Dysfunctional Uterine Bleeding

Definition

Dysfunctional uterine bleeding (DUB) is a descriptive term used for abnormal uterine bleeding not associated with tumor, pregnancy or inflammation.

Description

DUB most commonly occurs because steady exposure to estrogen, without orderly episodes of progesterone, disturbs the normal sequence and timing of growth in the uterine lining.

Progesterone, which is produced by the ovary only after ovulation has occurred, is responsible for the final maturation of the lining and its underlying blood vessels. This prepares the lining for menstruation by assuring that all of the surface layer is ready to fall off neatly, and all at once, or within a few days.

Steady estrogen exposure results in growth of the lining, but some areas may be thicker than others, or out of synchrony, so that bleeding can begin from one area, followed a few days later by bleeding from another area.

Symptoms

In some cases, bleeding is light, although unpredictable and possibly prolonged. Moderate to heavy bleeding persistent enough to cause anemia is not uncommon. In some cases, hemorrhage can be severe enough to require hospitalization and even blood transfusion.

Treatment

Treatment will depend upon the underlying cause and the age of the patient. The initial goal in treatment of dysfunctional bleeding is to control the bleeding. If bleeding is very heavy or has been prolonged, the clinician will probably prescribe high doses of estrogen.

Estrogen is almost always effective in stopping bleeding temporarily. If bleeding is light or moderate, or if estrogen has temporarily stopped it, then cyclic treatment with synthetic progestin with combined estrogen and progestin is a reasonable plan.

For a young woman who has heavy bleeding or needs birth control protection, birth control pills may be a logical choice. After the first treatment week, pills are stopped and a fairly heavy (and crampy) period should start within two to three days. The next 21-day cycle of pills is started on the fifth day after bleeding, at the normal dose of one tablet daily. The amount of bleeding during periods will decrease after the first pill cycle or two are completed.

Treatment with progestin alone can be used for a young woman who does not need birth control or for an older woman who should not take birth control pills. Bleeding after an initial ten-day treatment may be quite heavy as the uterus expels whatever lining has been built up in the weeks or months preceding. Subsequent progestin-induced periods, however, should be more reasonable.

If cyclic hormone treatment with birth control pills or with progestin fails to induce bleeding two to seven days later, or if abnormal bleeding persists despite treatment, then reevaluation is necessary. If treatment is successful, then it should be continued until spontaneous ovulation cycles return or pregnancy is desired. Pregnancy is unlikely unless regular ovulation is occurring.

Questions to Ask Your Doctor

What is the cause of the abnormal bleeding?

Is this estrogen-related?

Is progestin needed also?

Do you recommend birth control pills?

When should be expected with the next menstrual period?

Will it be normal?