Dysfunctional Uterine Bleeding (DUB) is the most common cause of functional abnormal uterine bleeding, which is
abnormal genital tract bleeding based in the
uterus and found in the absence of demonstrable organic
pathology.
Diagnosis must be made by exclusion, since organic pathology must first be ruled out.
It can be classified as
ovulatory or
anovulatory, depending on whether
ovulation is occurring or not.
Ovulatory
Ovulatory DUB happens with the involvement of ovulation, and may represent a possible
endocrine dysfunction, resulting in
menorrhagia or
metrorrhagia.
Mid-cycle bleeding may indicate a transient
estrogen decline, while late-cycle bleeding may indicate
progesterone deficiency.
Anovulatory
Anovulatory cycle DUB happens without the involvement of
ovulation.
The etiology can be
psychological stress, weight (
obesity,
anorexia, or a rapid change),
exercise,
endocrinopathy,
neoplasm,
drugs, or it may be otherwise
idiopathic.
Assessment of anovulatory DUB should always start with a good medical history and physical examination.
Laboratory assessment of hemoglobin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, T4, thyroid stimulating hormone (TSH), pregnancy (by βhCG), and androgen profile should also happen.
More extensive testing might include an ultrasound and endometrial sampling.
Management
Management of dysfunctional uterine bleeding predominantly consists of reassurance, though mid-cycle
estrogen and late-cycle
progestin can be used for mid- and late-cycle bleeding respectively.
Also, non-specific
hormonal therapy such as combined estrogen and progestin can be given.
The goal of therapy should be to arrest bleeding, replace lost iron to avoid anemia, and prevent future bleeding.
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