UTERINE BLEEDING, DYSFUNCTIONAL

(Premenopausal Abnormal Uterine Bleeding)

 Basic information

description

Dysfunctional uterine bleeding (DUB) is bleeding that is abnormal, irregular, and not part of a normal menstrual period. There is no tumor, infection, or pregnancy involved. It most often occurs in women ages 40 to 50 and in those under age 20.

FREQUENT SIGNS & SYMPTOMS

• Bleeding between periods. Blood flow may be light or heavy, prolonged, or random, and may contain clots.
• Periods last for more than 7 days and/or occur less than 21 days apart and may have extra heavy bleeding.

causes

The normal menstrual cycle depends on a balance of estrogen and progesterone. Bleeding problems occur if they get out of balance. There is too much estrogen or not enough progesterone. This happens most often due to anovulation (failure of the ovaries to produce or release eggs). Anovulation is more likely to occur in women who are close to menopause and young girls whose menstrual cycles have just started.

risk increases with

• Women ages 40 to 50 and under age 20.
• Polycystic ovary syndrome (cysts on the ovaries).
• Obesity.
• Athletes.
• Emotional stress.
• Eating disorders.

PREVENTIVE MEASURES

No specific preventive measures.

expected outcomes

Outcome will depend on the woman's medical condition, age, the severity of the problem, and treatment.

possible complications

• Anemia due to excessive bleeding.
• Cancer (rare).
• Infertility from lack of ovulation.

 diagnosis & treatment

general measures

• Your health care provider will usually do a physical exam and a pelvic exam. Questions will be asked about your symptoms and activities. Dysfunctional uterine bleeding is diagnosed after other causes of abnormal uterine bleeding have been ruled out. These include diseases, drugs, pregnancy, eating disorders, gynecological infections, polyps or other growths, or tumors. One or more medical tests are needed to help confirm the diagnosis. These will be explained to you.
• Goals of treatment are to return periods to a normal cycle or stop the bleeding altogether. Treatment will depend on a woman's age, other medical conditions, and the severity of the bleeding.
• If bleeding is severe, a hospital stay may be needed to bring it under control.
• Treatment will be given for anemia if it exists.
• If symptoms are not severe, treatment may involve watchful waiting. This means monitoring the bleeding for a few months before treating it.
• Hormone therapy is usually the first treatment step, particularly in younger women.
• If hormones do not help the bleeding, surgery may be needed. Your health care provider will discuss options, benefits, and risks. Together, you'll choose the treatment that will work best for you:
  • Dilation and curettage (D & C) may be the recommended procedure.
  • Other surgery options include endometrial ablation (destruction or removal of the uterine lining), or hysterectomy. These procedures mean a woman can no longer become pregnant. They may be used for women who are close to menopause.
• To learn more: Women's Health Information Center; (800) 994-9662; website: www.womenshealth.gov.

medications

• Hormone therapy may be prescribed. This includes birth control pills, hormone-replacement therapy, or progesterone.
• Iron supplements may be recommended for anemia.

activity

No limits.

diet

With anemia, an iron-rich diet may be recommended.

 notify our office if

• You or a family member has symptoms of dysfunctional uterine bleeding.
• Bleeding becomes heavy (filling a pad or tampon more often than once an hour).
• Signs of infection develop, such as fever, a general ill feeling, headache, dizziness, or muscle aches.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

Special Notes: