Abnormal Uterine Bleeding

One classifies Dysfunctional uterine bleeding (DUB) as menstrual bleeding on days that do not fall within the normal menstrual cycle, and an imbalance in sex hormones can cause this condition.

What is dysfunctional uterine bleeding?
What causes DUB?
How do doctors diagnose DUB?
What are the treatment options for DUB?

WHAT IS DYSFUNCTIONAL UTERINE BLEEDING?

On average, a healthy woman’s menstrual cycle takes place every 24 to 35 days, and the menstrual bleeding can persist for two to seven days¹. Accordingly, a doctor can diagnose a woman as suffering from dysfunctional uterine bleeding (DUB) when these criteria are not met.¹
Medical Professionals characterise dysfunctional uterine bleeding as menstrual bleeding on days that do not fall within the normal menstrual cycle. Moreover, an imbalance in sex hormones can be the primary cause.²
Hormonal imbalances often occur when young girls start puberty and when women start experiencing menopause. What’s more, this hormonal balance can persist for months, even years.²

The following are signs of DUB:

infrequent or sporadic bleeding, especially outside of the normal menstrual cycle;²
heavy bleeding that can also contain blood clots;² and
spotting, which is lighter than a normal menstrual period and often appears brown, pink, or light red.²

WHAT CAUSES DUB?

The most common cause of abnormal uterine bleeding is hormonal.³ Sometimes, in girls going through puberty and woman starting menopause, the endometrium can build up too much. Subsequently, this can result in an irregular or heavy period or spotting between periods.³

The following are other factors that affect your hormones:

birth control pills, some medicines, as well as hormone therapy;
rapid weight loss or gain;
emotional or physical stress;
an intrauterine device (IUD);
polycystic ovary syndrome (PCOS).

DUB can also result from the following less common, conditions:

bleeding or clotting disorders;
cancer of the cervix,
endometrium or uterus;
illness that affects kidneys, liver, thyroid or adrenal glands;
infection of the cervix or endometrium;
and sexually transmitted diseases³.

HOW DO DOCTORS DIAGNOSE DUB?

It will certainly help your doctor with a diagnosis if you take notes during a few consecutive cycles, detailing specific symptoms.³ Furthermore, your doctor will want to know about your overall health, carry out a pregnancy test, as well as conduct a physical examination, including the procedures below.³

Your doctor will conduct a blood test to check if your body is short of iron. Heavy bleeding can, of course, be the reason for this. The blood test will also determine whether your hormones are functioning as they should be and whether you have a chronic illness or a blood disorder.³
A doctor mayl also inspect the images that an ultrasound takes of the inside of your uterus to look for fibroids or polyps.³
The doctor will look into your uterus by way of a hysteroscopy, which involves inserting a tiny, lighted scope through your cervix into your uterus.³
The doctor may conduct a biopsy which involves removing a small piece of tissue. After this, a specialist will examine the specimen under a microscope for abnormal cells.³
Magnetic resonance imaging makes detailed pictures of your uterus. While doctors do not often use this technique, it can help spot adenomyosis.³

WHAT ARE THE TREATMENT OPTIONS FOR DUB?

The correct treatment of DUB often depends on why a patient experiences excessive bleeding.² For example, if a woman experiences DUB at the onset of puberty, often no action is taken as hormonal imbalances can eventually correct themselves.²
If you are not trying to fall pregnant, your doctor may recommend one of two contraceptive methods to regulate and control the menstrual cycle. Firstly, a combination of oral contraceptives containing synthetic oestrogen and progesterone, and doctors use these most frequently.² Secondly, the use of progestin IUDs or a progestin implant to regulate hormonal imbalances.²
On the other hand, doctors can treat sudden heavy bleeding using intravenous oestrogen.² Once the bleeding has stopped, they could follow this treatment by oral progestin to balance hormones.²
However, if you’re trying to conceive, stimulating ovulation using an ovulation-stimulating drug can stop prolonged menstrual bleeding by resetting your menstrual cycle.²
Moreover, a procedure called dilation and curettage, or D&C, is a surgical procedure that removes some of the uterine lining, and surgeons sometimes use this to treat heavy and prolonged bleeding accompanied by a thickened uterine lining.²
Finally, your doctor may order an additional biopsy if they find your uterine cells to be abnormal.² A hysterectomy, which involves the complete removal of the uterus, may be recommended if the biopsy shows that the cells are cancerous; however, this is usually a last resort.²