Dysfunctional uterine bleeding and dysmenorrhea.

Normal menstruation involves the breakdown, remodelling and repair of the functional endometrial layers. Endometrial destruction and regeneration are largely controlled local factors, that are dependent on the levels of estradiol and progesterone. Prostaglandins and endothelins appear to be powerful vasoactive substances in the control of menstrual blood loss. The tissue endothelin concentration may interact with relaxing factors, such as nitric oxide, prolonging or increasing menstrual blood loss. Disturbances of menstrual bleeding and dysmenorrhea are a major medical problem not only for women but also for their families and health services. Management of dysfunctional uterine bleeding is determined by the needs of the patient: oral contraceptives are used for women of reproductive age with ovulatory uterine bleeding episodes who also require contraception; they have a strong progestogenic effect that is evident as early as the first week of pill intake. In the perimenopausal patient, dysfunctional uterine bleeding may be treated by cyclic progestins with or without conjugated equine estrogens; oral contraceptives can also be used in non-smokers who have no evidence of vascular disease. Dysmenorrhea is defined as a complaint of pain experienced during or immediately before menstruation. In the pathogenesis of dysmenorrhea, prostaglandins and arachinodonic acid metabolites play an important role, being elevated in women with dysmenorrhea. Oral contraceptives are very effective in the treatment of dysmenorrhea; they act mainly by reducing the levels of the prostaglandins and arachinodonic acid metabolites. For women reluctant to take oral contraceptives, non-steroidal anti-inflammatory drugs may be a better option.