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Etiology and Treatment of Dysfunctional Uterine Bleeding

From the Department of Obstetrics and Gynecology at Duke University School of Medicine, Durham, North Carolina and the Department of Gynecology and Obstetrics at The Johns Hopkins University School of Medicine, Baltimore, Maryland.

Patients with dysfunctional uterine bleeding of perimenarcheal, postmenarcheal and perimenopausal years were evaluated with daily follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels, urinary or serum estrogens, vaginal smears for maturation index determination and basal body temperature charts. Tubal and endometrial pathology, and complications of pregnancy were excluded from the diagnosis. Anovulatory bleeding in the perimenarcheal and postmenarcheal groups was treated with clomiphene citrate or administration of a progestational agent. In the perimenarcheal group, short ovulatory cycles or irregular anovulatory bleeding patterns were observed. The gonadotropin determinations were compatible with a central defect, probably an immature hypothalamus. In the perimenopausal group, bleeding was most commonly associated with anovulation, secondary to ovarian failure. Markedly elevated FSH levels and normal or slightly elevated LH levels were obtained. The postmenarcheal group included patients with a variety of disorders: Stein-Leventhal syndrome, obesity stress, premature menopause, and congenital ovarian anomalies. In those patients with central defects, LH predominance was observed, whereas in patients with ovarian problems an FSH predominance prevailed.