Abnormal Uterine Bleeding and Issues
Reproductive Tract Diseases for human females are typically focused in the upper reproductive tract or the lower reproductive tract. The upper tract includes the fallopian tubes, ovary and uterus, while the lower reproductive tract focuses on the vagina, cervix and vulva. There are three major types of infections: endogenous, iatrogenic and sexually transmitted diseases. Endogenous diseases arise from internal cellular structures and may be bacterial, viral or genetic, usually the most common and arise from an overgrowth of organisms that are already present in the vagina; iatrogenic diseases are the result of medical or surgical treatment, and sexually transmitted diseases occur between humans as a result of sexual behavior. In addition to infections, there are congenital abnormalities, cancers and functional problems. Each infection has its own specific cause and symptoms; caused by bacteria, virus, fungi or other organisms. Indeed, some are easily treatable and cured, others are more difficult, and some are non-curable at this time (e.g. Herpes and HIV) (Population Council, 2012).
Cancers of the reproductive system may include breast, ovarian, uterine or cervical. Congenital abnormalities of the female reproductive system are varied, and functional problems may interfere with reproduction or urination or cause low or heightened states of sexual desire. Many of these non-genetic issues arise upon puberty, and many are serious enough to affect the ability to reproduce. Most recently, doctors have seen an increase in disruptions of the endocrine system, causing the development of the reproductive system to fail or become damaged. This is often the results of increased lead, dioxins, pesticides or other toxic materials in the environment. These chemicals and toxins are also known to have an effect upon puberty development, early onset menses, or other issues that cause abnormalities in the reproductive system (Safer Chemicals Coalition, 2012).
Reproductive Tract Infections are recognized as public health problems globally, and rank second as the cause of a loss of life or health among women of reproductive age in many developing countries. If left untreated, many of these infections have the potential to cause infertility, ectopic pregnancy, cervical cancer, menstrual disturbances, and pregnancy loss or low-birth weight off spring. The presence of these infections, particularly the ulcer causing infections, also promote the acquisition and transmission of HIV (Rabiu, K., et al., 2010).
Abnormal Uterine Bleeding Overview — Abnormal or dysfunctional uterine bleeding (DUB) is an excess of bleeding based in the uterus without demonstrable structural or organic pathology. Usually, it is due to hormonal disturbances, reduced levels of prostaglandins or progesterone, and is typically classified as ovulatory or an ovulatory depending on whether ovulation is occurring. Some scholarly sources indicate that most cases of DUB have some sort of a hormonal mechanism attached to the issue (Fraser, I., et al., 2011).
Roughly, 10% of DUB cases occur in women who are ovulating, yet progesterone secretion is prolonged and robust because estrogen levels are low. This combination of chemical imbalance causes an irregular shedding of the uterine lining and then resultant break-through bleeding. Additional evidence shows that ovulatory DUB may result with women who have more fragile uterine blood vessels. In addition, ovulatory DUB may indicate some sort of endocrine dysfunction that causes menorrhagia or metorrhagia. Menorrhagia is a heavy and prolonged menstrual period at regular intervals, typically caused by abnormal blood clotting or issues with the uterine lining, often resulting in painful menses (dysmenorrhea). Metorrhagia is uterine bleeding at irregular intervals, often between expected menstrual periods (Azim, P., et al., 2011).
Mid-cycle bleeding or the quantity and quality of associated bleeding or pain may also indicate a decline in estrogen, while late-cycle bleeding also may indicate progesterone deficiencies. Often, it is difficult to find exact pathology for this type of DUB, and diagnosis may be the result of eliminating variables and the frequency of DUB on the patient (Khosla, S., et al., 2011).
About 90% of DUB events occur outside of the ovulation period. Anovulatory menstrual cycles are common at the extremes of reproductive age — early puberty and perimenopause. In these cases, the patient does not develop and release a mature egg, and the corpus luteum, the mound of tissue that produces progesterone, does not form. This results in estrogen being conti8nually produced, causing an unnatural overgrowth of the uterine lining. The heavy growth causes menstruation that is prolonged and heavy, and may also be accompanied by excessive pain and cramping (Gray, 2013).
There are a number of causes of anovluatory DUB: stress, psychological issues, obesity, anorexia, exercise, drugs or other issues. Like other DUB issues, it is often quite difficult to accurately assess the causes of the affliction. Besides a thorough medical history, it is often wise to order lab tests that assess hemoglobin levels, luteinzining hormones, prolactin, T3=4 hormones (TSH), a pregnancy test and an androgen profile. Ultrasounds or endometrial sampling may be indicted depending on the severity of the issue (Sweet, 2012).
Iatrogenic Causes- These causes occur when the infection from a bacterium or other organism is introduced into the reproductive tract through a medical procedure such as menstrual regulation, induced abortion, or an IUD. Many times this happens if a surgical instrument was not properly sterilized. This may also occur if there is an infection already present in the lower reproductive tract and pushed through the cervix into the upper tract (Fraser, I., et al., 2011).
Systemic Disease — Systemic diseases that may cause DUB include hypothyroidism, cirrhosis or coagulation disorders. Subclinical hypothyroidism must be first confirmed by lab tests and generally manifests with fewer or milder symptoms of actual hypothyroidism. These may include fatigue, and intolerance for cold, unusual and consistent weight gain, some memory issues and depression. Clinical results often show a slightly high TSH (thyroid-stimulating hormone) level as well as a normal or slightly low thyroxine (T4) level. Upwards of 20% of women over the age of 60 have subclinical hyperthyroidism and 2-5% of those with the condition develop a gradual loss of thyroid gland function and true hypothyroidism annually. Many studies show that those with subclinical hypothyroidism are at greater risk for coronary failure. However, many of these studies show conflicting results with larger population cohorts; likely due to differences in demographics (age, gender, TSH levels, pre-existing conditions) or lifestyle issues (Rodondi, N., et al., 2010).
Cirrhosis is the result of chronic liver disease in which liver tissue is replaced by care tissue of fibrosis. The most common causes of cirrhosis are alcoholism, hepatitis B and C, and fatty liver disease. Symptoms include: 1) Ascites — Fluid retention in the abdominal cavity, one of the most common complications. Causes risk of infection and poor quality of life; 2) Jaundice — yellowing of the skin, mucus membranes or the eyes caused by an overproduction of bilirubin in the blood due to partial liver shutdown; 3) Liver Encephalopathy — confusion, altered levels of consciousness and psychotic episodes, even coma, as a result of liver failure and toxin buildup 4) Abnormal Nerve Function — nerve endings fire uncontrollably or are painful 5) Portal Hypertension — high blood pressure in the portal vein that delivers blood to the liver. The imbalance of blood factors based on hepatic issues then tends to increase abnormal bleeding in the uterine tissues (Wang, L., et al., 2011).
Coagulation issues including blood clotting, thin blood, or Von Willebrand disease are actually more common than many believe. VWD is a hereditary coagulation abnormality in humans, but can also manifest and develop through a number of other conditions. The results are either a qualitative or quantitative deficiencies of the von Willebrand factor, which is a protein required for the blood platelets to adhere to one another. There are actually three forms; inherited, acquired and platelet. In women, symptoms range from mild nosebleeds to heavy menstruation, For women with moderate or chronic coagulation issues, most estrogen-containing oral contraceptives are effective in reducing both frequency and duration of the menstrual periods (Davidson, B., et al., 2012).
Vaginitis is one of the most common lower reproductive tract infections; most commonly caused by infections like candida, bacteria, or other bacteria. It is both treatable and less serious than other infections, but has the potential of migrating up the reproductive tract and causing more serious infections. Cervical infection is caused by a variety of pathogens, especially STDs like gonorrhea and chlamydia. These are more severe than vaginitis because they usually reside in the upper reproductive tract and are more difficult to diagnose and treat since they are often asymptomatic (Population Council, 2012).
Azim, P., et al. (2011). Evaluation of Abnormal Uterine Bleeding. Isra Medical Journal, 3(3). Retrieved November 2013, from http://22.214.171.124/Isra%20Medical%20Journal%20Volume-III%20Issue-III.pdf#page=6
Davidson, B., et al. (2012). Abnormal Uterine Bleeding During the Reproductive Years. Journal of Midwifery and Women’s Health, 57(3), 248-54.
Fraser, I., et al. (2011). The FIGO Recommendations on Terminologies and Definitions for Normal and Abnormal Uterine Bleeding. Seminars in Reproductive Medicine, 29(5), 383-90.
Gray, S. (2013). Menstural Disorders. Pediatrics in Review, 34(1), 6-18.
Khosla, S., et al. (2011). The unitary model for estrogen deficiency. Journal of the Bone and Mineral Research, 26(3), 441-51.
Population Council. (2012, July). Reproductive Tract Infections: An Introductory Overview. Retrieved from popcouncil.org: http://www.popcouncil.org/pdfs/RTIFacsheetsRev.pdf
Rabiu, K., et al. (2010). Female Reproductive Tract Infections. BMC Women’s Health, 10(8). doi:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851660/?report=reader#__ffn_sectitle
Rodondi, N., et al. (2010). Subclinical Hypothyroidism and the Risk of Coronary Heart Disease and Mortality. Journal of the American Medicial Association, 304(12), 1365-74. doi:10.1001/jama.2010.1361
Safer Chemicals Coalition. (2012, October). Reproductive Health and Fertility Problems. Retrieved from healthreport.saferchecmicals.org: http://healthreport.saferchemicals.org/reproductive.html
Sweet, M. e. (2012). Evaluation and Management of Abnormal Uterine Bleeding in Premenopausal Women. Journal of the American Academy of Family Physicians, 85(1), 35-42. Retrieved November 2013, from http://drkney.com/pdfs/vagbleed_010112.pdf
Wang, L., et al. (2011). The Diagnosis and Treatment of Abnormal Uterine Bleeding in Nonpregnant Patients with Hepatic Cirrhosis. European Pub Med Central, 19(1), 52-4. Retrieved November 2013, from http://europepmc.org/abstract/MED/21272460/reload=0;jsessionid=BgHP6IKlqmk4nm0rQwZJ.52
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