Dysfunctional Uterine Bleeding, help!!

Some options you could ask about (trying to avoid offering medical advice here):

Treating the headaches with something beyond fluids - they may lessen over time

NSAIDs - obviously can help headaches, but also acts to decrease menstrual bleeding

GnRH agonists - often used in women who can't do hormones

Estrogen metabolism can be affected by liver damage, causing DUB. Something else to think about.

Hope that helps you.

Just wanted to add:

Pt age: 39

She said she hasn't been too worried about irregular menses since hubby has vasectomy. She said she thought it was just perimenopause. Apparently the OB said not a chance, she was too young.

Anyway, we did give Naprosyn as often as we could (with other analgesics) but headache never got below an 8/10 while taking the hormones.

The OB at this time believes she has:

• "Estrogen breakthrough bleeding

• • Anovulatory cycles have no corpus luteal formation. Progesterone is not produced. The endometrium continues to proliferate under the influence of unopposed estrogen.

• • Eventually, this out-of-phase endometrium is shed in an irregular manner that might be prolonged and heavy. This pattern is known as estrogen breakthrough bleeding and occurs in the absence of estrogen decline."

Since this isn't my area of expertise, I've been trying to google some info so I can call the doc back confidently and suggest something else for her, since nothing has worked so far.

Sure sounds like Prmenrs is onto something. Perimenopause/fibroids? Endocrine problems?

I agree also, time to see the GYN for a consult stat---and perhaps referral to an endoncrinologist if it's not purely a GYN problem. I wish this poor gal well.

The OB at this time believes she has:

• "Estrogen breakthrough bleeding

• • Anovulatory cycles have no corpus luteal formation. Progesterone is not produced. The endometrium continues to proliferate under the influence of unopposed estrogen.

• • Eventually, this out-of-phase endometrium is shed in an irregular manner that might be prolonged and heavy. This pattern is known as estrogen breakthrough bleeding and occurs in the absence of estrogen decline.".

This makes total sense and correlates with her personal menstrual history. If she is anovulatory, then she isnt' making a corpus luteum that cycle, and not getting natural progesterone. She needs the progesterone to balance the estrogen. She just needs something else to help manage the headaches as well.

This is a good website that really explains a lot about progesterone.

http://www.wdxcyber.com/nmood11.htm

Interestingly, that site mentions something about a correlation about depression and progesterone..

Progestogens, probably more so than natural progesterone, increase MAO concentration thus producing depression and irritability. Pure progestogen treatment without estrogen, such as DepoProvera® is know to worsen depression in women who already have a tendency toward or clinical signs of depression..

I personally take progesterone also, but only in a cream form. I don't get the headaches, but I know of many women who get them. They can be awful. (I get my headaches with estrogen).

Thanks to all that responded, your insights and expertise are appreciated. I did go to the websites you mentioned and copied a few things for the pt, she was thankful to receive this info. Her endo biopsy came back negative, but she did have proliferative endometrium. She will be following up q3 mos with the Gyn for awhile, and her meds were switched from medroxyprogesterone to Prometrium, MD says many women tolerate it better.

This is such a different thing for me to deal with, I appreciate the resources here!

I forgot to mention, weight gain, especially around midriff and hip areas is extremely common in my research for this condition, and MD pointed out to pt that weight loss is necessary to mitigate further endocrine problems.

I found this interesting because in this case, this gal did have a hormonal imbalance causing her weight gain, I know this is often brushed aside as an excuse, but in this pt it was real. So if anyone else runs across an apple shaped body with menstrual irregularities, maybe this will be a red flag for them in their assessments.

Every time I see apple shaped women, I assume that they at least have heavy periods! Estrogen is stored in fat...

Has she had thyroid function testing done? This, too, can cause irregular bleeding.

CJ