Dysfunctional uterine bleeding (DUB)

Alternative names
Anovulatory bleeding; Bleeding - dysfunctional uterine; DUB

Definition
Dysfunctional uterine bleeding (DUB) is abnormal vaginal bleeding that occurs during a menstrual cycle that produced no egg (ovulation did not take place).

Causes, incidence, and risk factors

Anovulatory or dysfunctional uterine bleeding is a diagnosis of exclusion. This means that it is determined only AFTER other causes of abnormal uterine bleeding - such as systemic diseases, medications, early pregnancy disorders, eating disorders, gynecological infections, structural anomalies, or tumors - have been ruled out.

Anovulatory cycles are common for the first year after menarche (when a girl begins to menstruate), and later in life as a woman approaches menopause (when menstrual periods stop). Approximately 20% of cases occur in adolescents and 40% in women over 40. Obesity, excessive exercise, and emotional stress may be risk factors for DUB.

Symptoms

     
  • Vaginal bleeding between periods  
  • Abnormal menstrual periods  
  • Variable menstrual cycles (usually less than 28 days between menstrual periods)  
  • Variable menstrual flow ranging from scanty to profuse  
  • Infertility  
  • Mood swings  
  • Hot flashes  
  • Vaginal tenderness  
  • Hirsuitism - excessive growth of body hair in a male pattern

Signs and tests

A pelvic examination will be performed.

Tests to evaluate women with DUB usually include:

     
  • CBC  
  • Serum HCG (to rule out pregnancy)  
  • Thyroid function tests specific hormonal regulation tests       o Prolactin       o Androgen levels       o FSH (follicle-stimulating hormone)       o LH (luteinizing hormone)

Diagnostic procedures that may be performed include:

     
  • Endometrial biopsy  
  • D and C (dilatation and curettage)  
  • Pelvic ultrasound  
  • Hysteroscopy

Treatment

Young women within several years of menarche (the first menstrual period) are not treated unless symptoms are exceptionally severe, such as heavy blood loss causing anemia.

In women of childbearing age, treatment is aimed at achieving regular menstrual cycles with normal patterns. Oral contraceptives or progestogen therapy are frequently used for this purpose. If anemia is present, iron supplementation may be recommended. If pregnancy is desired, ovulation induction may be attempted with medication.

Women whose symptoms are severe and resistant to medical therapy may choose surgical treatments including endometrial ablation (a procedure that burns or removes the lining of the uterus) or hysterectomy.

In older women who may be approaching menopause, treatment may be elected to offset symptoms. Women may choose from treatments such as hormone supplementation or surgery.

Expectations (prognosis)
Hormonal regulation is usually successful in alleviating symptoms. Induced ovulation, in women desiring pregnancy, is successful in approximately 80% of cases.

Complications

     
  • Infertility resulting from lack of ovulation  
  • Severe anemia as a result of prolonged or heavy menstrual bleeding  
  • Prolonged buildup of the uterine lining without adequate menstrual bleeding (a possible factor in the development of endometrial cancer)

Calling your health care provider
Call your health care provider if you have unusual vaginal bleeding.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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