REVIEW OF LITERATURE

The physiological cyclical uterine bleeding occurring due to the shedding of the

uterine endometrium due to the action of hormones through the hypothalamo-pituitary-

ovarian (HPO) axis is referred to as menstruation. It is a result of a closely coordinated

interaction of various hormones of the hypothalamus, pituitary and the ovaries, which

requires endometrium responsiveness to the various hormones as well as coordinated

functioning of the HPO axis and the anatomical patency of the genital tract.

The duration of a normal menstrual cycle varies between 21-35 days with an average

of 28 days, duration of menstruation being 4-5 days and the amount of blood loss estimated

to be 20-80 ml with an average of 35 ml.8,9 The menstrual discharge consists of uterine blood,

mucus, vaginal epithelial cells, endometrial shreds, various prostaglandins and enzymes

along with bacteria.

The onset of first menstruation (menarche) varies between 11-15 years. The

menstrual cycle is temporarily suspended during pregnancy and lactation and it ceases at the

age of 45-50 years (menopause).

Dysfunctional uterine bleeding (DUB) is defined as a state of abnormal uterine

bleeding without any clinically detectable organic, systemic and iatrogenic cause.1 It is

typically characterized by excessive, heavy, prolonged or frequent bleeding of uterine origin.

DUB is a common gynecological disorder affecting about 10-15% of the women in the

reproductive age group, and constituting 20% of gynecology OPD visits.1,4,5

Menorrhagia / Hypermenorrhea is defined as cyclic bleeding at normal intervals

with bleeding being either excessive in amount (>80 ml) or duration (>7 days) or both.