lesions, thereby facilitating appropriate patient management.

Our result revealed that patients with young age or lived in highly urbanized areas preferred to receive TCM treat- ment, which was consistent with the previous studies [16, 17]. TCM is popular among female patients. Our previous study found that patients with uterine fibroid had a high utilization rate of TCM [9]. In this study, we found that large portions of TCM seekers also received conventional treatment. It is possible that patients with better Table 1 Demographic characteristics of the patients with newly diagnosed dysfunctional uterine bleeding from 1997 to 2010 in Taiwan

Abstract A questionnaire was sent to 121 women with dysfunctional uterine bleeding who had been treated with the HTA i . Prior to treatment the women had received advice about the failure rate of the HTA i . There was a 68% (82) response rate, of which 11% (9/82) of patients had a hysterectomy. Of these patients 7.3% (6/82) were performed for persistent pelvic pain and 1.2% (1/82) for irregular vaginal bleeding. The projected Kaplan-Meier survival rate for the device over a 5-year period was 89%. The amenorrhoea rate was 42.7% and the oligomenorrhoea rate was 81.7%. The HTA i is an effective form of treatment for DUB and the majority of women are likely to avoid a hysterectomy at 5 years.

Abstract Abnormal uterine bleeding is one of the most common problems in women of reproductive age, and dysfunctional uterine bleeding (DUB) accounts for about half the cases. The aim of this review is to present all treatment options for women suffering from DUB and to evaluate their effectiveness. A detailed search strategy on electronic databases was carried out to identify trials and reviews on management of abnormal uterine bleeding. Tranexamic acid is the most effective medical treatment. A levonorgestrel-releasing intrauterine device is a low-cost, simple, and effective medical method, comparable to hysterectomy in terms of quality of life. In cases of DUB resistant to medical treatment, surgical treatment should be offered. First-generation ablation techniques are effective, but have a long learning curve. Second-generation ablation devices are highly effective and safe alternatives, thorough- ly compared to first-generation techniques. Hysterectomy is the only method that guarantees treatment of dysfunctional uterine bleeding, but is a major operation associated with higher morbidity and mortality rates. Proper counseling of each woman with DUB regarding all treatment modalities can provide the best choice for each patient. More prospective randomized trials are needed to establish the effectiveness of these methods

Methods: This prospective study was done on 100 women presenting with dysfunctional uterine bleeding, of 20-50 years of age, who were ready for follow-up and were allocated into two equal groups, one was given Ormeloxifene and the other was given Norethisterone for a period of 3 months. Haemoglobin levels, endometrial thickness on ultrasound and Pictorial Blood loss Assessment Chart (PBAC) scores were assessed before and after the treatment. Results: It was found that both Ormeloxifene and Norethisterone reduced menorrhagia, with a significant difference in PBAC scores (p value <0.05). There was a notable reduction in PBAC scores in Ormeloxifene group (66.53% change from pretreatment mean value) as compared to Norethisterone group (31.38% change from pretreatment mean value); and same holds true for the change in haemoglobin levels as well as endometrial thickness. Ormeloxifene was found to have a greater effect on heavy menstrual bleeding in comparison to Norethisterone.

Immunohistochemical analysis of estrogen and progesterone receptors in endometrium is a very useful adjuvant investigation in the management of DUB patients. We support the role of these receptors in the etiopathogenesis of DUB and consequently the development of simple endometrial hyperplasia, which is a pre-cancerous lesion. Our correlation of ER/PR with sonographic endometrial thickness in DUB implies that the later may help in predicting the behavior of these receptors in endometrium. There are limited reports available on the study of both glandular and stromal hormonal receptors in simple endometrial hyperplasia. We conclude that glandular estrogen receptor is a better predictor of disease behavior than other receptors in these patients. There is a subset of DUB patients with increased concentration of ER & PR, who might benefit from the receptor-targeted drugs, such as progesterone antagonists and receptor modulators. This obviates the need for invasive surgeries. We advocate the use of these drugs in the treatment of patients with dysfunctional uterine bleeding and endometrial hyperplasia. However, this

● Asrigdar is a disease caused by vitiation of all the three Doshas, with a clear pre- dominance of Pitta (as evidenced by Samprapti) and manifesting as excessive amount of blood loss or long duration of blood loss or short inter menstrual period, as well as presence of any two or three as cardinal symptoms of Asrigdar. This can be correlated to dysfunctional uterine bleeding in present context.

Background: Dysfunctional Uterine Bleeding (DUB), is the commonest cause of Abnormal Uterine Bleeding (AUB). It causes morbidity, anaemia, and unnecessary hysterectomies in women of fertile age group. This study attempts to study efficacy of medical management especially Selective Estrogen Receptor Modulator (SERM) namely Ormeloxefine (ORM) (Sevista®) in Perimenopausal women. Ormeloxifene was marketed in India for contraception under brand names Centron, Saheli, Choice-7, Novex and Novex-DS. It’s a benzopyran derivative also known as Centchroman which causes asynchronousity between ovulation and menstrual cycles possibly because of both estrogenic and anti-estrogenic actions. It has been known to cause delay in ovulation in clinical trials; however, majority have been unaffected. It causes delay in proliferation of endometrium thereby causing asynchronous cycles. It also improves motility of ciliary lining of Fallopian tubes thereby reducing the chances of implantation of fertilized egg.

Any abnormality in Rutuchakra (menstrual rhythm) leads to excessive and irregular uterine bleeding is known as Raktapradara or Dysfunctional Uterine Bleeding (DUB).The main ingredients of indi- genous compound churna are SHUNTHI and BHARANGI. SHUNTHI which is vata- kaphahara, di- pana, bhedana, raktashodaka, sophahara, possess significantly antioxidant properties, an effective supplement for heavy menstrual bleeding and act as raktapittahara and anti-inflammatory in action. Bharangi is kapha- vatahara, jvarahara, kasahara, raktadoshahara and amapacana. In present study 30 patients were selected that fulfilled the criteria of diagnosis and consented for the study. Af- ter completion of three consecutive cycles, treatment was withdrawn and net follow up was taken again after interval of one month to know any recurrence of sign/symptoms. The parameters selected for the study were Duration of menstrual flow, Amount of menstrual bleeding, consistency, inter- menstrual cycle, backache, pain in abdomen and haemogram.53.33% patients had moderately im- proved after third follow-up. The trial drugs are significant in the management of Raktapradara. Keywords: Raktapradara, SHUNTHI, Bharangi.

Background: Dysfunctional Uterine bleeding (DUB) is the most common cause of abnormal uterine bleeding (AUB). Medical therapy being the first line of management, an ideal drug should be able to block the estrogenic effects on the Endometrium without interfering with its beneficial effects on other tissues. Both Ormeloxifene - a selective estrogen receptor modulator (SERM) and Tranexamic acid-an anti fibrinolytic inhibitor is important in the treatment of DUB. The aim of this study is to assess the efficacy and safety of Ormeloxifene v/s Tranexamic acid in the treatment of DUB.