Dysfunctional Uterine Bleeding (DUB)

Dysfunctional uterine is bleeding from your uterus (womb) that is not caused by a tumor, infection, or pregnancy. It usually happens to women who are either at the start of their reproductive years (under 20 years old), or near the end of their reproductive years (over 45 years old). It is a diagnosis used when other causes have been ruled out. It is often seen in women who have polycystic ovary syndrome (cysts on your ovaries). Women who are on kidney dialysis or use an IUD for birth control may have heavy or long periods.

It can be similar to other kinds of uterine bleeding.

• Menorrhagia (hypermenorrhea) really long, heavy periods often with clots. Your period lasts more than 7 days. This may or may not be a sign of a serious problem.
• Metrorrhagia is heavy, irregular bleeding between your periods.
• Polymenorrhea is having your period more often than 21 days. Usually you do not ovulate (produce an egg).

Should I be worried about irregular bleeding?

• Light spotting a couple of days before your period is normal
• When you first start on birth control pills, you may have some spotting for the first few months
• If you are menopausal or postmenopausal and taking hormone replacement therapy taking estrogen every day plus progestin 10 to 12 days per month, you may have some bleeding a few days a month like a period.
• If you are menopausal or postmenopausal and not on hormone replacement, you should see your doctor if you have any vaginal bleeding.
• Young girls who have not entered puberty and have vaginal bleeding should have it checked by the doctor.

Causes:

• Menorrhagia can be a sign of DUB. Causes of menorrhagia can be:
• Hormone imbalance between estrogen and progesterone
• Growths near your uterus, fibroid tumors in or on your uterus
• Infection in your reproductive area
• Endometrial polyps or cancer
• Endometriosis
• Using an IUD
• Hypothyroidism
• Problems with your blood clotting (this is very rare)
• Lupus, advanced liver disease, kidney disease, chemotherapy
• Use of steroids
• When all the potential causes that are related to pregnancy, infection, and tumors (cancerous or not) are eliminated then the heavy, extended bleeding is most likely due to DUB.

Things to know and do:

• Keep a record of how long and how often your period is. You should note if it is heavy or not, with or without clots, how long you have had the problem for, and if you have noticed any pattern to it.
• Tell your doctor about any sicknesses or any health problems they may not know you have.
• Your doctor will ask you about your sexual activity, what kind of birth control you use, if any, any medications you take and any operations you have had in the past.
• It may take a long time to diagnose DUB because of all the testing needed.

Treatment:

• What kind of treatment is given depends on how old you are and what is causing your bleeding. If the problem is found during testing, then that disorder is treated.
• The main goal is to relieve your symptoms, so it does not interfere with your everyday life. Treatment may range from medication to surgery.
• How you respond to the treatment is different for each person. Often it depends on how old you are and if you have any other medical problems.
• It is not preventable.

Return to the Emergency Department IF:

• You soak through more than 1 pad an hour for more than 2 to 3 hours
• You have any unexpected irregular vaginal bleeding.