UTERINE BLEEDING

abnormal bleeding from the uterus, which is not related to menstruation. Menstruation is the normal cyclic bleeding that occurs when the egg has been released from the ovary and fertilization has not occurred. Other episodes of bleeding that cannot be considered part of the normal cycle are called dysfunctional uterine bleeding. This occurs most often in women during early adolescence and immediately before menopause begins. Menopause is the period during which egg release and menstrual bleeding slacken and cease. Dysfunctional bleeding is thought to be caused by imperfect ovarian functioning. The ovaries are the source of the eggs and of hormones that act upon the uterus. The ovaries are controlled by the hypothalamus in the brain and by the pituitary; these structures give the ovaries the stimulus to produce and secrete the reproductive hormones estrogen and progesterone. A reduction in the amount of estrogen causes the walls of the uterus to shed part of their lining and bleed. Alterations in any of the structures controlling the uterus may create unusual bleeding patterns. The ovary itself may be mechanically disrupted by pressure from other organs, displacement, or tumour growths. Emotional stress or psychological disturbances may affect the hypothalamus and cause suppression of stimulants to the ovary, with resultant uterine bleeding. Dysfunctional bleeding can also be associated with changes in environments, obesity, chronic illness, and with psychologically seated sexual problems and anxieties. Blood and cardiovascular disorders such as anemia, clotting defects, fragile capillaries, and heart congestion also cause abnormal bleeding. Small blood vessels may spontaneously rupture if, for example, the blood pressure is high. Local injuries can bruise or injure the uterine wall. Intercourse, masturbation, abortion attempts, forceful inserting of tampons, and mechanical contraceptive devices may cause injury and irritation. Infections in the abdominal cavity, the ovaries, or the uterus may cause some bloody discharge. Such discharge is usually not severe and does not persist. The further away an infection is from the ovaries and uterus, the less likelihood it has of causing dysfunctional bleeding. Bleeding that is intermittent spotting or that gushes after intercourse or douching may be a sign of tumour growths or polyps. Some tumours produce estrogen that disrupts the normal menstrual cycle. Nearly all tumours in the uterus are richly supplied with blood vessels; when the tumours are moved or rotated, small vessels usually rupture, producing the abnormal bleeding. Treatment for dysfunctional bleeding is directed toward the underlying cause.