Dysfunctional Uterine Bleeding

Definition

Dysfunctional uterine bleeding refers to any abnormal endometrial bleeding without recognizable organic lesions. It may be occur during postmenarchal and perimenopausal periods in a woman's reproductive life. The prognosis varies with the cause. DUB is the indication for almost 25% of gynecologic surgical procedures.

Causes of Dysfunctional uterine bleeding

• DUB may be occur from an imbalance in the hormonal-endometrial relationship, where persistent and unopposed stimulation of the endometrium by estrogen occurs.
• Disorders that may cause sustained high estrogen levels are polycystic ovary syndrome, obesity, immaturity of the hypothalamic-pituitary-ovarian mechanism. 

In most cases of DUB, the endometrium shows no pathologic changes. But in chronic unopposed estrogen stimulation, the endometrium may show hyperplastic or malignant changes.

Symptoms of dysfunctional uterine bleeding

DUB usually occurs as metrorrhagia,  it may also occur as hypennenorrhea  or chronic polymenorrhea. Such bleeding is unpredictable and can cause anemia.

Treatment of dysfunctional uterine bleeding

• If drug therapy is ineffective, then you should use supplementary treatment through removal of a large portion of the bleeding endometrium. Because it may also help determine the original cause of hormonal imbalance and aid in planning further therapy. If fertility isn't an issue, endometrial ablation may be a treatment option. Regardless of the primary treatment, the patient may need iron replacement or transfusions of packed cells or whole blood, as indicated, because of anemia that may be caused by recurrent bleeding.
• For the treatment of this disease, you can use high-dose estrogen-progestogen combination therapy to control endometrial growth and reestablish a normal cyclic pattern of menstruation. You should be taken these drugs four times daily for 5 to 7 days, although bleeding usually stops in 12 to 24 hours. In patients over age 35, endometrial biopsy is necessary before the start of estrogen therapy to rule out endometrial adenocarcinoma. Because progestogen therapy is a necessary alternative in some women such as those susceptible to the adverse effects of estrogen.
• For the treatment of this disease, you should know about the importance of adhering to the prescribed hormonal therapy. If a D&C or endometrial ablation is ordered, explain this procedure and its purpose.
• You should do regular checkups to assess the effectiveness of treatment.