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All About Dysfunctional Uterine BleedingAll About Dysfunctional Uterine Bleeding
What Is Dysfunctional Uterine Bleeding?
Dysfunctional uterine bleeding (DUB) occurs outside of the normal menstrual cycle in women between 35-50 and adolescents between 12-16 years of age. DUB may reflect a cycle disruption in the normal pattern of ovulatory hormonal stimulation. These random hormone levels (imbalance of estrogen) can over stimulate the growth or thickness of the uterine lining (endometrium),* which is broken down in the form of cells, tissue and blood and shed from the uterus. Bleeding can be heavy or light, frequent or random, irregular (spotting) or longer than a normal period. DUB is considered the most common type of abnormal uterine bleeding.
*Each month the uterine lining (endometrium) builds up, then sheds resulting in a period (menses). The average cycle is about 28 days but can be shorter or longer (25-35 days). The menstrual flows last 3 to 7 days.
What Are the Symptoms of DUB?
What Causes DUB?
Irregular, unpredictable or heavy menstrual bleeding can have many causes, which include:
Diagnosing DUB
DUB generally occurs without recognizable pelvic disease or pregnancy. A doctor will first rule out, following a thorough examination, any unusual causes of irregular menstrual bleeding, such as fibroids, endometrial polyps, endometriosis and endometrial cancer. The exam generally involves:
The physician may decide to order one or more of the following diagnostic procedures:
Treatment Options
Once a physician determines the hormonal imbalance that is causing abnormal bleeding, appropriate treatment can be recommended. (If DUB is short term, no treatment may be necessary).
· Oral birth control pills, considered the first line of treatment, should restore normal periods in younger women. However, in more mature women, the birth control pill may not be safe or cause side effects. Therefore, regular hormone replacement therapy (HRT) may be prescribed to restore normal periods. (Progesterone taken the last 10-14 days of the cycle should regulate a period). The pros and cons of HRT are discussed with all menopausal women.
· Iron supplements and a diet high in iron are recommended if a patient loses iron due to excessive menstrual bleeding
Surgical Options
Women with DUB may choose one of the following surgical procedures if HRT does not stop abnormal bleeding:
· Endometrial ablation utilizes laser, thermal, cold, microwave or electricity to remove those areas of the uterine lining which are causing the high rate of bleeding
· D&C with a hysteroscopy will aid in the treatment of endometrial polyps. However, D&C is not considered the most effective treatment
· Laparoscopy is minimally invasive surgery that utilizes a thin lit telescope
threaded through small incisions below the navel. A hysteroscopy uses the same telescopic device through the cervix into the uterus. One of these two procedures may be recommended to remove, depending on the size and access, offending endometrial lining, fibroids or cysts.
· Laparotomy is invasive surgery that requires a larger incision in the abdominal wall to access larger pelvic areas and to remove endometrial overgrowth, fibroids or cysts.
· Abdominal or vaginal hysterectomy (removal of the uterus) can be performed via an invasive laparotomy or a minimally invasive hysteroscopy
Conclusion
Abnormal uterine bleeding is an important reason for women of all ages to consult their family physician. Therapy to control or prevent recurrent bleeding or treat disease that may be preventing a desired pregnancy can then be addressed.  |
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