A General Overview
Dysfunctional uterine bleeding (DUB) is a common disorder of excessive uterine bleeding that affects premenopausal women, not because of pregnancy or any known uterine diseases. Researchers suggest that basic pathophysiology happens because of ovarian hormonal dysfunction. However, the exact mechanisms still unknown. DUB usually appears as heavy, prolonged, or frequent bleeding of the uterus.
What are Medical Conditions?
There are certain medical conditions that lead to dysfunctional uterine bleeding, including:
- Polycystic ovary syndrome (PCOS) is a disorder causing an imbalance in estrogen and progesterone hormones leading to absence or irregularity in women’s menstrual cycles.
- Endometriosis is a condition happening when the uterine lining develops outside the uterus on the ovaries for instance. It usually leads to heavy bleeding during the regular menstrual periods.
- Uterine polyps are small growths that happen inside the uterus. The reason causing them is unknown, but the hormone estrogen seems to heavily affect them. DUB can be caused due to small blood vessels such as spotting between periods.
- Uterine fibroids are also small growths that take place inside the uterus, uterine lining or uterine muscle. Similar to polyps, the reason behind uterine fibroids is unknown. However, estrogen plays a key role in its growth and development.
- Sexually transmitted diseases (STDs) can lead to inflammation such as gonorrhea and chlamydia may also cause dysfunctional uterine bleeding.
What are the Causes of Dysfunctional Uterine Bleeding?
In general, the most common reason for abnormal uterine bleeding is having problems with hormones. During ovulation, one of the ovaries releases an egg each month and certain hormones develop then shed the lining of the uterus (known as the endometrium). With teenagers and menopause women, the endometrium can develop too much which can lead to irregular or heavy periods.
What are the Types of Dysfunctional Uterine Bleeding?
Until recent times, the description of the bleeding alone can determine the diagnosis. However, there is a new classification system that introduces the general diagnosis of abnormal uterine bleeding or AUB.
It is, later defined depending on the quality of bleeding AUB:
- Abnormal uterine bleeding with heavy menstrual bleeding (AUB/HMB)
- Abnormal uterine bleeding with bleeding between periods (AUB/IMB)
What are the Symptoms of Dysfunctional Uterine Bleeding?
Bleeding outside of the normal menstrual periods is the most common cause of the dysfunctional uterine bleeding. Moreover, it can take place during the menstrual periods and it could include the following patterns:
- Bleeding that contains large or many clots
- Heavy menstrual bleeding
- Bleeding that lasts for more than a week
- Bleeding that takes place in less than 21 days from the last menstrual cycle
- Spotting between periods
- Bleeding between periods
In addition to these common symptoms that may occur:
- Breast tenderness
- Pelvic pain
If a woman experiences any of the following DUB symptoms, that means she has severe symptoms and should contact her doctor right away. These symptoms include:
- Low blood pressure
- Increase in heart rates
- Pale skin
- Having large clots
The Diagnosis of Dysfunctional Uterine Bleeding
In order to diagnose dysfunctional uterine bleeding, the doctor will check the woman’s medical history and her cycle history as well. This will help them determine the risks of having some reproductive disorders such as polycystic ovary syndrome and endometriosis. In addition to this, taking detailed notes over a few cycles can also provide doctors with important information about the symptoms. A physical examination may be required along with a pregnancy test. Additionally, some of the following tests:
An ultrasound may be needed to check the reproductive organs. It will reveal if there are any abnormal growths such as polyps or fibroids. In addition, it can help eliminate internal bleeding.
In order to measure hormone levels, blood tests need to be made. Hormone levels can usually give a quick overview of the cause of bleeding. However, if a woman is having heavy or prolonged bleeding, a complete blood count test must be made to find out if the red blood cells are too low as this could refer to anemia.
If bleeding happens due to abnormal growth, the doctor will need to take a sample of the uterine tissue for testing. A biopsy will tell if there are any abnormal cell changes within the lining as they can indicate hormone imbalance.
The Treatment for Dysfunctional Uterine Bleeding
There are many available treatment options for dysfunctional uterine bleeding. The right treatment will depend on the main cause of bleeding. The most common treatment option is a combination of oral contraceptives. It has synthetic estrogen and progesterone that both control the menstrual cycles.
If the bleeding happens suddenly and is very heavy, medications are not an available option, intravenous estrogen can be carried out until the bleeding stops. Then a course of oral progestin is followed in order to balance the hormones.
Dilation and Curettage (D and C) is a procedure that treats the thickened uterine lining together with heavy bleeding.
If the uterine cells seem to be abnormal, the doctor will need to run an additional biopsy after treatment.
Can Dysfunctional Uterine Bleeding Lead to Complications?
In general, dysfunctional uterine bleeding is a temporary medical condition. In general, once the sex hormones are managed, abnormal bleeding stops. Anemia is one of the major complications of heavy bleeding. If a woman develops anemia because of significant blood loss, the physician will recommend treating it with mineral supplements. However, in some rare situations, where the bleeding has led to incredible blood loss, the patient may need a blood transfusion.
Is there a Possible way to Prevent Dysfunctional Uterine Bleeding?
No, there is no possible way to prevent dysfunctional uterine bleeding. If a woman continues to have irregular or absent menstrual periods, she should seek help. Early diagnosis and treatment can help regulate regular menstrual periods again.
When to See a Doctor?
If a woman is having any of the following symptoms such as abdominal pain, dizziness, fainting, heavy bleeding or severe fevers, she should see a doctor right away.