Uterine Bleeding, Dysfunctional

uterus– Abnormal uterine bleeding not associated with recognizable organic lesion, inflammation, ovulation, or pregnancy.

Causes and Incidence

Dysfunctional uterine bleeding (DUB) usually results from an imbalance in the hormone-endometrium relationship when unopposed estrogen stimulates the endometrium. Contributing factors include polycystic ovaries, anovulation, obesity, nulliparity, and use of exogenous estrogen. Variation in uterine bleeding is the most frequently encountered health problem in women, and DUB is the most common cause of abnormal bleeding. It is typically seen at the extremes of reproductive life, with 50% of cases occurring after 45 years of age and another 20% in adolescence.

Disease Process

Unopposed estrogen stimulation often causes an endometrial hyperplasia. The endometrium becomes thickened by the estrogen, and when it can no longer be maintained, the endometrial lining sloughs in an incomplete and irregular pattern, leading to irregular, prolonged bleeding.

Symptoms

The main sign is painless, irregular, heavy vaginal bleeding. Midcycle spotting, oligomenorrhea, or amenorrhea may also be present.

Potential Complications

Anemia is the chief complication.

Diagnostic Tests

The diagnosis is made on the basis of the history, a pelvic examination, and laparoscopy to rule out other bleeding disorders or underlying disorders. Endometrial biopsy can rule out cancer.

Treatments

Surgery
Laser ablation or fulguration of endometriosis; presacral neurectomy when bleeding is severe and does not respond to other treatment.

Drugs
Combination contraceptives to control bleeding.

General
Iron replacement or packed cells for associated anemia; adequate nutritional intake; cessation of extreme exercise schedules.