Dysfunctional uterine bleeding (DUB) is a condition that affects nearly every woman at some point in her life. Also called abnormal uterine bleeding (AUB), DUB is a condition that causes vaginal bleeding to occur outside of the regular menstrual cycle. According to the American Society for Reproductive Medicine, it is most common during puberty and menopause, but can occur anytime hormones are imbalanced (ASRM). Certain hormonal conditions and medications may also trigger DUB.
The main cause of dysfunctional uterine bleeding is an imbalance in the sex hormones. Girls experiencing puberty and women entering menopause can have imbalanced hormone levels for months or even years. This causes sporadic bleeding, heavy bleeding, and/or spotting. Spotting is bleeding that is lighter than a normal menstrual period. It often appears brown, pink, or light red.
The hormonal imbalances that cause DUB can also be side effects of medical conditions or of medications themselves.
Medical conditions that often cause dysfunctional uterine bleeding are:
Polycystic Ovary Syndrome (PCOS). This is an endocrine disorder that causes a woman to produce an increased amount of sex hormones. This may lead to an imbalance in estrogen and progesterone, making the menstrual cycle irregular.
Uterine Polyps. These small growths occur within the uterus. Although their cause is unknown, polyp growth is heavily influenced by the hormone estrogen. Small blood vessels in the polyps can cause DUB.
Uterine Fibroids. Uterine fibroids are small growths that occur within the uterus, uterine lining or uterine muscle. Like polyps, the causes of uterine fibroids are unknown. But estrogen seems to play a role in their growth.
Certain medications can also cause dysfunctional uterine bleeding, including:
- birth control pills
- hormonal agents
- Warfarin (Coumadin)
The most common sign of DUB is bleeding outside of your normal periods. However, it can also occur within your menstrual cycle. In this case, it might include:
- heavy menstrual bleeding
- bleeding that contains many clots or large clots
- bleeding that lasts more than seven days
- bleeding that occurs less than 21 days from the last cycle
Other common DUB symptoms are:
- bleeding between periods
- breast tenderness
If you experience any of the following severe DUB symptoms, contact your doctor immediately:
- low blood pressure
- increased heart rate
- pale skin
- passing large clots
- soaking a pad every hour
To diagnose DUB, your doctor will ask questions about your medical history and the history of your cycle. These answers will help him or her determine your risks for certain reproductive disorders like PCOS and endometriosis. If you are taking any medication, including birth control, mention this to your doctor as such drugs cause abnormal bleeding.
Your doctor may recommend an ultrasound to view your reproductive organs. This examination will reveal whether or not you have any abnormal growths such as polyps or fibroids. It can also help to rule out internal bleeding.
Blood tests are used to measure your hormone levels and your complete blood count. Your hormone levels can often give quick insight into the cause of your bleeding. If you’ve had heavy or prolonged bleeding, a complete blood count reveals whether your red blood cell count is too low. A low red blood cell count can indicate anemia.
If an abnormal growth is causing the bleeding, or your uterine lining is unusually thick, your doctor will take a sample of the uterine tissue for testing. If there are any abnormal cell changes in the lining, a biopsy will reveal it. Abnormal cells can indicate hormone imbalances or cancer, among other things.
There are many treatment options available for DUB. Sometimes, in cases of puberty especially, no action is taken as the hormones usually correct themselves. However, the right treatment for you will depend on the underlying cause of the bleeding.
The most common and simplest treatment option for dysfunctional uterine bleeding is combination oral contraceptives. Combination oral contraceptives contain synthetic estrogen and progesterone. These both work to control and regulate the menstrual cycle. If you aren’t trying to conceive, your doctor may recommend taking these as a treatment option.
If the bleeding is heavy and combination oral contraceptives aren’t an option, intravenous estrogen can be administered until the bleeding subsides. This is normally followed by a course of oral progestin to balance the hormones.
If you are trying to conceive and you don’t have heavy bleeding, your doctor may prescribe the ovulation-stimulating drug clomiphene, also called clomid. Stimulating ovulation can stop prolonged menstrual bleeding.
Heavy and prolonged bleeding accompanied by a thickened uterine lining can be treated with a procedure called dilation and curettage (D and C). This is an outpatient surgical procedure used to remove part of the uterine lining by scraping it away.
If your uterine cells are found to be abnormal, your doctor may order an additional biopsy after treatment. Depending on the results of the biopsy—if the cells are cancerous, for instance—a hysterectomy may be recommended. A hysterectomy is a complete removal of the uterus and is usually a last resort (Vilos, et.al., 2001).
Generally, DUB is a temporary condition. Once the sex hormones are regulated, abnormal bleeding usually subsides.
Anemia is one of the main complications of heavy bleeding. If you develop anemia due to significant blood loss, your physician may treat it with minerals and vitamin supplements. In rare cases where the bleeding has caused significant blood loss, you may need a blood transfusion.