Dysfunctional Uterine Bleeding (Dub)

Dysfunctional Uterine Bleeding (Dub)


INTRODUCTION:

  • Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time.
  • Bleeding may be heavier or lighter than usual and occur often or randomly.
  • Irregular ripening of endometrium and Irregular shedding of endometrium leads to DUB
RISK FACTORS:
  • As spotting or bleeding between your periods
  • After sex
  • For longer days than normal
  • Heavier than normal
  • After menopause

ETIOLOGY:

Hormonal imbalance due to:

  • Thickening of the uterine wall or lining
  • Uterine fibroids
  • Uterine polyps
  • Cancers of ovaries, uterus, cervix, or vagina
  • Bleeding disorders or problems with blood clotting
  • Polycystic ovary syndrome
  • Severe weight loss
  • Hormonal birth control, such as birth control pills or intrauterine devices (IUD)
  • Excessive weight gain or loss (more than 10 pounds or 4.5 kilograms)
  • Infection of the uterus or cervix

TYPES:

DUB is of two types :          

Anovulatory (80%) : 

  • Threshold bleeding of puberty menorrhagia
  • Metropathia hemorrhagica/cystic glandular hyperplasia
  • Premenopausal DUB (Atrophy of endometrium).

Ovulatory (20%) :           

  • Irregular ripening
  • Irregular shedding
  • IUCD insertion
  • Following sterilization operation.

SYMPTOMS:

Symptoms of AUB may include:

  • Bleeding or spotting from the vagina between periods
  • Periods that occur less than 28 days apart (more common) or more than 35 days apart
  • Time between periods changes each month
  • Heavier bleeding (such as passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 to 3 hours in a row)
  • Bleeding that lasts for more days than normal or for more than 7 days
  • Associated with Metropathia-haemorrhagica

Other symptoms caused by changes in hormone levels may include:

  • Excessive growth of body hair in a male pattern (hirsutism)
  • Hot flashes
  • Mood swings
  • Tenderness and dryness of the vagina

A woman may feel tired or fatigued if she loses too much blood over time. This is a symptom of anemia.

DIAGNOSIS:

  • Complete blood count (CBC)
  • Blood clotting profile
  • Liver function tests (LFT)
  • Fasting blood glucose
  • Hormone tests(Increased oestrogen) for FSH, LH, male hormone (androgen) levels, prolactin, and progesterone(decreased)
  • Pregnancy test
  • Thyroid function tests
  • Pap smear
  • D and C 
  • Culture to look for infection
  • Biopsy to check for precancer, cancer, or to help decide on hormone treatment 
  • Hysteroscopy, performed in your provider’s office to look into the uterus through the vagina
  • Ultrasound to look for problems in the uterus or pelvis
  • Histopathological findings include:Hyperplastic endometrium, Irregular shedding & ripening , Atrophic pattern & Normal secretory endometrium 

TREATMENT:

  • Treatment may include one or more of the following:
  • Low-dose birth control pills
  • Hormone therapy(Progesterone i.e. Norethisterone)
  • High-dose estrogen therapy for women with very heavy bleeding
  • Intrauterine device (IUD) that releases the hormone progestin
  • Nonsteroidal anti-inflammatory drugs (NSAID) taken just before the period starts
  • Surgery, if the cause of the bleeding is a polyp or fibroid

COMPLICATIONS:

  • Infertility (inability to get pregnant)
  • Severe anemia due to a lot of blood loss over time
  • Increased risk for endometrial cancer
Exam Question
 
  • Treatment of DUB in young female is Hormones
  • Causes of dysfunctional uterine bleeding can be Irregular ripening of endometrium
  • The most common histological finding of endometrium in DUB is  Hyperplastic
  • Treatment for 32 years old multipara with dysfunc­tional uterine bleeding (DUB) is Progesterone
  • In DUB, there is Increased oestrogen
  • Dysfunctional uterine bleeding is associated with Metropathia-haemorrhagica
  • Dysfunctional uterine bleeding is defined as abnormal bleeding due to Anovulatory cycle
  • In a case of dysfunctional uterine bleeding thehormone which is usually deficient is Progesterone
  • The progestogen with the greatest haemostatic effect used in dysfunctional uterine bleeding (DUB) is  Norethisterone
  • D and C is useful in the diagnosis of DUB
Don’t Forget to Solve all the previous Year Question asked on Dysfunctional Uterine Bleeding (Dub)

Leave a Reply

Free Mini Course on Stomach

Mini Course – Stomach

22 High Yield Topics in Stomach

in Just 2 Hours

Submission received, thank you!

Close Window
%d bloggers like this:
Malcare WordPress Security