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Forum Name: Gynecology

Question: Worried bout irregular periods


 amanda42071 - Fri Jun 03, 2005 10:58 am

I am 19yrs old and have been having very regular periods since I was 12 at least until now. I did not have my January period but I didn't think too much about it. I started bleeding on February 27, 2005. At first it was very light which is unusual for me. Then my period continued all the way through March. During this time, I went to my regular doctor and she did labwork such as pregnancy test and to see if I was anemic and some other tests. She also ordered an ultrasound done. Everything came back normal. I was then referred to a gynecologist. She looked over my ultrasounds and did an examination but said everything was normal and gave me birth control pills to stop the bleeding. I took them and the bleeding did stop but they kept making me really sick to my stomach. I was having really bad stomach cramps and vomitting, so I stopped taking them in April. I started bleeding a few days later but it stopped within 7 days. I have not had a period since then. I am seriously concerned that is something wrong even though everything appears normal. Is this normal for a person my age. I do not smoke or drink am active and healthy. I have been tested for stds and do not have any. What could be wrong?
 Dr. Tamer Fouad - Wed Jan 11, 2006 7:26 am

User avatar Hello,

Evaluating abnormal uterine bleeding in the reproductive years requires the exclusion of pregnancy or pregnancy-related disorders, medications known to cause abnormal uterine bleeding, iatrogenic causes, obvious genital tract pathology, and systemic conditions.[1] Once all these causes are excluded it can be presumed that you have dysfunctional uterine bleeding.

Any medicine or herbal product known to cause abnormal uterine bleeding must be excluded. These include anticoagulation therapy, contraceptive use such as an intrauterine device, Levonorgestrel implant (Norplant System), Medroxyprogesterone contraceptive injection (Depo-Provera), oral contraceptives in addition to hormone replacement therapy and psychotropic agents.[1]

The presence of systemic diseases such as cirrhosis, coagulation disorder or hypothyroidism is known to cause abnormal uterine bleeding.[1]

Once all these causes are excluded it can be presumed that you have dysfunctional uterine bleeding. Dysfunctional uterine bleeding is a diagnosis of exclusion. This ovulatory or anovulatory bleeding. In the vast majority of cases, it is secondary to anovulation (lack of ovulation). If you do not experience cramps or other premenstrual symptoms this could be a manifestation of anovulation.

Anovulatory dysfunctional uterine bleeding is a disturbance of the hypothalamic-pituitary-ovarian axis that results in irregular, prolonged, and sometimes heavy menstrual bleeding. It may occur immediately after menarche but before maturation of the hypothalamic-pituitary-ovarian axis, or it may occur during perimenopause, when declining estrogen levels fail to regularly stimulate the LH surge and resulting ovulation.

Some common causes of hypothalamic anovulation are weight loss or gain, eating disorders, stress, chronic illness, and excessive exercise. Women with chronic anovulation that is not attributable to any of these causes are considered to have idiopathic chronic anovulation.[3]

Anovulatory bleeding can be thought of as estrogen breakthrough bleeding. This type of bleeding is related to the levels of estrogen stimulating the endometrium. For example, high levels of estrogen for prolonged periods result in amenorrhea followed by acute intermittent heavy bleeding, and continually low levels of estrogen availability result in intermittent spotting.[4]

Endometrial evaluation should be considered in women under 35 years of age who show evidence of chronic anovulation. These women are at increased risk for endometrial carcinoma secondary to prolonged unopposed estrogen stimulation of the endometrium.[1]

References:
==========
1. Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol 1996;175(3 Pt 2):766-9.
2. Petrozza J, Poley K. Dysfunctional uterine bleeding. In: Curtis MG, Hopkins MP, eds. Glass's office gynecology. 5th ed. Baltimore: Williams & Wilkins, 1999;241-64.
3. Oreil KA, Schrager S. Abnormal uterine bleeding. Am Fam Physician 1999;60(5):1371-82.
4. Speroff L, Glass RH, Kase NG, eds. Dysfunctional uterine bleeding. In: Clinical gynecologic endocrinology and infertility. 5th ed. Baltimore: Williams & Wilkins, 1994:575-93.

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