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Normal uterine anatomy (cut section)
Normal uterine anatomy (cut section)


Definition:

Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the vagina that is not due to a physical (anatomical) cause.



Alternative Names:

Anovulatory bleeding; Bleeding - dysfunctional uterine; DUB; Abnormal uterine bleeding



Causes, incidence, and risk factors:

DUB may be caused by an imbalance of hormones -- estrogen or progesterone.

Risk factors include:

  • Emotional stress
  • Excessive exercise
  • Obesity

DUB occurs in women during their reproductive years (they have started their period but have not reached menopause ). About 20% of DUB cases occur in adolescents and 40% occur in women over 40.



Symptoms:
  • Abnormal menstrual periods
  • Bleeding from the vagina between periods
  • Changing menstrual cycles (usually less than 28 days between menstrual periods)
  • Changing menstrual flow ranging from very little to a lot
  • Excessive growth of body hair in a male pattern (hirsutism)
  • Hot flashes
  • Infertility
  • Mood swings
  • Tenderness of the vagina


Signs and tests:

Dysfunctional uterine bleeding (DUB) is diagnosed after all other causes of abnormal uterine bleeding are ruled out. This includes:

  • Disease
  • Early pregnancy disorders
  • Infection
  • Structure problems
  • Tumors

The health care provider will do a pelvic examination.

Tests usually include:

The following procedures may be done:



Treatment:

Young women within a few years of their first period are not treated unless symptoms are very severe, such as heavy blood loss causing anemia .

In other women, the goal of treatment is to control the menstrual cycle. Oral birth control pills or progestogen therapy are often used for this purpose. Women with anemia may get iron supplements.

If you want to get pregnant, you may be given medication to stimulate ovulation.

Women whose symptoms are severe and resistant to medical therapy may need surgical treatments including:

  • Burning or removing the lining of the uterus (endometrial ablation)
  • Hysterectomy

Older women who may be getting close to menopause may receive hormones or surgery to relieve symptoms.



Support Groups:



Expectations (prognosis):

Hormone therapy usually relieves symptoms.



Complications:
  • Infertility from lack of ovulation
  • Severe anemia from prolonged or heavy menstrual bleeding
  • Buildup of the uterine lining without enough menstrual bleeding (a possible factor in the development of endometrial cancer )


Calling your health care provider:

Call your health care provider if you have unusual vaginal bleeding.



Prevention:



References:

Rakel P, ed. Conn’s Current Therapy 2005. 57th ed. Philadelphia, Pa: WB Saunders; 2005:1286-1288.

Stenchever A, et al. Comprehensive Gynecology. 4th ed. St. Louis, Mo: Mosby; 2001:1082-1084.

Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby; 2007.




Review Date: 2/5/2008
Reviewed By: Peter Chen, MD, Department of Obstetrics & Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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789 Central Avenue, Dover, NH 03820
Phone: (603) 742-5252
Toll free: 1 (877) 201-7100