Dysfunctional uterine bleeding

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Dysfunctional Uterine Bleeding (DUB) is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable organic pathology. It can be classified as ovulatory or anovulatory.

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 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 otherwise idiopathic.

Assessment of anovulatory DUB should happen as follows:

  1. History
  2. Physical examination
    • Volume status
    • Stigmata of endocrinopathy
  3. Laboratory assessment
  4. Other

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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