Abnormal Uterine Bleeding

What is DUB?

Any abnormal uterine bleeding in absence of pregnancy, genital tract pathology, or systemic disease Menorrhagia.

What causes abnormal uterine bleeding?

Also known as Abnormal Uterine Bleeding (AUB), DUB is a condition that causes vaginal bleeding to occur outside of the regular menstrual cycle.
Certain hormonal conditions and medications may also trigger DUB.

Causes Of Abnormal Uterine Bleeding

The main cause of dysfunctional uterine bleeding is an imbalance in the sex hormones.
The hormonal imbalances that cause DUB can also result from certain medical conditions or be side effects of medications.

Medical conditions

Medical conditions that often cause dysfunctional uterine bleeding are:
Polycystic ovary syndrome (PCOS)
Endometriosis
Uterine polyps
Uterine fibroids
Sexually transmitted diseases (STDs)
Pregnancy

Polycystic ovary syndrome (PCOS)

This is an endocrine disorder that causes a woman to produce an imbalanced amount of sex hormones.
This may lead to an imbalance in estrogen and progesterone, making the menstrual cycle irregular.

Endometriosis

 This condition results when the uterine lining grows outside of the uterus, such as on the ovaries. 
Endometriosis can cause heavy bleeding during regular periods.

Uterine polyps

 These small growths occur within the uterus. Although their cause is unknown, polyp growth is heavily influenced by the hormone estrogen. Small blood vessels in the polyps can cause DUB, including spotting between periods.

Uterine fibroids

 Uterine fibroids are small growths that occur within the uterus, uterine lining, or uterine muscle.
Like polyps, the causes of uterine fibroids are unknown. But estrogen seems to play a role in their growth.

Sexually transmitted diseases (STDs)

 STDs that cause inflammation, like gonorrhea and chlamydia, may lead to DUB.
Bleeding caused by STDs usually occurs after sex, when the lesions are aggravated.

Pregnancy

AUB can be an early symptom of pregnancy.

Medications causing abnormal uterine bleeding

Certain medications can also cause dysfunctional uterine bleeding, including:
Birth control pills
Hormonal agents, like spironolactone and tamoxifen
Warfarin (Coumadin)

Symptoms

The most common symptom of DUB is bleeding outside of your normal periods. It can also occur within your menstrual cycle. Suspicious bleeding patterns include:
Heavy menstrual bleeding

  • Containing many clots or large clots
  • Lasts more than 7 days
  • Occurs less than 21 days from the last cycle
  • Bleeding that occurs later than 35 days from the last cycle
  • Spotting
  • Bleeding between periods

Other common symptoms that can occur with DUB are:

  • Bloating
  • Pelvic pain or pressure
  • Dizziness
  • Fainting
  • Weakness
  • Low blood pressure
  • Increased heart rate
  • Pale skin
  • Pain
  • Passing large clots
  • Soaking a pad every hour
  • Bleeding with a positive pregnancy test

Diagnosis

  • Timing of bleeding,
  • quantity of bleeding
  • menstrual history including
  • menarche and recent periods
  • family history of bleeding
  • Disorders.

Physical examination

Vaginal or cervical source of bleeding.
Bimanual may reveal bulky uterus/discrete fibroids.
Assess for obesity, hirsutism, stigmata of thyroid disease (hypothyroidism associated with anovulation), signs of hyperprolactinemia (visual field testing, galactorrhea).

Investigations

Blood test to measure hormone levels and complete blood count.
Pap smear
Endometrial biopsy
Pregnancy Test

Imaging
Ultrasound
Sonohystogram or hysterosalpingogram
Ultrasound
Ultrasound to view the reproductive organs. This examination can help to reveal whether abnormal growths, such as polyps or fibroids are found.
It can also help to rule out internal bleeding.

Treatment of abnormal uterine bleeding


There are many treatment options available for DUB.
Sometimes, in cases of puberty especially, no action is taken, as the hormones usually correct themselves.
The right treatment will depend on the underlying cause of the bleeding.

Oral contraceptives and IUDs

The most common and simple treatment option for dysfunctional uterine bleeding is combination oral contraceptives.

Combination oral contraceptives contain synthetic estrogen and progesterone. These both work to control and regulate the menstrual cycle.

Contraceptive methods including some progestin IUDs and the progestin implant can also be used as hormonal treatment.

Medications

If the bleeding is suddenly very heavy and lower-dose medications aren’t an option, intravenous estrogen can be administered until the bleeding subsides.
This may be followed by a course of oral progestin to balance the hormones.
Stimulating ovulation can stop prolonged menstrual bleeding by resetting your menstrual cycle.

D & C

Heavy and prolonged bleeding accompanied by a thickened uterine lining can be treated with a procedure called dilation and curettage (D and C).
This is an outpatient surgical procedure used to remove part of the uterine lining by scraping it away.

BIOPSY

If the uterine cells are found to be abnormal,doctor may order an additional biopsy after treatment.

HYSTERECTOMY

Depending on the results of the biopsy
If the cells are cancerous, for instance — a hysterectomy may be recommended.

A hysterectomy is a complete removal of the uterus
and is usually a last resort.

Complications of abnormal uterine bleeding

Anemia
In rare cases where the bleeding has caused significant blood loss, you may need a blood transfusion.

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