Why is high dose estrogen used to treat DUB?

[drmedstudent]

I thought DUB occur due to anovulation, which means there is a LOT of estrogenized endometrium. Why give more estrogen?

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[DrMaheshmaidsh]

yup, 90 % DUB s due to anovulation and 10 % due to estrogen deficiency... Mid cycle bleeds are due to estrogen deficiency.. In both the conditions, estrogen in high dose will help by 1. estrogen source in estrogen deficient states 2. high dose estrogen will help platelet plug formation and 3. promote healing of denuded surface..

 

[drmedstudent]

yup, 90 % DUB s due to anovulation and 10 % due to estrogen deficiency... Mid cycle bleeds are due to estrogen deficiency.. In both the conditions, estrogen in high dose will help by 1. estrogen source in estrogen deficient states 2. high dose estrogen will help platelet plug formation and 3. promote healing of denuded surface..

so why do people with PCOS bleed in the first place since they have so much estrogen which will form platelet plugs and heal denuded surface

 

[DocInProgress]

so why do people with PCOS bleed in the first place since they have so much estrogen which will form platelet plugs and heal denuded surface

because in pcos, u get a higher amount of estrogen release and thus, the endometrial lining proliferates endlessly until the vasculature can't support the endometrium.. as a result, the lining sloughs off and they bleed.

 

[drmedstudent]

because in pcos, u get a higher amount of estrogen release and thus, the endometrial lining proliferates endlessly until the vasculature can't support the endometrium.. as a result, the lining sloughs off and they bleed.

so how does giving even more estrogen (which caused bleeding in the 1st place) actually STOP the bleeding??

 

[DocInProgress]

so how does giving even more estrogen (which caused bleeding in the 1st place) actually STOP the bleeding??

According to FA Step 2, it's only used for heavy bleeding where prolonged and heavy uterine bleeding has likely denuded the endometrial cavity and thus, estrogen is needed to rapidly promote endometrial growth.

For mild non-heavy bleeds, progestins to stimulate w/d bleeding is the usual treatment for anovulatory DUB. Otherwise, use NSAIDs for ovulatory bleeding to decrease blood loss.

 

[SlaveOfTCMC]

Dr. Sakala of Kaplan mentioned something along the lines of using high dose IV estrogen for adolescents within 2 years of menarche

His rationale, although not clearly explained, seemed to be that until the adolescent has established regular menstrual cycles, there can be unopposed estrogen stimulation leading to DUB

Thus, giving high dose estrogen will proliferate the basalis layer of endometrium, which is what is being sloughed off.... and somehow this stops the bleeding

I am missing a step in my four dot ellipsis...

Can anyone fill this in?