الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The term ”dysfunctional uterine bleeding” (DUB) refers to extremely heavy, protracted, or frequent uterine bleeding that isn’t related to pregnancy or a clearly identifiable pelvic or systemic illness. It is frequently linked to anovulatory cycles and is typically caused by a disruption in the thyroid, pituitary, and ovarian (HPO) axis’ normal functioning. This traditional interpretation emphasizes that anovulatory uterine hemorrhage is an excluding diagnosis. Though its exact etiology is still unclear, DUB can occur in both anovulatory and ovulatory menstrual cycles..
Progestogen, danazol, and gonadotropin-releasing hormone analogues, progestogen, tranexamic acid, progestin-releasing intrauterine devices, combination oral contraceptive tablets, and other hormonal therapies are examples of medical treatments. Since there is no one best medical therapy, each woman should have her needs properly evaluated to determine the best course of action..
Doctors should recommend an alternate surgical procedure to women with DUB who are not responding to conventional medicinal care. Given the patient’s age, physical condition, and willingness to undergo surgery, one might decide between hysterectomy and endometrial ablation procedures in these individuals..
Another useful alternative treatment for DUB that also provides women with contraception is the combination oral contraceptive pill. It lessens blood loss during menstruation, but not enough information is available to compare its benefits to those of other medications.. (5, 6) Therefore, it seems sense to provide a combination oral contraceptive pill (COC) to young women with DUB who also want to get pregnant at the same time..
Dienogest is a new progestogen that is semisynthetic and oral that has anti-androgenic qualities. Its progestogenic potency (ovulation dosage/transformation dose) is approximately four times larger than that of any other progestogen, indicating the power of its impact on the endometrium. Its inability to bind to sex hormone binding globulin (SHBG) contributes to the maintenance of low levels of free testosterone and high amounts of dienogest in the blood. Studies on measures related to estrogen, such as SHBG levels and vasodilatation indicators (cyclic guanosine monophosphate, 5-hydroxylindole acetic acid), have clearly shown that dienogest has little antiestrogenicity. Dienogest and cyproterone acetate have comparable antiandrogenic actions, according to receptor binding tests..
With a weak affinity similar to that of progesterone, dienogest agonistically activates at the progesterone receptor (PR) and has a strong progestagenic action in the endometrium, leading to endometrial atrophy with continuous usage.. On endometrial tissue, it stimulates antiproliferative, immunologic, and antiangiogenic actions. Dienogest inhibits oestradiol’s trophic effects on the eutopic and ectopic endometrium by lowering the amount of oestradiol produced naturally. When dienogest is taken continuously, the endocrine milieu becomes hyperprogestogenic and somewhat hypoestrogenic, which leads to the first decidualization of endometrial tissue. It acts as an antagonist on androgen receptors, reducing the appearance of androgenic symptoms such hirsutism and acne..
The main issue with administering tranexamic acid for the treatment of DUB is the potential risk of thromboembolic disease due to its antifibrinolytic effect. Tranexamic acid has been shown to be more effective than placebo, NSAIDs, progestogen in the luteal phase of the menstrual cycle, or ethamsylate, all without any serious side effects. While this is always a concern, it appears that the risk does not become statistically significant, particularly in situations of severe anemia.