Dysfunctional 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
any time that hormones are imbalanced. Certain hormonal conditions and
medications may also trigger DUB.
The 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.
The hormonal imbalances that cause DUB can also be side
effects of medical conditions or of medications themselves.
Medical conditions that often cause dysfunctional uterine
- Polycystic 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 irregular.
- Endometriosis: This
condition results when the uterine lining grows outside of the uterus, such as
on the ovaries. Endometriosis often causes heavy bleeding during regular
- Uterine polyps: These
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.
- Uterine fibroids: Uterine
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.
- Sexually 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.
Certain medications can also cause dysfunctional uterine
- birth control pills
- hormonal agents
- Warfarin (Coumadin)
Symptoms of DUB
The most common symptom of DUB is bleeding outside of your
normal periods. It can also occur within your menstrual cycle. In this case, it
- heavy menstrual bleeding
- bleeding that contains many clots or large clots
- bleeding that lasts more than seven days
- bleeding that occurs less than 21 days from the
Other common DUB symptoms are:
- bleeding between periods
- breast tenderness
If you experience any of the following severe DUB
symptoms, contact your doctor immediately:
- low blood pressure
- increased heart rate
- pale skin
- passing large clots
- soaking a pad every hour
How Is DUB
To 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.
Your 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
Blood 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.
If 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.
There are many treatment options available for DUB.
Sometimes, in cases of puberty especially, no action is taken, as the hormones
usually correct themselves. The right treatment for you will depend on the
underlying cause of the bleeding.
The most common and simplest treatment option for dysfunctional
uterine bleeding is a combination of 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 option.
If 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
If you’re 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.
Heavy 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.
If 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.
Can DUB Cause
Generally, 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