1. Dysfunctional Uterine Bleeding (DUB) www.freelivedoctor.com

2. Definition an abnormal uterine bleeding without an obvious organic abnormality (neoplasma, pregnancy, inflammation, trauma, blood dyscrasia,hormoneadminstration，at el) unnormal releasing of sex hormones www.freelivedoctor.com

3. Anovulatory functional bleeding ovulatory functional bleeding DUB occur in before the menopause(50%) after menarche(20%) in reproductive times(30%). www.freelivedoctor.com

4. Anovulatory functional bleeding www.freelivedoctor.com

7. nervous

8. circumstance

9. PCOS,TSH↑,PRL↑

10. excessive physical exercisewww.freelivedoctor.com

12. complex hyperplasia(Adenomatous hyperplasia ,precursor of carcinoma)

13. atypital hyperplasia(10%-25%-> carcinoma)

14. proliferative phase of endometrium (no secretive change )

15. atrophic endometriumwww.freelivedoctor.com

17. no mature follicle

18. no corpus luteum

19. only have estrogen, but no progestin

20. breakthrough bleeding, spotingwww.freelivedoctor.com

22. polymenorrhea

23. hypermenorrhea

24. hypomenorrhea

25. irregular intervals and durationwww.freelivedoctor.com

27. initial regularity of cycle,

28. cycle length, amount, duration of flow,

29. parity, contraceptive pill

30. abortion, ectopic pregnancy,

31. endometriosis,

32. pelvic inflammatory diseasewww.freelivedoctor.com

34. endocrinopathies,

35. traumas,

36. nutritional status To decide :the dysfunctional bleeding or anatomic abnormality www.freelivedoctor.com

38. endocrine studies

39. curettagewww.freelivedoctor.com

42. cyclic low dose oral contraceptive for 3 month ( for adolescent)

43. continue cyclic low dose oral contraceptive,( no fertility demands)3. induce ovulation Clomiphene, HMG, FSH,GnRH) www.freelivedoctor.com

44. Curettage for adults rarely use for teenagers unless bleeding is very severe) aims 1.arrest an acute severe bleeding quickly and effectively 2.to prevent chronic recurrence of DUB 3.diagnosis www.freelivedoctor.com

46. never been done in adolescentwww.freelivedoctor.com

48. luteal phase is short

49. inadequate secretion ofprogesteronewww.freelivedoctor.com

52. endometrium biopsy specimen taken just before menses reveal to bad for secretive phasewww.freelivedoctor.com

54. progestin(15th day X 10 days)

55. ovulation induction (Clomiphone, HMG, FSH, mature follicle --- good corpus luteum) www.freelivedoctor.com

57. estrogen and progesterone maintain to effect the endometriumwww.freelivedoctor.com

59. Regular cycles with hypermenorrheaDiagnosis: endometrium biopsy specimen taken on 5th days after the onset of bleeding, reveal a mixture of persistent secretive glands with the proliferative glands www.freelivedoctor.com

61. ovulation induction www.freelivedoctor.com