Dysfunctional uterine bleeding
Dysfunctional uterine bleeding (DUB) is defined as a change in menstrual bleeding patterns that is most commonly caused by a change in hormonal balance between estrogen and progesterone. It can be described as:
- Vaginal bleeding occurring closer than 21 days or farther than 35 days apart
- Vaginal bleeding lasting longer than seven days
- Heavy bleeding with pads or tampons filled more frequently than one hour apart.
DUB has to be distinguished by a physician from bleeding that occurs from a miscarriage, fibroids, a blood clotting disorder or cancers. In studies, the most common age groups for DUB are before age 20 and after age 40. The normal menstrual cycle occurs when the egg is released from the ovary (ovulation). DUB occurrs when an egg is not released (anovulation). Whenever anovulation occurs the balance between estrogen and progesterone is disturbed and this can cause skipped periods, more frequent periods, heavier or longer bleeding.
What other conditions can cause abnormal bleeding?
- Hormone changes other than estrogen and progesterone including changes in the hormones manufactured by the adrenal gland (cortisol) or the thyroid gland can affect bleeding patterns. Polycystic ovarian syndrome which is an abnormality of multiple hormone systems including insulin, ovarian hormones and cortisol can also change bleeding patterns.
- Obesity – in fat cells other hormones can be converted to estrogen thus altering the balance between estrogen and progesterone.
- Abnormalities of the uterus – fibroids, polyps, cancers of the vagina, cervix or endometrium, adenomyosis can produce abnormal bleeding.
- Infections – pelvic inflammatory disease, gonorrhea or Chlamydia
- Medications – blood thinners, tamoxifen, low-dose birth control pills, Implanon or hormone implants, and Mirena IUD can change bleeding patterns and cause DUB
Your physician will have to rule out abnormalities before assuming that the bleeding is DUB. The evaluation of DUB must be to establish a cause and rule out risk of cancer. Laboratory tests will help to rule out anemia, hormonal imbalances, bleeding disorders, and polycystic ovarian disease. Physical exam can help to rule out abnormalities of the uterus, cervix and vagina.
What are the therapies available for DUB?
Once the evaluation has been completed and no other abnormalities have been found there are several therapy options that can be considered.
- Progesterone therapy – in women who have a high estrogen level and low progesterone level progesterone can be used on a cyclic basis to rebalance the hormones and control bleeding patterns.
- If an abnormal level of cortisol or thyroid is found then therapy for the specific condition can be used.
- Combination estrogen and progesterone – either in individual tablets or combination such as birth control pills, the hormones can be used to re-establish a normal menstrual cycle.
- Hysteroscopy – a surgical procedure to evaluate the lining of the uterus to rule out risk of cancer or polyps
- Endometrial ablation – a surgical procedure to reduce the lining of the uterus and prevent a build up of the lining that can produce heavy bleeding. There are several techniques available including resection of the endometrium, thermal destruction of the endometrium with electrical current or heated fluid, or destruction with radio-frequency waves. These procedures can produce improvement in approximately 90 percent of women. Approximately 30 percent of the treated women may stop menstrual periods completely.
If you have abnormal bleeding, see you family physician or a gynecologist to be evaluated and discuss your options for treatment.