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Dysfunctional Uterine Bleeding



Dysfunctional Uterine Bleeding
Let us understand menstrual cycle disorder also known as Dysfunctional Uterine Bleeding which is experienced by most of the women for at least once in their life.
Dysfunctional Uterine Bleeding (DUB):
Dysfunctional Uterine Bleeding as name suggests is one of the most common causes of abnormal vaginal bleeding in women during their reproductive years. Although it can occur any time throughout woman’s reproductive years, it generally occurs at the beginning or end of it.

Normally women lose about 40-155 ml blood during their menstrual cycle which occurs every 21 to 35 days. During the first four days of menstrual cycle disintegration and sloughing of the functionalis layer (endometrium) takes place. For next 8-9 days follicular (proliferation) phase takes place in which estrogen stimulation brings about endometrial proliferation. Follicle Stimulating Hormones (FSH) helps ovarian follicles produce the estrogen. During this phase, the complexity of spiral arteries increases along with its length. Next, the ovarian follicle ruptures and ovulation takes place followed by luteal phase in which corpus luteum produces progesterone and estrogens in rest of the days till next cycle starts.

Types of Dysfunctional Uterine Bleeding:
Types of Dysfunctional Uterine Bleeding are:
1) Metrorrhagia
2) Menorrhagia
3) Menometrorrhagia
4) Postcoital Bleeding
5) Polymenorrhea
6) Amenorrhea
7) Intermenstrual Uterine Bleeding (also known as Spotting)
8) Oligomenorrhea

What causes DUB?
There are quite a few causes of DUB:
Imbalance between Estrogen and Progesterone play an important role in DUB development in women. A prolonged bleeding may result due to improper built up of endometrial lining caused by low level of estrogen. Women who consume oral contraceptive pills (OCPs) may experience such problems.

In most of the cases, DUB in women is caused by Anovulatory Cycle in which high estrogen are produced with no progesterone. The functionalis layer keeps on developing until feedback causes a drop in Follicle Stimulating Hormone (FSH). During this, the blood supply outgrows leading the condition in parting of endometrium slough. The type of DUB resulting is known as Menometrorrhagia.

Luteal phase deficiency is the second most common cause of DUB. Luteal phase is shortened due to the insufficient progesterone availability accompanied by the low, high or normal level of estrogen. The problems which develop in this type of DUB are almost same as those which are developed in Anovulatory Cycle.

The third type of DUB is developed in women above age 38. In this, the quality and quantity of ovarian follicles produced fall to a very low level. Due to this, the developed follicles are unable to produce enough/sufficient estrogen to help trigger ovulation. The estrogen production does not stop but late production results in late cycle estrogen breakthrough bleeding.

Along with the above mentioned reasons, endocrine disorder, polycystic ovary disease, hyperprolactinemia, Cushing’s disease, hypothyroidism, hyperthyroidism, premature ovarian failure, structural or malignant lesion of vagina/cervix (Postcoital bleeding), Uterine Polyps and enlarged uterus are also considered to be associated with the development of DUB in women.

Diagnosis:
The diagnosis of DUB involves analyzing patient’s history (everything about menstrual cycle, age, habits, medical history, amount of bleeding, usage of contraceptives etc.), physical condition, examination of uterus, carefully understanding the available data and if the patient has enlarged uterus then in such cases, doctor may need to confirm if it is related to DUB development. As the symptoms experienced by the patient are somewhat similar to early symptoms of endometrial cancer, endocrinopathies, hyperprolactinemia, hypothyroidism, hyperthyroidism, your doctor may also suggest you to undergo certain tests to rule out/confirm possibility of other diseases. Analysis of basal temperature helps understand the ovulation timing and other things is also performed during diagnosis.

Your doctor may also suggest you to undergo some tests such as urine pregnancy test, CBC, FSH, PT/PTT, PAP SMEAR, liver test, TSH, DHEAS, prolactin level test, endometrial biopsy, uterine ultrasound (including transvaginal ultrasonography), dilatation and curettage, hysteroscopy, etc. to help confirm if the patient is not pregnant and not suffering from other diseases but DUB.

Treatment:
Dysfunctional Uterine Bleeding in women is treated with the help of medication, surgery and combination of both and depends on several factors, such as patient’s condition, severity of bleeding, fertility etc.

Your doctor may start treatment with dosage of intravenous estrogen or Oral conjugated estrogen in specific amount needed. The treatment also needs to be changed/decided based on the other factors such as any disease patient is currently suffering from, after confirming the source of bleeding, need of contraception, and need of surgery etc. Along with other medications non-steroidal anti-inflammatory drugs, Dilatation and curettage, surgical methods such as laser endometrial ablation (surgical method to treat endometrium), hysteroscopic transervical resection of the endometrium (TCRE) which uses electrocautery loop to remove the endometrium and hysterectomy etc. also may help control and cure DUB.