What Is Dysfunctional Uterine Bleeding?
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?
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.
hormonal imbalances that cause DUB can also be side effects of medical
conditions or of medications themselves.
conditions that often cause dysfunctional uterine bleeding are:
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
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.
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.
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.
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 can also cause dysfunctional uterine bleeding, including:
- birth control pills
- hormonal agents
- Warfarin (Coumadin)
Recognizing the Signs of DUB
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
- bleeding that lasts more than seven
- bleeding that occurs less than 21
days from the last cycle
common DUB symptoms are:
- bleeding between periods
- breast tenderness
you experience any of the following severe DUB symptoms, contact your doctor
- low blood pressure
- increased heart rate
- pale skin
- passing large clots
- soaking a pad every hour
How Is DUB Diagnosed?
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.
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.
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.
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?
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
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
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.
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.
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.
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,
Can DUB Cause Complications?
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.