Introduction
The female reproductive system is regulated by various hormonal levels, most importantly estrogen and progesterone. The changes in these hormonal levels maintain the menstrual cycle. Ovulation is the release of the mature egg from the follicle which is an important event that regulates the cycle. The absence of ovulation due to variations in hormonal levels can cause irregular uterine bleeding. Women may experience uterine bleeding other than the usual menstrual bleeding, which is abnormal.
What Is Dysfunctional Uterine Bleeding?
Dysfunctional uterine bleeding or DUB is an abnormal uterine bleeding different from the usual menstrual bleeding. Dysfunctional uterine bleeding occurs due to hormonal imbalances and no associated structural or organic pathology. This type of bleeding can happen in the absence of a pregnancy tumor and infection. It is often associated with anovulation or continuous ovarian estrogen production with non-secretory endometrium. Commonly seen in young girls reaching puberty and women reaching menopause. Dysfunctional uterine bleeding can be divided into ovulatory DUB and anovulatory DUB.
What Are the Causes of DUB?
Abnormalities in the Reproductive Tract:
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Fibroids or abnormal growths in the uterus.
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Infections of the reproductive tract.
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Endometriosis is a condition where tissue similar to the uterine tissue grows outside the uterus.
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Adenomyosis, where the uterine tissue grows into the muscular wall of the uterus.
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Cervical polyps, small growths on the cervix causing bleeding
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Benign pelvic lesions.
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Malignancy of female reproductive organs.
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Trauma.
Pregnancy Complications:
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Molar pregnancy, rare complications were the unusual growth of cells and it becomes the organ that feeds the growing fetus.
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Ectopic pregnancy, where the fertilized egg starts to grow outside the uterus.
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A placental polyp, is a retained part of placental tissue after abortion or childbirth.
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Missed abortion, called in utero death of the fetus before 20 weeks of gestation.
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Incomplete abortion, partial or complete loss of the products of pregnancy before 20 weeks of pregnancy.
Due to Medications:
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Anticoagulation therapy.
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Hormonal replacement therapy.
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Indra uterine devices.
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Contraceptive use
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Levonorgestrel implant.
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Contraceptive injection.
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Oral contraceptive.
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Psychiatric drugs.
Systemic Diseases:
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Coagulation disorder.
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Hypothyroidism.
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Liver cirrhosis.
What Are the Signs and Symptoms of DUB?
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Commonly, bleeding occurs outside the normal periods. But can occur during periods with abnormal bleeding patterns.
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Heavy menstrual flow.
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Bleeding with large blood clots.
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Bleeding occurs in less than 21 days from the previous cycle.
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Bleeding occurs later than 35 days.
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Bleeding in between periods.
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Spoting.
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Pelvic pain or pressure.
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Amenorrhea, which is the absence of menstruation during the reproductive age of a woman.
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Continuous uterine bleeding.
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Secondary anemia
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Infertility
What Are the Types of DUB?
Ovulatory DUB:
About 10 percent of ovulatory DUB is seen in women who are ovulating. In females, progesterone secretion is prolonged due to reduced estrogen levels. This irregularity in hormone levels leads to the shedding of the uterine lining, causing bleeding. In ovulatory dysfunctional uterine bleeding, the blood vessels in the uterus are more fragile. It can also occur due to endocrine dysfunction coaching menorrhagia or metrorrhagia. A bleeding scene during mid-cycle indicates a transient estrogen decline, and bleeding that occurs in the late cycle indicates progesterone deficiency.
Anovulatory DUB:
About 90 percent of dysfunctional uterine bleeding occurs due to the absence of ovulation. This occurs during early puberty or late in the menopause. Common age presentation is less than 20 and more than 40 years. In women where the proper development and release of a mature egg do not occur, chances for anovulatory DUB are higher. The follicles do not rupture to release eggs. The hormonal level of estrogen is higher due to the continuous production causing the overgrowth of the uterine lining. Also, the absence of the Corpus luteum that produces progesterone causes irregularities in hormonal levels. Regular menstruation is delayed; when it occurs, it will be heavy and prolonged bleeding. The other possible etiology can be
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Obesity.
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Psychological stress.
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Endocrinopathy.
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Neoplasm.
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Drugs.
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Idiopathic causes.
How Is DUB Diagnosed?
After reporting to a doctor, the diagnosis begins with taking a medical history and previous history of the menstrual cycle. The answers can help to reach a differential diagnosis. The various diagnostic procedures include
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Ultrasound: In an ultrasound procedure, the reproductive organs are viewed to find any abnormal growth like polyps or fibroids and to rule out internal bleeding.
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Endometrial Biopsy: In patients with abnormal bleeding caused to buy thickened uterine lining, a sample tissue is taken for testing. Any abnormal changes in cell growth are identified.
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Blood Test: A complete blood count and measuring the hormone levels are important to find the exact cause. The abnormal hormone levels can be linked to DUB. In patients with prolonged bleeding, a lower blood cell count or anemia is suspected.
What Are the Treatment Options for DUB?
Dysfunctional uterine bleeding is not a permanent condition and can be treated by regulating hormonal levels. In patients with severe bleeding, anemia develops and needs to be treated.
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In patients at the age of puberty, no particular treatment is necessary as the hormone levels are corrected by themselves. The treatment also depends on the cause of the bleeding.
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Common and simple therapy for dysfunctional uterine bleeding is a combination of oral contraceptives. The combination of synthetic estrogen and progesterone helps in regulating the menstrual cycle.
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Progestin uterine devices and progestin implants can be used as hormonal treatment if not trying to conceive.
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Intravenous estrogen is given in patients with heavy uterine bleeding, followed by oral progestin to balance the hormonal level.
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In patience with light bleeding and trying to conceive, the treatment is by giving ovulation-stimulating drugs like clomiphene. This track helps to stop the long menstrual bleeding and reset the menstrual cycle.
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In patients with heavy and prolonged bleeding combined with increased uterine thickness, a procedure called dilatation and curettage (D&C) is carried out. The overgrown uterine tissue is removed in this procedure. The removed abnormal tissues are also sent for biopsy.
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If the overgrown cells are cancerous, the doctor may recommend removal of the uterus.
Conclusion
Dysfunctional uterine bleeding occurs due to hormonal irregularities causing the absence of ovulation and abnormal bleeding. Commonly reported in the early age of puberty or late in menopause. It does not cause serious clinical problems and resolves with hormonal regulation. Any concerned about any symptoms, consult with a doctor.
