Women's Services Encyclopedia

Dysfunctional Uterine Bleeding

Dysfunctional uterine bleeding (DUB) refers to bleeding from the vagina that is excessive or that is unrelated to your normal menstrual cycle. Most women with DUB are either teenagers who have just started to menstruate or older women who are undergoing menopause.

Normal menstruation takes place every 21 to 35 days and most women lose 20 to 60 milliliters of blood or a little less than two ounces over the entire period. Anything more than 80 milliliters loss during a period is considered excessive, but estimating your own flow is not easy. If you are suddenly soaking through pads or tampons at a faster rate (six pads a day when you usually use three), you should suspect excessive bleeding.

The bleeding you experience is not related to menstruation, but at the same time there is no other diagnosable problem, so, in a way, DUB is a diagnosis left after all the others have been eliminated.

Other causes of abnormal vaginal bleeding include pregnancy, pelvic diseases, blood coagulation problems, thyroid problems, uterine cancer, and benign uterine tumors.

Diagnosis:

• To diagnose DUB, your physician will need a history of your menstrual cycle; at what age you started having periods, what your normal cycle length is, whether you’ve ever been pregnant, and what other signs of a menstrual cycle (such as breast swelling or premenstrual tension) you feel.
• Your physician will give you a pelvic examination, a pregnancy test, and a PAP smear test to check for certain types of cancer.
• You may be asked to take your basal body temperature every morning for a month to see whether you are ovulating.
• In about 25% of teenagers with excessive bleeding, blood coagulation problems are present. Other symptoms are easy bruising or bleeding from the gums while brushing teeth.

Treatment:

• If coagulation is normal, lack of ovulation may be the problem and a physician will prescribe oral birth control or progestogen pills to regulate the menstrual cycle.
• In an older woman, especially if profuse bleeding is occurring, a physician may choose to perform curettage, a minor surgical procedure where the uterus is dilated and its interior is scraped and examined for signs of endometriosis. Endometriosis can be photocoagulated with a laser, but women who have had as many children as they wish may consider hysterectomy. DUB not related to endometriosis may also be controlled with various types of hormones.
  

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