Dysfunctional Uterine Bleeding
Dysfunctional uterine bleeding (“DUB”) , is abnormal menstrual bleeding that occurs due to hormonal anomalies rather than due to an anatomic factor. Dysfunctional uterine bleeding often occurs as a result of anovulation, which gives high estrogen levels that are not balanced by an appropriate level of progesterone. This prevents an egg from being released, the unopposed estrogen thickens the uterine lining and causes it to shed irregularly.
Symptoms of dysfunctional uterine bleeding may include:
- Bleeding or spotting between periods
- Periods that are less than 25 days apart
- Periods that are more than 35 days apart
- Heavy menstrual bleeding
- Menstrual bleeding lasting longer than 7 days
- Anemia due to menstrual bleeding
Dysfunctional uterine bleeding occurs most often at the extremes of reproductive life, in women over the age of 40, as well as in adolescents. Adolescents will often “outgrow” DUB as their menstrual control matures. Women over 40 are often cured by entering menopause.
Diagnostic testing to assess the causes of abnormal uterine bleeding include blood hormone levels, testing for bleeding disorders such as von Willebrandt’s disease, pelvic ultrasonography and occasionally, endometrial biopsy. The dilation and curettage that was so often used in the 1980s-90s has now largely been replaced by ultrasound and minimally invasive biopsy and is only rarely required.
Treatment is directed at the specific cause and takes into account will the patient’s age, severity of bleeding and whether or not a future pregnancy is considered.
Treatment options may include a nasal spray to correct bleeding disorders, medication to stimulate ovulation, oral contraceptives to produce a regular flow, progesterone or its analogs (“progestins”) to stabilize the endometrium, drug therapy to stimulate menopause, or endometrial ablation. Hysterectomy is rarely required as many easier options exist, most of which can be performed in the office.