Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding (DUB) is an abnormal uterine bleeding which is associated with hormone level changes but is not be related to any pathology or disease condition. ^[1] Most patients are managed using medications while some may undergo surgical procedures as part of treatment. ^[2]

Epidemiology

DUB is a frequent condition especially in the outpatient setting. Most patients belong to the adolescent group and perimenopausal group. ^[1]

Causes

DUB is largely classified into two types namely anovulatory and ovulatory. In the first type, there is unsuccessful cyclical secretion of progesterone leading to unrestricted estradiol. The upshot is overgrowth of the endometrium resulting to necrosis and irregular bleeding. The second type is less frequent and is theorized to be brought about by a defect in local endometrial hemostasis. Factors that may increase the chance of an individual to have the condition include adolescence or perimenopause, obesity, cigarette smoking and having conditions like polycystic ovarian syndrome. ^[3]

Signs and Symptoms

Patients usually experience bleeding in between periods. The periods do not fall within the normal time frame which is less than 28 days apart or more than 35 days part. The timing between periods may seem to vary every month and the menstruation is heavier as the sanitary napkin becomes more soaked than usual and large clots are passed. Also, the duration is menstruation is longer than normal (greater than seven days). Some patients may have hot flashes, mood disturbances and excessive body hair. ^[4]

Diagnosis

After getting the patient’s history, pelvic examination is typically performed. Some may do Pap smear. Among the laboratory exams that may be requested include pregnancy test, complete blood count, blood clotting profile, hormone level tests, transvaginal ultrasound and thyroid function test.^[4]

Treatment

The objective is to manage the menstrual cycle. The physician may prescribe contraceptive pills. In some instances, intrauterine device is recommended. Patients who have anemia may be given iron supplements. When the case is severe and the patient is not looking forward to have children, surgical procedure like hysterectomy may be an option. ^[4]

References:

1. http://emedicine.medscape.com/article/257007-overview#a0101
2. https://www.clinicalkey.com/topics/obstetrics-gynecology/dysfunctional-uterine-bleeding.html
3. https://www.clinicalkey.com/topics/obstetrics-gynecology/dysfunctional-uterine-bleeding.html
4. http://www.nlm.nih.gov/medlineplus/ency/article/000903.htm

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Ferrous Sulfate (Iron Supplement) [1, 2, 3]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present. 

Recommendation: Strongly in favor (Iron supplements are recommended to take to avoid anaemia)

Grade of Evidence: Moderate quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. http://emedicine.medscape.com/article/953078-treatment

2. https://www.nlm.nih.gov/medlineplus/ency/article/000903.htm

3. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Menstruation_abnormal_bleeding

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