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What is Dysfunctional Uterine Bleeding
Dysfunctional Uterine Bleeding (DUB) – bleeding from the UTERUS through the VAGINA that occurs outside the hormonal bleeding normally associated with the MENSTRUAL CYCLE. Doctors believe DUB results from an imbalance between ESTROGENS and PROGESTERONE, the hormones that regulate the menstrual cycle, which allows the endometrium (lining of the uterus) to grow unchecked. The excess tissue dies and sloughs away, producing clotty bleeding.
Vaginal bleeding that saturates more than eight pads in 24 hours for longer than two days may signal a health concern other than Dysfunctional Uterine Bleeding and requires prompt medical evaluation.
Symptoms of Dysfunctional Uterine Bleeding and Diagnostic Path
Because there are numerous causes for abnormal vaginal bleeding, Dysfunctional Uterine Bleeding is a diagnosis of exclusion: The doctor concludes the situation is one of Dysfunctional Uterine Bleeding after ruling out other possible causes for the bleeding. The essential symptom of Dysfunctional Uterine Bleeding is excessive vaginal bleeding. Though the bleeding often has the characteristics of a heavy menstrual period, it may not follow the timing of the woman’s menstrual cycle. Some women experience DUB as episodes of bleeding that occur between menstrual periods and for other women the bleeding may be fairly constant or occur with no predictable pattern. Further symptoms of Dysfunctional Uterine Bleeding may include HOT FLASHES and mood swings. Cramping and PAIN are uncommon; these symptoms suggest a diagnosis other than DUB.
Because doctors consider DUB as a diagnosis of exclusion—that is, a diagnosis the doctor reaches after ruling out other possible causes for the bleeding—the diagnostic path may include tests for SEXUALLY TRANSMITTED DISEASES (STDS), BLOOD test to check for PREGNANCY, and other blood tests to measure estrogen, progesterone, and LUTEINIZING HORMONE (LH). A key factor in establishing the diagnosis of DUB is the absence of OVULATION, which characterizes most DUB. The doctor may also check other HORMONE blood levels such as thyroid hormones.
Dysfunctional Uterine Bleeding Treatment Options and Outlook
For most women the first course of treatment for DUB is HORMONE THERAPY to restore the body’s natural estrogen–progesterone balance. For women of childbearing age this might mean oral contraceptives (birth control pills); for women near MENOPAUSE this might mean a hormone medication such as conjugated estrogens with progesterone or progesterone supplementation. The general therapeutic approach is to take hormone therapy until the menstrual cycle returns to normal, typically three to six months. Nonhormonal medications that may relieve mild DUB include NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS). Because longterm excessive bleeding commonly results in irondeficiency ANEMIA, the doctor may also prescribe an iron supplement.
When the medication path is not sufficient, the gynecologist may choose to perform endometrial ablation, in which the gynecologist uses electrocautery, hot balloon, or surgical laser to burn away the endometrial lining and the thin layer of uterine tissue beneath it. This restores the inside of the uterus to its base level so it can resume its natural cycle of thickening and sloughing. Other surgical options include DILATION AND CURETTAGE (D&C), to gently scrap away the endometrial lining, and HYSTERECTOMY (removal of the uterus). Though DUB is one of the most common reasons for hysterectomy, hysterectomy is generally the treatment of final choice for DUB, the treatment gynecologists turn to when other treatment options are not practical or are not successful. Because hysterectomy is a major surgery with numerous potential risks and permanently ends a woman’s ability to become pregnant, it is an option that requires careful consideration.
Risk Factors and Preventive Measures
Dysfunctional Uterine Bleeding occurs most often during the first and last years of the menstrual cycle. Progesterone-only methods of CONTRACEPTION may also precipitate Dysfunctional Uterine Bleeding. However, there are no known measures for preventing Dysfunctional Uterine Bleeding.