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  DYSFUNCTIONAL UTERINE BLEEDING (DUB)

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  DYSFUNCTIONAL UTERINE BLEEDING (DUB)

Dysfunctional uterine bleeding is a common disorder marked by an irregular uterine bleeding that is found in the absence of structural pelvic pathology, pregnancy or general medical disease.

  • The bleeding is unpredictable, it may be excessively heavy or light and may be frequent, random or prolonged.
  • The condition affects nearly every woman at some point in their life.
  • Dysfunctional uterine bleeding can impact your life in a negative way. Not being aware of when the bleeding will start can cause anxiety and heavy menstrual bleeding may limit daily activities during period.
  • It is usually a menstrual disorder, although it is possible for the uterus to bleed abnormally outside menstruation.
  • Dysfunctional uterine bleeding can be classified as ovulatory or anovulatory depending whether ovulation is present or not
  • Anovulatory occurs when ovulation is not occurring and this type makes up about 90% of cases.
  • An anovulatory menstrual cycle is common at early puberty and the period around menopause.
  • In these cases, the period is delayed and when it occurs, menstruation can be very heavy and prolonged. This happens when women do not properly develop and release a matured egg, as a result, the corpus luteum that produces progesterone does not the form leading to a continuous production of estrogen which causes the overgrowth of the uterus lining.
  • Anovulatory dysfunctional uterine bleeding is also sometimes due to a delay in the full maturation of the reproductive system in teenagers.
  • About 1-2% of women with improperly treated anovulatory bleeding may develop endometrial cancer
  • Ovulatory dysfunctional bleeding makes up about 10% of cases. This happens in women who are ovulating but have a prolonged progesterone secretion due to a low estrogen level causing an irregular shedding of the uterine lining.

CAUSES

In many women, dysfunctional uterine bleeding is caused by an ovarian hormonal dysfunction. Other causes may include:

  • Endometrial polyps
  • Uterine fibroids
  • Infections of the uterus or cervix
  • Thickening of the uterine wall or lining
  • Endometrial cancer
  • Stress
  • Polycystic ovary syndrome
  • Some birth control
  • Weight loss
  • Excessive exercise
  • Obesity

SYMPTOMS

Menorrhagia which is a heavier and increased bleeding lasting longer than a week at regular intervals. Women may bleed enough to soak through one tampon or sanitary pads every hour.

Metrorrhagia which is a period that occurs at regular intervals or frequent bleeding at various amounts but not heavy.

DIAGNOSIS AND TREATMENT

In evaluating dysfunctional uterine bleeding, a thorough history is taken. This includes establishing the patient’s age, birth-control method, date of last menstrual period and whether she could have been pregnant (a miscarriage may cause unpredictable heavy bleeding)

To help differentiate between anovulatory and ovulatory dysfunctional uterine bleeding, the doctor will ask whether you are experiencing premenstrual symptoms such as fullness, bloating, mood changes or breast tenderness.

Laboratory studies used may include:

Complete blood count (CBC) to make sure there is no low blood count from the blood loss

Beta-human chorionic gonadotropin test to rule out pregnancy as a cause of bleeding

Pap smear which can reveal visible cervical lesions

Endometrial sampling collected in the office to rule out endometrial cancer

FSH estradiol testing to determine whether irregular bleeding is related to perimenopause

Imaging studies such as pelvic ultrasound to visualize the pelvic area so as to detect unusual masses or cyst on the ovaries.

TREATMENT

Treatment option may include hormone therapy and surgery. The aim of treatment is to suppress endometrial development, decrease menstrual flow, replace lost iron to avoid anemia and prevent future bleeding.

Hormone therapy may involve continuous exposure to progestin and estrogen

Ormeloxifene is a non-hormonal medication that treats the disorder but it is only legally available in India

Surgery may depend on whether you plan to have children as this might not be safe after some treatment or may not be possible at all. This may include ‘

Hysterectomy where the uterus is removed. After this surgery, you won’t have any more periods and won’t be able to get pregnant.

Endometrial ablation is a surgical operation where the lining of the uterus is destroyed. The procedure may stop all menstrual period in some women, some may have light bleeding or spotting and a few women may have regular menstrual periods.  The uterus is not removed, but in most cases, pregnancy is not likely after the procedure.