Dysfunctional Uterine Bleeding

The Normal Menstrual Cycle
It can be difficult to know whether you are suffering from DUB if you don't know what your regular menstrual cycle is. Menstruation is based on the amount of estrogen and progesterone released in your body. The following is an example of a normal cycle. Remember that this is only an example and can vary a few days in each stage.

Day of Cycle
1-6 - menstrual flow begins with days 1-3 being the heaviest and then a gradual tapering off; flow can last from 2-6 days

7-16 - proliferative phase; estrogen levels rise resulting in the growth of the endometrial walls in the uterus. The level of estrogen present directly affects how much lining is produced in the uterus

17-28 - secretory phase; this begins the day after ovulation occurs. Progesterone secretion increases which in turn stops the growth of the endometrium.

What is Dysfunctional Uterine Bleeding?
WHAT - Abnormal vaginal bleeding usually resulting from a hormonal imbalance.

WHY - The amount of estrogen needed in the proliferative stage varies for each woman. The type of abnormal bleeding is a reflection of the level of estrogen released. For example, women with lower-levels of estrogen will have intermittent spotting while those with higher levels will experience long periods without menstruation and then have excessive bleeding.

OR An anatomical lesion such as cervical lesions (tumors, infections, lacerations, uterine lesions)

Reasons for DUB vary depending on age group.

Some Helpful Terminology
Vaginal bleeding can vary in frequency, quantity and causes. When a diagnosis is given by your doctor, he/she can describe your individual case with many different terms. The following are some frequently used terms.

Ovulatory Bleeding - regular premenstrual symptoms are experienced, i.e., bloating, mood swings, weight gain etc. and bleeding occurs at regular intervals (including menorrhagia and intermenstrual bleeding)

Metromenorrhagia - excessive or prolonged bleeding at irregular intervals

Oligomenorrhea - uterine bleeding occuring at intervals of 35 days to six months

Polymenorrhea - uterine bleeding at many short intervals, less than 21 days

Amenorrhea - six month absence of uterine bleeding

Intermenstrual Bleeding - bleeding occuring between regular menstrual cycles, also known as breakthrough bleeding

Differences Through Age
Adolescence - Some common causes among teen-agers are anovulatory uterine bleeding, coagulation disorders, pregnancy related causes, functional ovarian cysts, breakthrough bleeding, and withdrawal bleeding.

The menstrual cycle of an adolescent girl takes a while to develop so varying lengths and quantities are normal within the first 15 months. If an adolescent is sexually active or anemic, a pelvic exam is recommended.

As long as pregnancy has been excluded, treatment can begin upon diagnosis. Therapy should last 3-6 months, after which it should be charted whether a regular menstrual cycle occurs.

Reproductive Age - Some common causes among reproductive-aged women are pregnancy related.

Peri/Postmenopausal - Some common causes among peri/postmenopausal women are: anatomic lesions, anovulatory dysfunctional uterine bleeding, bleeding disorders, liver disease, anticoagulen therapy, trauma.

With age, the body produced less estrogen so that the estrogen level needed to trigger progesterone release is not reached. The uterus continues to build lining and eventually intermittent bleeding occurs.

A detailed menstrual history, obstetrical history, gynecological history and medication are important for diagnosis.

Steps in Treatment
When seeking treatment or diagnosis your doctor should check the following things:

  • complete medical and gynecological history
  • normal menstrual cycle and relative blood loss
  • pain, nausea, bruising, abnormal nongynecological bleeding
  • sexual activity, contraception use (IUD) and pregnancy
  • possible complete/incomplete abortions and/or ectopic pregnancy
  • systemic diseases (hepatic, thyroid, renal diseases)
  • history of excessive bleeding after dental work or other operations
  • acute or chronic liver disease
Physical Exam
A full physical exam is important. For reproductive women a physical should include a pelvic exam.

Oral Contraceptives
The use of oral contraceptives are recommended to treat menorrhagia (excessive or prolonged bleeding at irregular intervals) or to regulate bleeding caused by fibroids. Menstrual bleeding decreases by 50%. Oral contraceptives are most effective for adolescents and women under 35.

Is effective for women experiencing anovulatory or menorrhagia bleeding. Medication is taken from the first day of menstruation until the last day on a regulated cycle. Are low cost, have few side effects and are taken only during menstruation.

Progestational Agents
Progesterone can be utilized when there is heavy bleeding on a regular basis. Medicine should be administered until there has been no bleeding for 3-4 weeks, after which it should be stopped, some withdrawal bleeding will occur. Birth control should still be used with the progesterone treatment.

Some side affects are weight gain, bloating, mood swings, headaches, acne, nausea.

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