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Dysfunctional uterine bleeding

 
Medical Encyclopedia: Dysfunctional Uterine Bleeding

Definition

Dysfunctional uterine bleeding is irregular, abnormal uterine bleeding that is not caused by a tumor, infection, or pregnancy.

Description

Dysfunctional uterine bleeding (DUB) is a disorder that occurs most frequently in women at the beginning and end of their reproductive lives. About half the cases occur in women over 45 years of age, and about one fifth occur in women under age 20.

Dysfunctional uterine bleeding is diagnosed when other causes of uterine bleeding have been eliminated. Failure of the ovary to release an egg during the menstrual cycle occurs in about 70% of women with DUB. This is probably related to a hormonal imbalance.

DUB is common in women who have polycystic ovary syndrome (cysts on the ovaries). Women who are on dialysis may also have heavy or prolonged periods. So do some women who use an intrauterine device (IUD) for birth control.

DUB is similar to several other types of uterine bleeding disorders and sometimes overlaps these conditions.

Menorrhagia

Menorrhagia, sometimes called hypermenorrhea, is another term for abnormally long, heavy periods. This type of period can be a symptom of DUB, or many other diseases or disorders. In menorrhagia, menstrual periods occur regularly, but last more than seven days, and blood loss exceeds 3 oz (88.7 ml). Passing blood clots is common. Between 15–20% of healthy women experience debilitating menorrhagia that interferes with their normal activities. Menorrhagia may or may not signify a serious underlying problem.

Metrorrhagia

Metrorrhagia is bleeding between menstrual periods. Bleeding is heavy and irregular as opposed to ovulatory spotting which is light bleeding, in mid-cycle, at the time of ovulation.

Polymenorrhea

Polymenorrhea describes the condition of having too frequent periods. Periods occur more often than every 21 days, and ovulation usually does not occur during the cycle.

— Tish Davidson



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n.

Bleeding from the uterus due to an endocrine imbalance.

Wikipedia: Dysfunctional uterine bleeding
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Dysfunctional uterine bleeding
Classification and external resources
ICD-9 626.8

Dysfunctional Uterine Bleeding (DUB) is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable organic pathology, and is the most common cause of functional abnormal uterine bleeding. Diagnosis must be made by exclusion, since organic pathology must first be ruled out. It can be classified as ovulatory or anovulatory, depending on whether ovulation is occurring or not.

Contents

Ovulatory

Ovulatory DUB happens with the involvement of ovulation, and may represent a possible endocrine dysfunction, resulting in menorrhagia or metrorrhagia. Mid-cycle bleeding may indicate a transient estrogen decline, while late-cycle bleeding may indicate progesterone deficiency.

Anovulatory

Anovulatory cycle DUB happens without the involvement of ovulation. The etiology can be psychological stress, weight (obesity, anorexia, or a rapid change), exercise, endocrinopathy, neoplasm, drugs, or it may be otherwise idiopathic.

Assessment of anovulatory DUB should always start with a good medical history and physical examination. Laboratory assessment of hemoglobin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, T4, thyroid stimulating hormone (TSH), pregnancy (by βhCG), and androgen profile should also happen. More extensive testing might include an ultrasound and endometrial sampling.

Management

Management of dysfunctional uterine bleeding predominantly consists of reassurance, though mid-cycle estrogen and late-cycle progestin can be used for mid- and late-cycle bleeding respectively. Also, non-specific hormonal therapy such as combined estrogen and progestin can be given.

The goal of therapy should be to arrest bleeding, replace lost iron to avoid anemia, and prevent future bleeding.

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