A survey of functional uterine bleeding with special reference to progesterogen therapy

Abstract 1.1. During the past seven years, approximately 700 cases of functional bleeding have been seen in the gynecologic out-patient department of the Johns Hopkins Hospital. During this same period, 104 young women with severe symptoms have been selected from the general dispensary for referral to the special functional bleeding clinic. Thus, only about one case in seven was severe enough symptomatically or in the proper age group to require conservative therapy other than curettage. 2.2. When 104 cases of functional uterine bleeding were classified according to the endometrial diagnosis of the original curettings, 66 per cent were hyperplastic, 16 per cent interval nonsecretory, 12 per cent secretory, and the remaining 6 per cent were chronic endometritis and atrophic types. 3.3. A total of 234 curettements was done on these 104 patients. Sixty-three per cent of the repeated curettages performed for a recurrence of symptoms showed no change in the endometrial pattern. Of the remaining 36 per cent of patients who showed a variation in pattern, none of the untreated varied from the nonsecretory type to secretory.The patients showing endometrial hyperplasia and other types of nonsecretory endometrium were clinically similar and on subsequent curettages showed the endometrial patterns to be mutually interchangeable. For this reason, no differentiation has been made between these groups in the evaluation of therapy. 4.4. Seventy-four of the 91 patients showing nonsecretory endometrium were considered suitable for cyclic progesterogen therapy in that they constituted a group of young women with severe symptoms which did not respond to other forms of treatment. In 72 cases, the bleeding symptoms were satisfactorily controlled. A patient with an ovarian neoplasm and another with gonorrheal cervicitis and an associated pelvic inflammatory disease failed to respond to therapy. Thirty-one patients had no recurrence of symptoms following the initial three-month cyclic course of medication. Sixteen of these thirty-one patients had no adjunctive therapy. Recurrences which occurred in forty patients were successfully treated again with progesterone. 5.5. Oral progeninolone has been as satisfactory as intramuscular progesterone in the present series, in approximately 90 per cent of the patients. 6.6. Estrogen has been used in conjunction with progesterone only in the two cases of bleeding associated with an atrophic type of endometrium. 7.7. There were thirteen cases showing secretory endometrium and originally considered to be truly functional in type. Of these, however, only four proved to have uncomplicated functional bleeding. These cases had a disturbance in the menstrual interval. In the other nine cases there were prolonged, profuse, but regular menses, although some of these had spotting during the menstrual interval. Six patients in this group showing secretory endometrium were treated with progesterone and none responded to therapy. It has been assumed, therefore, that although progesterogen therapy is excellent in functional bleeding associated with nonsecretory endometrium, it is unsatisfactory in those patients who have abnormal bleeding associated with secretory endometrial patterns.