Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding (DUB) is a menstrual cycle disorder, which is experienced by most of the women at least once in their lives.
HerHaleness Staff
Dysfunctional Uterine Bleeding is one of the most common causes of abnormal vaginal bleeding in women during their reproductive years. Although it can occur any time throughout woman's reproductive years, it generally occurs at the beginning or end of it.

Normally, women lose about 40-155 ml blood during their menstrual cycle, which occurs every 21 to 35 days. During the first four days of the cycle, disintegration and sloughing of the functionalis layer (endometrium) takes place. For the next 8-9 days, the follicular (proliferation) phase takes place, in which estrogen stimulation brings about endometrial proliferation. Follicle Stimulating Hormones (FSH) help ovarian follicles produce the estrogen. During this phase, the complexity of the spiral arteries increases along with its length. Next, the ovarian follicle ruptures, and ovulation takes place followed by the luteal phase, in which the corpus luteum produces progesterone and estrogens for the rest of the days till next cycle starts.

Types
  1. Metrorrhagia
  2. Menorrhagia
  3. Menometrorrhagia
  4. Postcoital Bleeding
  5. Polymenorrhea
  6. Amenorrhea
  7. Intermenstrual Uterine Bleeding (also known as Spotting)
  8. Oligomenorrhea
Causes
  1. Imbalance between estrogen and progesterone play an important role in the development of this condition.
  2. A prolonged bleeding may result due to improper built up of endometrial lining caused by low level of estrogen. Women who consume oral contraceptive pills (OCPs) may experience such problems.
  3. In most of the cases, it is caused by the Anovulatory Cycle, in which high estrogen is produced with no progesterone. The functionalis layer keeps on developing until feedback causes a drop in Follicle Stimulating Hormone (FSH). During this time, the blood supply outgrows leading the condition in parting of endometrium slough. The type of the resulting disorder is known as Menometrorrhagia.
  4. Luteal phase deficiency is the second most common cause.The luteal phase is shortened due to the insufficient progesterone availability, accompanied by the low, high, or normal level of estrogen. The problems which develop in this type are almost same as those which are developed in Anovulatory Cycle.
  5. Menometrorrhagia is developed in women above age 38.
  6. In this, the quality and quantity of ovarian follicles produced, fall to a very low level. Due to this, the developed follicles are unable to produce enough/sufficient estrogen to help trigger ovulation. The estrogen production does not stop, but late production results in late cycle estrogen breakthrough bleeding.
  7. Along with these, endocrine disorder, polycystic ovary disease, hyperprolactinemia, Cushing's disease, hypothyroidism, hyperthyroidism, premature ovarian failure, structural or malignant lesion of vagina/cervix (Postcoital bleeding), Uterine Polyps, and enlarged uterus are also considered to be associated with the development of this disorder in women.
Diagnosis

The diagnosis involves analyzing the patient's history (everything about menstrual cycle, age, habits, medical history, amount of bleeding, usage of contraceptives, etc.), physical condition, examination of uterus, careful understanding the available data, and if the patient has enlarged uterus then in such cases, doctor may need to confirm if it is related to DUB development. As the symptoms experienced by the patient are somewhat similar to early symptoms of endometrial cancer, endocrinopathies, hyperprolactinemia, hypothyroidism, and hyperthyroidism, your doctor may also suggest you to undergo certain tests to rule out/confirm possibility of other diseases. Analysis of basal temperature helps understand the ovulation timing and other things is also performed during diagnosis.

Your doctor may also suggest you to undergo some tests such as urine pregnancy test, CBC, FSH, PT/PTT, PAP SMEAR, liver test, TSH, DHEAS, prolactin level test, endometrial biopsy, uterine ultrasound (including transvaginal ultrasonography), dilatation and curettage, hysteroscopy, etc., to help confirm if the patient is not pregnant and not suffering from other diseases.

Treatment:

The disease is treated with the help of medication, surgery, and a combination of both. Treatment depends on several factors, such as the patient's condition, severity of bleeding, fertility, etc.

Your doctor may start treatment with dosages of intravenous estrogen or oral conjugated estrogen in the specific amount needed. The treatment also needs to be changed/decided based on the other factors, such as any disease the patient is currently suffering from (after confirming the source of bleeding), need of contraception, need of surgery, etc. Along with other medications, non-steroidal, anti-inflammatory drugs, dilatation and curettage, surgical methods such as laser endometrial ablation (surgical method to treat endometrium), hysteroscopic (a transcervical resection of the endometrium (TCRE), which uses electrocautery loop to remove the endometrium and hysterectomy), etc., may also help control and cure this medical condition.

Disclaimer: This HerHaleness article is for informative purposes only, and should not be used as a replacement for expert medical advice.