Bleeding anovulatory

Describe the underlying etiology and pathophysiology of amenorrhea, menorrhagia, anovulatory bleeding, and dysmenorrhea and how they relate to selection of effective treatment modalities. 

Recommend appropriate lifestyle and dietary modifications and pharmacotherapeutic interventions for patients with amenorrhea, menorrhagia, anovulatory bleeding, dysmenorrhea, premenstrual symptoms, and premenstrual dysphoric disorder. 

Anovulatory bleeding, also referred to as dysfunctional uterine bleeding, is secondary to the effects of unopposed estrogen and does not include bleeding owing to an anatomic lesion of the uterus. 

The use of metformin and thiazolidinediones for anovulatory bleeding associated with polycystic ovary syndrome is beneficial for anovulatory bleeding and fertility and also improves glucose tolerance and decreases overall cardiovascular risk. 

Anovulatory bleeding is the most common form of non-cyclic uterine bleeding.11 Patients often seek medical care to regulate... 

Amenorrhea related to anovulation resulting from PCOS may respond to the use of agents that reduce insulin resistance. The use of metformin for this purpose will be discussed in the anovulatory bleeding section that follows. 

Anovulatory bleeding Combination OC Optimal dose unknown15 As noted above for CEE, ethinyl estradiol, and combination OC (progesterone side effects with the OC depend on agent chosen)... 

Nonpharmacologic treatment options for anovulatory bleeding depend on the underlying cause. In a woman of reproductive I age with PCOS, weight loss may be beneficial. In women who... 

Specifically, for women with PCOS, the use of depot and intermittent oral medroxyprogesterone acetate suppresses pituitary gonadotropins and circulating androgens.15 Further, the use of cyclic progesterone may benefit women over age 40 and in whom anovulatory bleeding occurs.11... 

Assess symptoms to determine if patient-directed therapy is appropriate (e.g., NSAIDs for dysmenorrhea) or whether the patient should be evaluated by a physician (e.g., amenorrhea, menorrhagia, anovulatory bleeding, or PMDD). Does the patient have any related complications, such as symptoms of anemia in patients presenting with menorrhagia or complaints of difficulty conceiving in women with amenorrhea or anovulatory bleeding. 

American College of Obstetricians and Gynecologists. Management of anovulatory bleeding. ACOG Practice Bulletin number 14. Obstet Gynecol 2000 March 1-9. 

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