Abnormal Uterine Bleeding

Abnormal Uterine Bleeding

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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. A woman can be diagnosed as suffering from dysfunctional uterine bleeding (DUB), when these criteria are not met.1

Dysfunctional uterine bleeding is characterised by menstrual bleeding on days that do not fall within the normal menstrual cycle and can be caused by an imbalance in the sex hormones.2

Hormonal imbalances often occur when young girls start puberty and when women start experiencing menopause.  This hormonal balance can persist for months, even years.2

Signs of DUB are:

  • infrequent or sporadic bleeding, outside of the normal menstrual cyle;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
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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, resulting in an irregular or heavy period or spotting between periods.3

Other factors that affect your hormones:

  • birth control pills, some medicines, as well as hormone therapy;3
  • rapid weight loss or gain;3
  • emotional or physical stress;3
  • an intrauterine device (IUD);3 and
  • polycystic ovary syndrome (PCOS).3

DUB can also result from the following, less common, conditions: bleeding or clotting disorders; cancer of the cervix, endometrium or uterus; illness that affect kidneys, liver, thyroid or adrenal glands; infection of the cervix or endometrium; and sexually transmitted diseases3.

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How is DUB diagnosed?

It will help your doctor with a diagnosis if you take notes during a few consecutive cycles, detailing specific symptoms.3  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

  • A blood test will be conducted to test if your body is short of iron, which can be caused by heavy bleeding.  A blood test will also determine whether your hormones are functioning as they should be, whether you have a chronic illness or a blood disorder.3
  • A doctor will 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 which will be examined under a microscope for abnormal cells.3
  • Magnetic resonance imaging makes detailed pictures of your uterus. While this is not often used, it can help spot adenomyosis.3
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How can DUB be treated?

The correct treatment of DUB often depends on why excessive bleeding is experienced.2 If DUB is experienced 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.2 The first is combination oral contraceptives, which contain both synthetic oestrogen and progesterone, and are most commonly used.2  The second is the use of progestin IUDs or progestin implant to regulate hormonal imbalances.2

Sudden heavy bleeding can be treated using intravenous oestrogen.2 Once the bleeding has stopped, this treatment could be followed by oral progestin to balance hormones.2

If you’re trying to conceive, stimulating ovulation using an ovulation-stimulating drug can stop prolonged menstrual bleeding by resetting your menstrual cycle.2

A procedure called dilation and curettage, or D&C, is a surgical procedure that removes some of the uterine lining and is sometimes used to treat heavy and prolonged bleeding accompanied by a thickened uterine lining.2

Your doctor may order an additional biopsy if your uterine cells are found 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

Medical References

  1. Chin. J.Obstet, Gynecol. Clinical Guidelines for Diagnosis and Treatment of Dysfunctional Uterine Bleeding. March 2009, Vol. 44, No. 3, 234-236.
  2. April Kahn, What You Should Know About Dysfunctional Uterine Bleeding, updated 15 March 2021. https://www.healthline.com/health/dysfunctional-uterine-bleeding-dub Accessed 20 October 2021. 3. Stephanie Langmaid, Abnormal Uterine Bleeding, WebMD, reviewed 22 September 2020, https://www.webmd.com/women/abnormal-uterine-bleeding#2-4 . Accessed 20 October 2021.

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