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There are 16 possible causes of dysfunctional uterine bleeding

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What Is Dysfunctional Uterine Bleeding? 

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.

What Causes Dysfunctional Uterine Bleeding? 

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

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.  

Endometriosis. This condition results when the uterine lining grows outside of the uterus, often on the ovaries. Endometriosis often causes heavy bleeding during regular periods. 

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. 

Sexually Transmitted Diseases (STDs). STDs that cause lesions, like gonorrhea and chlamydia, may lead to DUB. Bleeding caused by STDs usually occurs after sex, when the lesions are aggravated.  

Medications

Certain medications can also cause dysfunctional uterine bleeding, including:

  • birth control pills
  • hormonal agents
  • Warfarin (Coumadin)

Recognizing the Signs of DUB 

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:

  • spotting
  • bleeding between periods
  • breast tenderness
  • bloating

If you experience any of the following severe DUB symptoms, contact your doctor immediately:

  • dizziness
  • fainting
  • weakness
  • low blood pressure
  • increased heart rate
  • pale skin
  • pain
  • passing large clots
  • soaking a pad every hour

How Is DUB Diagnosed? 

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.

Ultrasound

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

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.

Endometrial Biopsy

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.

Is DUB Treatable? 

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).

Can DUB Cause Complications? 

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.

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Possible Causes - Listed in order from the most common to the least.

1

Postmenopausal Bleeding

Postmenopausal bleeding is bleeding from the vagina after a woman has stopped having menstrual cycles due to menopause.

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2

Threatened Abortion

This condition is considered a medical emergency. Urgent care may be required.

Threatened abortion describes vaginal bleeding in early pregnancy. It could indicate risk of miscarriage. During miscarriage, women may have abdominal and lower back pain, and may pass clot-like material from the vagina.

Read more »

3

Genital Warts

Genital warts are soft growths that occur on the genitals. Genital warts are a sexually transmitted infection (STI) caused by certain strains of the human papillomavirus (HPV). These skin growths can cause pain...

Read more »

4

Inflammation of the Cervix (Cervicitis)

Cervicitis is a common condition that will affect more than half of all women in their adult lives. Normally caused by an infection, symptoms include vaginal bleeding and pain.

Read more »

5

Ovarian Cancer

The ovaries are small, almond-shaped organs located on either side of the uterus that produce eggs. As the disease progresses, symptoms include back pain and indigestion.

Read more »

6

Endometriosis

Endometriosis is a disorder in which the endometrium grows outside your uterine cavity. The endometrium is the tissue which makes up the inside surface of your uterus. Endometriosis occurs when this lining grows on th...

Read more »

7

Cervical Cancer Overview and History

HPV causes most cases of cancer of the cervix, the neck of the uterus. Once the cancer becomes invasive, symptoms include pelvic or back pain, constipation, and irregular bleeding.

Read more »

8

Hypothyroidism

The thyroid gland produces a hormone that controls how your cells use energy (metabolize). Hypothyroidism occurs when the body doesn

Read more »

9

Endometrial Cancer (Cancer of the Uterine Endometrium)

Endometrial cancer is a type of cancer that starts in the inner lining of the uterus. You are at greater risk if you are 60-70 years old and have used hormone replacement therapy that contains estrogen.

Read more »

10

Low-Lying Placenta (Placenta Previa)

The placenta develops in a woman’s uterus during pregnancy. This sac-like structure provides the developing baby with food and oxygen. It also removes waste products from the baby’s blood. The placenta i...

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11

Factor II Deficiency

Factor II deficiency is a very rare blood clotting disorder that results in excessive or prolonged bleeding after an injury or surgery. Factor II, also known as prothrombin, is a protein made in your liver that plays a...

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12

Urethritis

Urethritis is a condition that affects the urethra. The urethra is the tube that carries urine from the bladder so it can be expelled from the body. Semen also passes through the male urethra. The core cause o...

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13

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection of the reproductive organs in women. The pelvis is located in the lower abdomen and includes the fallopian tubes, the ovaries, the cervix, and the uterus. According t...

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14

Ovarian Cysts

The ovaries are part of the female reproductive system. They are located in the lower abdomen on both sides of the uterus. Women have two ovaries that produce eggs, as well as the hormones estrogen an...

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15

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome, or PCOS, is a condition in which a woman's levels of the sex hormones estrogen and progesterone are out of balance. This leads to the growth of ovarian cysts (benign masses on the ovaries)...

Read more »

16

Infertility

Infertility is defined as not being able to become pregnant after a year of trying - or after six months, if you are 35 or older (Mayo Clinic). And it's not just a woman's problem. One-third of infertility cases are du...

Read more »

This feature is for informational purposes only and should not be used to diagnose.
Please consult a healthcare professional if you have health concerns.
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