Dysfunctional Uterine Bleeding Health Article

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.

Causes and symptoms

Dysfunctional uterine bleeding often occurs when the endometrium, or lining of the uterus, is stimulated to grow by the hormone estrogen. When exposure to estrogen is extended, or not balanced by the presence of progesterone, the endometrium continues to grow until it outgrows its blood supply. Then it sloughs off, causing irregular bleeding. If the bleeding is heavy enough and frequent enough, anemia can result.

Menorrhagia is representative of DUB. It is caused by many conditions including some outside the reproductive system. Causes of menorrhagia include:

• adenomyosis (a benign condition characterized by growths in the area of the uterus)
• imbalance between the hormones estrogen and progesterone
• fibroid tumors
• pelvic infection
• endometrial cancer (cancer of the inner mucous membrane of the uterus)
• endometrial polyps
• endometriosis (a condition in which endometrial or endrometrial-like tissue appears outside of its normal place in the uterus)
• use of an intrauterine device (IUD) for contraception
• hypothyroidism
• blood clotting problems (rare)
• lupus erythematosus
• pelvic inflammatory disease
• steroid therapy
• advanced liver disease
• renal (kidney) disease
• chemotherapy (cancer treatment with chemicals)

To diagnose dysfunctional uterine bleeding, many of the potential causes mentioned above must be eliminated. When all potential causes connected with pregnancy, infection, and tumors (benign or malignant) are eliminated, then menorrhagia is presumed to be caused by dysfunctional uterine bleeding.

Diagnosis

Diagnosis of any menstrual irregularity begins with the patient herself. The doctor will ask for a detailed description of the problem, and take a history of how long it has existed, and any patterns the patient has observed. A woman can assist the doctor in diagnosing the cause of abnormal uterine bleeding by keeping a record of the time, frequency, length, and quantity of bleeding. She should also tell the doctor about any illnesses, including long-standing conditions, like diabetes mellitus. The doctor will also inquire about sexual activity, use of contraceptives, current medications, and past surgical procedures.

Laboratory tests

After taking the woman's history, the gynecologist or family practitioner does a pelvic examination and Pap smear. To rule out specific causes of abnormal bleeding, the doctor may also do a pregnancy test and blood tests to check the level of thyroid hormone. Based on the initial test results, the doctor may want to do tests to determine the level of other hormones that play a role in reproduction. A test of blood clotting time and an adrenal function test are also commonly done.