••• Chapter 24^ Functional and Dysfunctional Uterine Bleeding^245
❍ What are the lifestyle elements that may cause anovulatory bleeding?
Sudden weight loss, stress, and intense exercise.
❍ Decline in which hormone heralds the onset of menses?
Normal menses occurs because of progesterone withdrawal.
❍ What is the life span of a normal corpus luteum in the absence of pregnancy?
Approximately 14 days.
❍ What is Halban syndrome?
It is the persistence of a corpus luteum. Patients commonly present with delayed menses, pelvic mass, and negative
pregnancy test. Clinically, this is often confused with an ectopic pregnancy. Typically self-limited and usually does
not recur.
❍ How does one measure the strength of a progestational agent?
Delay of menses.
❍ In women of reproductive age, what is the most common cause of estrogen excess bleeding?
Chronic anovulation associated with polycystic ovaries.
❍ What are the medications that can cause vaginal bleeding?
Contraceptive medication [OCP, intrauterine device (IUD), Depo-Provera], hormone replacement therapy,
anticoagulants, corticosteroids, chemotherapy, dilantin, antipsychotic medication, and antibiotics (eg, due to toxic
epidermal necrolysis or Stevens-Johnson syndrome).
❍ What is the immediate objective of medical therapy in treating anovulatory bleeding?
To stabilize the endometrium and control acute hemorrhage.
❍ How does progesterone work at the cellular level to control DUB when prescribed in pharmacologic doses?
Progestins are powerful antiestrogens. They stimulate 17b-hydroxysteroid dehydrogenase and sulfotransferase
activity. This results in conversion of estradiol to estrone sulfate that is rapidly excreted in the urine. Progestins also
inhibit augmentation of estrogen receptors. Additionally, progestins suppress estrogen-mediated transcription of
oncogenes.
❍ Failure of oral contraceptives to control bleeding when given twice daily for 5 and 7 days should prompt
further evaluation. What are the most common diagnostic possibilities?
Complications of pregnancy (incomplete abortion, ectopic pregnancy), endometrial polyps, and endometrial
neoplasia (including hyperplasia).
❍ A 14-year-old female presents with her first menses. Her bleeding is profuse and her hemoglobin is 4 g/dL.
The pregnancy test is negative and to the best of your ability a bleeding disorder is excluded. What would
be your pharmacologic approach to this patient?
Conjugated estrogens 25 mg intravenously (IV) every 4 hours until bleeding stops or for 4 doses (12 hours).
Progestin treatment is started concurrently.