Dysfunctional Uterine Bleeding (DUB) Flashcards
Definition of DUB
irregular uterine bleeding that occurs in
the absence of recognisable pelvic pathology,
general medical disease, or pregnancy. It reflects a
disruption in the normal cyclic pattern of ovulatory
hormonal stimulation to the endometrial lining.
Aka abnormal uterine bleeding
Pathophysiology of DUB
Commonly occurs when the level of estrogen remain
high instead of decreasing as usual.
• Endometrial hyperplasia occurs before the
endometrium is shed.
• It shed incompletely and irregularly.
• Causing bleeding to be irregular, prolonged and
sometimes heavy.
Menorrhagia.
Prolonged or excessive uterine bleeding occurring at regular
intervals.
. Metrorrhagia
Uterine bleeding occurring at irregular and more frequent
than normal intervals.
. Oligomenorrhea
Light and infrequent menses, usually related to hormonal
imbalance (>35 days)
Menometrorrhagia
Prolonged bleeding that occurs at irregular intervals
Possible causes of DUB (PALM-COEIN)
P: Polyp •A: Adenomyosis • L: Leiomyoma • M: Malignancy and hyperplasia • C: Coagulopathy • O: Ovulatory dysfunction • E: Endometrial disorders • I: Iatrogenic • N: Not otherwise classified
Clinical manifestations of DUB
Bleeding or spotting from the vagina between
periods
Period that occur less than 28 days apart (more
frequent: most common) or more than 35 days
apart
Time between periods changes each month
Diagnostic investigations
Complete blood count (CBC) • Blood clotting • Hormone tests - FSH - LH - Prolactin - Progesterone • Ultrasound of pelvis
Medical management of DUB
- oral iron supplement
- hormonal therapy : combined oral contraceptives , a combination of estrogen and progesterone is prescribed. Given for 3 months
- NSAIDs : ibuprofen, mefenamic acid (postan)
- Progestin Intrauterin device (IUD)
Rationale for oral iron supplement
to replace iron lost through menstrual bleeding
Rationale for hormonal therapy
suppress endometrial development
re-establish predictable bleeding patterns
decrease menstrual flow
lower the risk of iron deficiency anaemia
Rationale for NSAIDS
To reduce the amount of menstrual bleeding
Rationale for intrauterine device
To reduce menstrual bleeding
surgical management of DUB
- dilatation and curettage (not recommended)
- Hysterectomy (removal of uterus)
- Failed or declined hormonal therapy
- Anemia
- Persistent unscheduled bleeding with disruption in
quality of life - Endometrial ablation:
An alternative for those
who wish to avoid
hysterectomy.
• Who are not candidates
for major surgery.
• destroys a thin layer of
the lining of the uterus:
decreased or stop
menstrual bleeding
