Dysfunctional uterine bleeding (DUB) is heavy, long, or frequent periods. By definition it is uterine bleeding not caused by easily definable pathologic abnormalities. In other words, problems like complications of pregnancies, tumors, growths, bleeding disorders, thyroid disorders, etc., have been ruled out.

Young girls and perimenopausal women are the most likely to be affected.  These are time periods in a woman's life when hormonal imbalances are common.

The usual cause of dysfunctional uterine bleeding is ovarian dysfunction (i.e., lack of ovulation every month, shortened luteal phase, shortened menstrual phase after ovulation, or inadequate hormonal support of ovulation). Dysfunctional bleeding may be manifested by continuous bleeding, more frequent periods, heavier periods on time, bleeding between periods, or even absence of periods for a length of time with heavier or normal flow to follow.

 Dysfunctional uterine bleeding, while a nuisance is rarely serious. It may become of more concern to the patient when it involves chronic iron deficiency, excessive blood loss, or infertility. Depending on which of the problems are pertinent to the patient in question, different types of workups and treatments may be done including: hormonal therapy, oral contraceptive agents, endometrial biopsy (sampling of the lining of the uterus), and lab tests. Your physician may follow your periods for a time to determine your natural bleeding cycle with menstrual calendars.

He or she may elect to treat with hormones, such as progestational agents -- depending on the type of abnormal bleeding, the patient's concerns and desires, and degree of the problem. In some cases, a D&C (uterine curettage) and/or hysteroscopy will be indicated to determine the source of the bleeding and to help stop it.

 An Office endometrial biopsy is a simple procedure indicated for a diagnosis of the nature of the bleeding. Endometrial cancer or hyperplasia must be ruled out.  In most cases the bleeding is secondary to simple hormonal imbalances or perimenopause.  Permanent treatment would include endometrial ablation or hydrothermablation, Mirena intrauterine insert, or rarely, hysterectomy. DUB goes away with menopause!!

 It is usually advisable to take iron replacement during and after the period of abnormal bleeding to replace iron stores. Over-the-counter iron tablets or vitamins with iron are recommended daily.

Please let your physician know if there is a family history of cancer, bleeding problems, or anemia.

Please note that passage of blood clots rarely are cause for concern and merely indicate that the blood clotted in the vagina rather than inside the uterus. If blood clots are passed from the uterus, however, there may be excessive cramping and your physician may elect to give you anti-cramping medications. If you are on any drugs such as thyroid medicine, other hormonal preparations, tranquilizers, or medications for arthritis or pain, or even heavy aspirin usage, please let your physician know as these also may affect your bleeding pattern. Things that may help with cramping include anti-prostaglandin medications such as ibuprofen (Advil, Motrin), Naproxen or Tylenol, bed rest, heating pad, and iron replacement as above.

 If you have specific questions concerning these problems, please write them down so nothing may be left out when you see your physician. Call if there is increased bleeding, fatigue, palpitations, fainting spells, abnormal pain, etc. Please note that contraception is a concern because conception during these abnormal bleeding episodes is possible.

See Hydrothermablation, Endometrial Ablation, and Mirena, for other details.


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