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Dysfunctional uterine bleeding is abnormal bleeding caused by hormonal changes rather than a tumor, pregnancy, inflammation, or injury. This type of bleeding occurs usually at the beginning and end of the reproductive years: about 20% of dysfunctional uterine bleedings occur in adolescent girls; and more than 50% in women over the age of 45. Most abnormal uterine bleedings are the dysfunctional kind, but the diagnosis is done only when all other medical conditions associated with uterine bleeding, have been excluded. Dysfunctional uterine bleeding usually is caused by sustained levels of estrogen, which leads the uterine lining to thicken. The endometrium is then shed irregularly and incompletely, leading to bleeding. Over the years, estrogen without sufficient progesterone to counteract its effects may cause abnormal dysfunctional uterine bleeding. Bleeding is prolonged, heavy, and irregular. A blood test is performed to check the extent of the blood loss. The dysfunctional uterine bleeding is diagnosed when other medical conditions associated with uterine bleeding are excluded. A biopsy of the endometrium is taken before medication treatment is started if a female is of age 35 or older and has ovaries syndrome, no children, and is not extremely overweight. A biopsy is needed, because these women have a higher risk of developing cancer of the endometrium. Treatment depends on the woman’s plans about pregnancy, age, and the condition of the endometrium (uterine lining). If the uterine lining contains abnormal cells and is thickened, frequently the uterus is removed, because the abnormal cells can be precancerous. If the endometrium contains normal cells, but is thickened, bleeding can be treated with large doses of oral contraceptives containing progestin and estrogen or with estrogen done intravenously where progestin is given by mouth. Bleeding usually stops within 1-2 days. Small doses of oral contraceptive can then be taken for a period of at least 3 months. Women who have not experienced heavy bleeding can take small doses from the beginning of treatment. If the treatment of dysfunctional uterine bleeding with estrogen or oral contraceptives is not appropriate, a progestin alone can be used by mouth for about 2 weeks each month. If the treatment with these hormones is not working, curettage (C and D), and dilation, in when tissue from the endometrium is taken out by scraping, is required. If a woman wishes to become pregnant, clomiphene can be taken by mouth to induce egg release.
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