Dysfunctional uterine bleeding

Dysfunctional Uterine Bleeding (DUB) is the most common cause of functional abnormal uterine bleeding, which is abnormal genital tract bleedingbased in the uterusand found in the absence of demonstrable organicpathology. Diagnosis must be made by exclusion, since organic pathology must first be ruled out. It can be classified as ovulatory or anovulatory, depending on whether ovulationis occurring or not.

Ovulatory

Ovulatory DUB happens with the involvement of ovulation, and may represent a possible endocrinedysfunction, resulting in menorrhagiaor metrorrhagia. Mid-cycle bleeding may indicate a transient estrogendecline, while late-cycle bleeding may indicate progesteronedeficiency.

Anovulatory

Anovulatory cycleDUB happens without the involvement of ovulation. The etiology can be psychologicalstress, weight (obesity, anorexia, or a rapid change), exercise, endocrinopathy, neoplasm, drugs, or it may be otherwise idiopathic.

Assessment of anovulatory DUB should always start with a good medical historyand physical examination. Laboratory assessment of hemoglobin, luteinizing hormone(LH), follicle stimulating hormone(FSH), prolactin, T₄, thyroid stimulating hormone(TSH), pregnancy(by βhCG), and androgenprofile should also happen. More extensive testing might include an ultrasoundand endometrialsampling.

Management

Management of dysfunctional uterine bleeding predominantly consists of reassurance, though mid-cycle estrogenand late-cycle progestincan be used for mid- and late-cycle bleeding respectively. Also, non-specific hormonaltherapy such as combined estrogen and progestin can be given.

The goal of therapy should be to arrest bleeding, replace lost ironto avoid anemia, and prevent future bleeding.

Resources

• Merck Manual: Abnormal Uterine Bleeding

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It uses material from the http://en.wikipedia.org/wiki/Dysfunctional+uterine+bleeding Wikipedia article Dysfunctional uterine bleeding.