What is Dysfunctional Uterine Bleeding?
Dysfunctional Uterine Bleeding (DUB) is a common problem often reported in the emergency department of the hospitals. It is any irregular bleeding that occurs, when there is no presence of any organic medical disease or condition, such as pregnancy. When there is no recognizable pelvic pathology, it shows that there is a disruption in the normal ovulation cycle or stimulation of the ovulatory hormones to the endometrial lining.
Dysfunctional Uterine Bleeding is basically abnormal vaginal bleeding in the reproductive years of a woman. It is a difficult condition for the woman, mentally as well as socially and also financially. In fact, about 1 to 2 % of all women, who report Dysfunctional Uterine Bleeding, develop endometrial cancer over time, if the anovulatory bleeding is not managed properly.
Symptoms of Dysfunctional Uterine Bleeding
Dysfunctional Uterine Bleeding is very unpredictable. Some have heavy bleeding, some have light bleeding. Sometimes it is frequent, sometimes it is random or at times it is prolonged.
Depending on the amount of bleeding, it can be classified as –
Polymenorrhea: If bleeding occurs more frequently (in less than 21 days or before the next menstrual cycle).
Menorrhagia or Hypermenorrhea: When it involves heavy blood loss (more than 80 mL in less than 7 days during menstrual cycle).
Metrorrhagia: When bleeding occurs frequently and irregularly between menstrual cycles.
Menometrorrhagia: When bleeding involves more blood loss during menstrual cycles and frequent and irregular bleeding between menstrual cycles.
Along with that, there are symptoms like –
- Uterine cramps
- Excessive growth of hair on the body and face
- Mood swings
- Dryness of vagina
- Large blood clots
- Hot flashes
- Tenderness in vagina.
Types of Dysfunctional Uterine Bleeding
Dysfunctional uterine bleeding can be classified into two types:
Ovulatory Dysfunction Uterine Bleeding:
About 10 women who have PCOS or Poly Cystic Ovarian Syndrome suffer from Ovulatory Dysfunctional Uterine Bleeding. As they have a prolonged progesterone secretion, they encounter abnormal uterine bleeding. Also, women, who suffer from endometriosis, can have Dysfunctional Uterine Bleeding. This condition does not impact their ovulation, but they encounter abnormal uterine bleeding during or between menstrual cycles.
Anovulatory Dysfunctional Uterine Bleeding:
This type of Dysfunctional Uterine Bleeding occurs when the woman is not in her reproductive years, or when she is not ovulating. This means, the condition occurs in the extremes of the reproductive age – before puberty and before or after menopause (perimenopause – the years around menopause).
Causes of Dysfunctional Uterine Bleeding
There can be many causes behind Dysfunctional Uterine Bleeding in women, who ovulate and who don’t. These would include –
- Hormonal changes
- Uterine polyps
- Uterine fibroids
- PCOS or poly cystic ovarian syndrome
- Uterine, ovarian, cervical or vaginal cancer
- Severe weight loss
- Excessive weight gain
- Intrauterine devices or birth control pills
- Clotting of blood
- Bleeding disorders
- Cervical or uterine infection.
Diagnosis of Dysfunctional Uterine Bleeding
Identifying the exact cause of Dysfunctional Uterine Bleeding is important in order to treat the condition and its cause. The diagnostic tests that can identify the reason behind the condition are –
- Complete blood count (CBC)
- Liver function tests (LFT)
- Thyroid function tests
- Blood clotting profile
- Hormone tests for FSH (follicle stimulating hormone), male hormone (androgen) levels, LH, progesterone and prolactin
- Fasting blood sugar test
- Pregnancy test
- Pap smear.
Imaging tests for the pelvic region and lower abdomen are also done. At times, the doctor may also recommend biopsy tests to check for cancer or to decide on hormone tests. If there is infection, the doctor will also recommend culture of the infection. The health care provider may also recommend a hysteroscopy in which the provider will look into the uterus through the vagina, using a camera.
Treatment for Dysfunctional Uterine Bleeding
Often the cause of Dysfunctional Uterine Bleeding is hormonal changes. Hormone therapies usually treat this condition. Along with that, the other treatments include –
- Low-dose birth control pills
- Intrauterine device (IUD) that releases the hormone progestin
- High-dose oestrogen therapy for women with very heavy bleeding
- Non-steroidal anti-inflammatory drugs (NSAID) to be taken just before the period starts
- Surgical removal of the polyp or fibroid tumour, if the cause of the bleeding is so.
If the doctor diagnoses precancerous symptoms, he/she may surgically remove the lining of the uterus or remove the uterus altogether known as Hysterectomy. The management depends on the cause; however, whatever the reason is, dysfunctional uterine bleeding should not be ignored. As soon as the symptoms are noted, one must seek medical advice.