WordNet

bleeding from the uterus that is not due to menstruation; usually indicative of disease (as cervical cancer)
(medicine) any disturbance in the functioning of an organ or body part or a disturbance in the functioning of a social group; "erectile dysfunction"; "sexual relationship dysfunction" (同)disfunction
impaired in function; especially of a bodily system or organ
(of a trait or condition) failing to serve an adjustive purpose; "dysfunctional behavior" (同)nonadaptive
of or involving the uterus; "uterine cancer"
the flow of blood from a ruptured blood vessel (同)hemorrhage, haemorrhage

PrepTutorEJDIC

機能障害,機能不全
子宮の / 同母異父の
出血する / 出血;放血

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/07 01:46:43」(JST)

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Dysfunctional Uterine Bleeding (DUB) is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable structural^[1] or organic pathology. It is usually due to hormonal disturbances: reduced levels of progesterone causes low levels of prostaglandin F2alpha and causes menorrhagia; increased levels of tissue plasminogen activator (TPA) (a fibrinolytic enzyme) leads to more fibrinolysis.

Diagnosis must be made by exclusion, since organic pathology must first be ruled out.

It can be classified as ovulatory or anovulatory, depending on whether ovulation is occurring or not.

Some sources state that the term implies a hormonal mechanism.^[2] Use of the term "dyfunctional uterine bleeding" is currently discouraged in favor of the term "abnormal uterine bleeding."

Ovulatory DUB

10% of cases occur in women who are ovulating, but progesterone secretion is prolonged because estrogen levels are low. This causes irregular shedding of the uterine lining and break-through bleeding. Some evidence has associated Ovulatory DUB with more fragile blood vessels in the uterus.

It may represent a possible endocrine dysfunction, resulting in menorrhagia or metrorrhagia. Mid-cycle bleeding may indicate a transient estrogen decline, while late-cycle bleeding may indicate progesterone deficiency.

Anovulatory DUB

About 90% of DUB events occur when ovulation is not occurring (Anovulatory DUB). Anovulatory menstrual cycles are common at the extremes of reproductive age, such as early puberty and perimenopause (period around menopause). In such cases, women do not properly develop and release a mature egg. When this happens, the corpus luteum, which is a mound of tissue that produces progesterone, does not form. As a result, estrogen is produced continuously, causing an overgrowth of the uterus lining. The period is delayed in such cases, and when it occurs menstruation can be very heavy and prolonged. Sometimes anovulatory DUB is due to a delay in the full maturation of the reproductive system in teenagers. Usually, however, the mechanisms are unknown.

The etiology can be psychological stress, weight (obesity, anorexia, or a rapid change), exercise, endocrinopathy, neoplasm, drugs, or it may be otherwise idiopathic.

Assessment of anovulatory DUB should always start with a good medical history and physical examination. Laboratory assessment of hemoglobin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, T₄, thyroid stimulating hormone (TSH), pregnancy (by βhCG), and androgen profile should also happen. More extensive testing might include an ultrasound and endometrial sampling.

Management

Drug of choice is progesterone. Management of dysfunctional uterine bleeding predominantly consists of reassurance, though mid-cycle estrogen and late-cycle progestin can be used for mid- and late-cycle bleeding respectively.

Also, non-specific hormonal therapy such as combined high-dose estrogen and high-dose progestin can be given. Ormeloxifene is a non-hormonal medication that treats DUB but is only legally available in India.

The goal of therapy should be to arrest bleeding, replace lost iron to avoid anemia, and prevent future bleeding.

A hysterectomy may be performed in some cases.^[3]

References

^ Bravender T, Emans SJ (June 1999). "Menstrual disorders. Dysfunctional uterine bleeding". Pediatr. Clin. North Am. 46 (3): 545–53, viii. PMID 10384806.
^ "Dysfunctional Uterine Bleeding". Retrieved 2010-01-23.
^ Bourdrez P, Bongers MY, Mol BW (July 2004). "Treatment of dysfunctional uterine bleeding: patient preferences for endometrial ablation, a levonorgestrel-releasing intrauterine device, or hysterectomy". Fertil. Steril. 82 (1): 160–6, quiz 265. doi:10.1016/j.fertnstert.2003.12.025. PMID 15237006.

External links

Merck Manual: Abnormal Uterine Bleeding
Dysfunctional Uterine Bleeding Research Video

UpToDate Contents

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1. 妊娠していない生殖可能年齢の女性における不正子宮出血に対するアプローチ approach to abnormal uterine bleeding in nonpregnant reproductive age women
2. 異常な子宮出血のマネージメント management of abnormal uterine bleeding
3. 思春期における異常子宮出血：鑑別診断およびアプローチ abnormal uterine bleeding in adolescents differential diagnosis and approach
4. 思春期における異常子宮出血：定義および評価 abnormal uterine bleeding in adolescents definition and evaluation
5. 思春期の異常子宮出血：マネージメント abnormal uterine bleeding in adolescents management

English Journal

Spontaneous cessation and recurrence of massive uterine bleeding can occur in uterine artery pseudoaneurysm after laparoscopically assisted myomectomy.

Oishi H, Wada-Hiraike O, Osuga Y, Yano T, Kozuma S, Taketani Y.SourceDepartment of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
The journal of obstetrics and gynaecology research.J Obstet Gynaecol Res.2012 Sep 25. doi: 10.1111/j.1447-0756.2012.01993.x. [Epub ahead of print]
A uterine artery pseudoaneurysm (UAP) is a rare but life-threatening complication that can occur after gynecologic surgery. Herein, we present a case of a 38-year-old woman who presented with massive uterine bleeding one month after a laparoscopically assisted myomectomy. Although the bleeding cease
PMID 23002950

Progestogens with or without oestrogen for irregular uterine bleeding associated with anovulation.

Hickey M, Higham JM, Fraser I.SourceThe University ofMelbourne, The RoyalWomen’sHospital,Melbourne, Australia. Martha.Hickey@thewomens.org.au.
Cochrane database of systematic reviews (Online).Cochrane Database Syst Rev.2012 Sep 12;9:CD001895. doi: 10.1002/14651858.CD001895.pub3.
BACKGROUND: Irregular menstrual bleeding may arise due to exogenous sex steroids, lesions of the genital tract or be associated with anovulation. Irregular bleeding due to oligo/anovulation (previously called dysfunctional uterine bleeding or DUB) is more common at the extremes of reproductive life,
PMID 22972055

Japanese Journal

Endometrioid adenocarcinoma with sex-cord like feature の 1 例

橋口真理子,中尾佳史,山崎文朗,安永牧生,内山倫子,野口光代,横山正俊,岩坂剛
日本臨床細胞学会雑誌 53(1), 13-18, 2014
背景 : 性索間質性腫瘍に類似する組織形態を併せもつ類内膜腺癌は子宮体癌としてまれである.症例 : 81 歳, 女性. 半年間持続する不正性器出血と貧血の進行を主訴として紹介され来院した. 子宮体部は手拳大に腫大しており, MRI では子宮内に 10.3×7.2 cm の腫瘤を認め, 造影効果より平滑筋肉腫あるいは癌肉腫が疑われた. 子宮内膜細胞診では, N/C 比の高い円形～類円形の腫瘍細胞が接 …
NAID 130004513226

2期的に子宮鏡視下病巣切除術で治療しえたポリープ状異型腺筋腫（APAM）の1例

竹中慎,森岡幹,石川哲也,遠武孝祐,青野抄子,豊澤秀康,荒木美智子,三村貴史,清水華子,飯塚千祥,宮本真豪,関沢明彦,九島巳樹
日本産科婦人科内視鏡学会雑誌 29(2), 453-458, 2013
… A 40-year-old nulligravida with a chief complaint of dysfunctional vaginal bleeding was found to have a 2 cm tumor in the uterine lower body by an ultrasound examination. …
NAID 130004554977

無排卵周期に伴う機能性出血の細胞像 : 特に endometrial glandular and stromal breakdown の細胞像について

則松良明
日本臨床細胞学会雑誌 51(2), 93-104, 2012-03-22
NAID 10030126265

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★リンクテーブル★

リンク元	「機能性子宮出血」「metrorrhagia」「機能障害性子宮出血」「不正子宮出血」「spotting」
関連記事	「dysfunction」「uterine」「uteri」「dysfunctional」