Topic Overview
Is this topic for you?
This topic is for women who
want to learn about or have been diagnosed with dysfunctional uterine bleeding
(DUB). It is related to abnormal changes in
hormone levels. If you don't know what kind of
bleeding you have, see the topic
Abnormal Vaginal Bleeding.
What is dysfunctional uterine bleeding?
Dysfunctional uterine bleeding is irregular bleeding from the
uterus. For example, you may get your
period more often than every 21 days or farther apart
than 35 days. Your period may last longer than 7 days. It is not serious, but
it can be annoying and can disrupt your life.
In most cases, this
problem is related to abnormal changes in hormone levels. It is not caused by other medical conditions, such as
miscarriage,
fibroids, cancer, or blood clotting problems. Your
doctor will rule out these and other causes of vaginal bleeding to confirm that
you have dysfunctional uterine bleeding.
What causes dysfunctional uterine bleeding?
Dysfunctional uterine bleeding is usually caused by abnormal changes in hormone
levels. In some cases the cause of the bleeding isn't known.
Normally one of your
ovaries releases an egg during your menstrual cycle.
This is called
ovulation. Dysfunctional uterine bleeding is often
triggered when women don't ovulate. This causes abnormal changes in hormone levels and
in some cases can lead to unexpected vaginal bleeding.
Women can
also get this condition even though they ovulate, although this is less common.
Experts don't fully understand this type of vaginal bleeding. It may be caused
by changes in certain body chemicals.
What are the symptoms?
You may have dysfunctional
uterine bleeding if you have one or more of the following symptoms:
- You get your period more often than every 21
days or farther apart than 35 days. A normal adult menstrual cycle is 21 to 35
days long. A normal teen cycle is 21 to 45 days.
- Your period lasts
longer than 7 days (normally 4 to 6 days).
- Your bleeding is
heavier than normal. If you are passing blood clots
and soaking through your usual pads or tampons each hour for 2 or more hours,
your bleeding is considered severe and you should call your doctor.
Talk to your doctor if you have had irregular vaginal
bleeding for three or more menstrual cycles or if your symptoms are affecting
your daily life.
How is dysfunctional uterine bleeding diagnosed?
Your doctor must first rule out all other causes of vaginal bleeding
before diagnosing dysfunctional uterine bleeding. These causes include
miscarriage and problems with pregnancy. Vaginal bleeding may also be caused by
common conditions, such as uterine fibroids.
Your doctor will ask
how often, how long, and how much you have been bleeding. You may also have a
pelvic examination, urine test, blood tests, and possibly an
ultrasound. These tests will help your doctor check for other causes of your
symptoms. He or she may also take a tiny sample (biopsy) of
tissue from your uterus for testing.
You have dysfunctional
uterine bleeding if, after testing, your doctor finds no other diseases or
conditions that are causing your symptoms.
How is it treated?
There are many things you can
do to treat dysfunctional uterine bleeding. Some are meant to return the
menstrual cycle to normal. Others are used to reduce bleeding or to stop
monthly periods. Each treatment works for some women but not others. Treatments
include:
- Hormones, such as a progestin pill or daily
birth control pill (progestin and estrogen). These hormones help control the
menstrual cycle and reduce bleeding and cramping.
- A short course of high-dose
estrogen. Estrogen is a hormone that is often used to
stop dangerously heavy bleeding.
- Use of the levonorgestrel
IUD, which releases a progesterone-like hormone into
the uterus. This reduces bleeding while preventing pregnancy.
- Rarely used medicines that stop estrogen production and
menstruation, such as gonadotropin-releasing hormones. These drugs can cause
severe side effects but are used in special cases.
- Surgery, such
as
endometrial ablation or
hysterectomy, when other treatments do not work.
If you also have menstrual pain or heavy bleeding, you
can take regular doses of a non-steroidal anti-inflammatory drug (NSAID), such
as ibuprofen.
In some cases, doctors use
watchful waiting, or a wait-and-see approach. It may
be okay for a teen or for a woman nearing
menopause. Some teens have times of irregular vaginal
bleeding. This usually gets better over time as hormone levels even out. Women
in menopause can expect their periods to stop. They may choose to wait and see
if this happens before they try other treatments.
Frequently Asked Questions
Learning about dysfunctional uterine bleeding: | |
Being diagnosed: | |
Getting treatment: | |
Cause
Dysfunctional uterine bleeding (DUB) is irregular vaginal bleeding that is not caused by a
serious medical condition.
Normally one of your
ovaries releases an egg during your
menstrual cycle. This is called ovulation. Most women who have dysfunctional uterine
bleeding get it when their ovaries don't release an egg. This can be caused by
abnormal hormone changes. When your hormone levels are out of
balance, they can affect the
lining in your uterus, causing bleeding. Dysfunctional
uterine bleeding is common before age 20 and after age 40.
Some women have dysfunctional uterine bleeding
even though they ovulate. Experts don't fully understand this type of vaginal
bleeding. It may be caused by changes in certain body chemicals.
Symptoms
Symptoms of
dysfunctional uterine bleeding (DUB) include:
- Vaginal bleeding that occurs more often than
every 21 days or farther apart than 35 days (a normal teen menstrual cycle can
last up to 45 days).
- Vaginal bleeding that lasts longer than 7 days (normally lasts 4
to 6 days).
- Blood loss of more than
80 mL (3 fl oz) each
menstrual cycle [normally about
30 mL (1 fl oz)]. If you are
passing blood clots and soaking through your usual pads or tampons each hour
for 2 or more hours, your bleeding is considered severe.
Most menstrual blood is lost in the first 3 days of the
period. So excessive blood loss is possible without having
exceptionally long periods.
The symptoms of DUB can also be signs
of another, more serious
condition with similar symptoms. If your abnormal
vaginal bleeding is undiagnosed, see your doctor.
What Happens
Dysfunctional uterine bleeding (DUB) occurs most often before age 20 and after age 40.
- Teen years. Some teens have times of irregular
vaginal bleeding. This usually gets better over time as hormone levels even out
and the menstrual cycle becomes more regular. If you need
treatment, your doctor may give you
hormones to help regulate your menstrual cycle. He or
she may also prescribe medicine to reduce bleeding.
- Reproductive years. Some women in their 20s and 30s
have dysfunctional uterine bleeding. Sometimes it's because of abnormal changes in hormone
levels. And sometimes the reason is not known. If your doctor rules out serious
causes of vaginal bleeding, he or she may diagnose you with dysfunctional
uterine bleeding without knowing why it is happening. Your treatment depends on
whether you are planning to have children.
- After age 40: Perimenopausal and menopausal years. After age 40, women tend to have changing hormone levels.
During this time before your period stops (perimenopause),
you may not always
ovulate. This can lead to irregular vaginal bleeding.
You can expect this bleeding to go away on its own when
menopause is complete. Your treatment options depend
on your child-bearing plans and how much your symptoms affect your daily
life. Your doctor may recommend a wait-and-see approach, hormones, or a
surgical procedure.
No matter what your age, see your doctor
if you have irregular vaginal bleeding.
What Increases Your Risk
Risk factors (things that increase your
risk) for
dysfunctional uterine bleeding (DUB) include:
- Your age. Dysfunctional uterine bleeding is
more common in teens, at the beginning of the reproductive years, and in
perimenopausal women at the end of their reproductive
years.
- Your weight. Overweight women more commonly develop
dysfunctional uterine bleeding.1
Some women have dysfunctional uterine bleeding even though
they have no risk factors.
When To Call a Doctor
If you have not been diagnosed with
dysfunctional uterine bleeding (DUB), see the topic
Abnormal Vaginal Bleeding to find out whether you
should see your doctor.
Any big change in
menstrual pattern or amount of bleeding that affects your daily life requires
evaluation by a doctor. This includes menstrual bleeding for three
or more menstrual cycles that:
- Occurs more frequently than every 21 days or farther apart than
35 days (a normal teen menstrual cycle can last up to 45
days).
- Lasts longer than 7 days.
- Consists of more than
80 mL (3 fl oz) of blood lost or involves passing blood
clots and soaking through your usual pads or tampons each hour for 2 or more
hours.
Watchful waiting
Watchful waiting is a wait-and-see approach. If
you have been diagnosed with dysfunctional uterine bleeding, you may consider
watchful waiting when:
- A careful examination has revealed no
other physical problem or disease.
- Blood loss is not severe
enough to cause
anemia.
- You prefer to wait and see if your
symptoms get better on their own. If you are a teen, you can expect your cycles
to even out with time. If you are nearing the age of
menopause, you can expect menstrual cycles to stop
sometime soon.
Talk to your doctor if you have not had a menstrual
period for more than 3 months.
Who to see
Your family doctor or general practitioner can do an initial evaluation of a vaginal bleeding problem. For treatment of dysfunctional uterine bleeding, you may be referred to a specialist, such as a gynecologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Examinations and Tests
Your doctor must first
rule out all
other medical causes of vaginal bleeding before
diagnosing
dysfunctional uterine bleeding (DUB).
First tests
First, your doctor will:
- Review your history of symptoms and menstrual
periods. (If possible, bring with you a record of the days you had your period,
how heavy or light the flow was, and how you felt each day.)
- Conduct a routine
pelvic examination.
- Find out whether you are
ovulating regularly. This is done using one or
more of the following:
- A daily record of your symptoms (menstrual
calendar)
- A daily
basal body temperature chart, if you have been keeping
track at home. This charts your at-rest temperature.
- A
progesterone test, because low levels during the third
week of a menstrual cycle suggest an ovulation problem
- An
endometrial biopsy for
perimenopausal women, because abnormal endometrial
tissue is common in this age group. The endometrial tissue is the lining of the uterus.
Other tests
If your symptoms are severe, your doctor
suspects a serious medical problem, or you are considering a certain treatment,
you may also have one or more other tests, such as:
- Blood tests, which may include:
- Pap smear and cultures to check for
infection or abnormal cervical cells.
- Urine test to
screen for infection, disease, and other signs of poor health.
- Transvaginal pelvic ultrasound, to check for any
abnormalities in the pelvic area. After the pelvic examination, a transvaginal
ultrasound is often the next step in diagnosing a vaginal bleeding problem. If
a pelvic mass is found, ultrasound results are useful for making further
testing and treatment decisions.
- Sonohysterogram, which uses
ultrasound to monitor the movement of a salt solution (saline), which is
injected into the uterus. This test may be done to look for uterine
polyps or
fibroids.
- Endometrial biopsy, usually for women older than 35 or
who are
post-menopausal, to learn whether the
lining of the uterus (endometrium) is healthy and
functioning normally.
- Hysteroscopy, if no cause is apparent
but a problem condition is suspected; to check for and treat a suspected
condition, such as uterine fibroids; or if bleeding continues despite
treatment.
Early Detection
Endometrial cancer risk increases with
age. Also known as uterine cancer, it is most common in women over age 50,
after
menopause. But endometrial cancer can also
develop earlier, during perimenopause or in women who have had abnormal
bleeding for many years.
- If you have heavy or unusual vaginal bleeding
after menopause, your doctor will do tests, usually either ultrasound or
endometrial biopsy, to look for cancerous cell changes.
- If you are
perimenopausal, have not responded to other treatment for uterine bleeding, or
have things that increase your risk for endometrial cancer, your doctor may recommend an
endometrial biopsy.
Treatment Overview
Dysfunctional uterine bleeding (DUB) can usually be
managed with medicine to reduce bleeding and/or hormone therapy to either stop
or regulate menstrual periods. Surgical treatment is reserved for bleeding that
can't be controlled with medicine or hormone therapy.
Acute, severe uterine bleeding
Severe uterine
bleeding is usually treated on an emergency basis with a short course of
high-dose
estrogen therapy. If that isn't effective in rare
cases, a
dilation and curettage (D&C) may be done to clear
the uterus of tissue. When needed, a
blood transfusion is used to quickly restore needed
blood volume.
If you are treated for severe uterine bleeding, you
and your doctor can then choose a treatment that is safe for the
longer term.
Ongoing uterine bleeding
Your age, the cause of
your condition, and any future plans for pregnancy will impact the treatment
choices available to you.
- If you are a teen, you
can expect your periods to become more regular as your body matures. You may
choose to wait and see if your periods become more regular. If you need
treatment, your doctor may prescribe
progestin or
birth control pills to regulate your cycle.
- If you are not ovulating regularly, it's difficult to predict how long your
irregular bleeding will last until you stop having periods completely (menopause). If you need treatment, your doctor may
give you hormone therapy (such as birth control pills or a hormonal IUD) to regulate your
cycle. If you have no future child-bearing plans and have severe symptoms, you
can opt for surgical treatment to remove your uterus (hysterectomy)
or to destroy the uterine lining (endometrial ablation).
- If you are ovulating regularly, have
irregular vaginal bleeding, and plan to become pregnant in the future, talk to
your doctor about your treatment options. He or she may recommend oral
progestin and/or birth control pills until your bleeding becomes more regular.
If you have no future pregnancy plans, you can consider endometrial ablation or
hysterectomy if other treatment doesn't help.
Gonadotropin-releasing hormone analogues (GnRH-As) are
rarely used now. These drugs reduce estrogen production, making your body think
it is in menopause. This reduces or stops menstrual periods for as long as you
take the medicine. After you stop taking the medicine, your symptoms will come
back unless you are close to menopause. Side effects with GnRH-As are common.
A medicine called tranexamic acid (such as Cyklokapron) is sometimes used for women who have bleeding that is heavier than normal. This medicine is not a hormone. It prevents bleeding by helping blood to clot. Talk to your doctor to find out if this option is right for you.
For more information about treatment options,
see:
Dysfunctional Uterine Bleeding: Should I Use Hormone Therapy?
What to think about
If you are thinking of getting treatment for
dysfunctional uterine bleeding, evaluate the following:
- Has irregular menstrual bleeding caused a
significant change in your lifestyle?
- Do you plan to become
pregnant in the future?
- Do you have anemia caused by irregular menstrual
bleeding?
- Do you want a treatment that will also provide birth
control?
- Do you prefer to avoid medical treatment if
possible?
- Will you be starting menopause soon? If you are
approaching menopause, you can expect uterine bleeding to naturally stop
without treatment.
The answers to these questions will help you and your
doctor select the treatment plan that is best for you.
Prevention
Usually dysfunctional uterine bleeding (DUB) results from
unpredictable hormonal changes, so it cannot be prevented. But
being overweight can affect your hormone production, which increases your risk for irregular menstrual bleeding. If you are overweight, losing weight
may help prevent dysfunctional uterine bleeding.
Home Treatment
You can use home treatment for some
problems related to
dysfunctional uterine bleeding (DUB).
For
menstrual pain and heavy bleeding, you can use a
non-steroidal anti-inflammatory drug (NSAID), such as
over-the-counter ibuprofen. This type of medicine lowers
prostaglandins, which cause menstrual pain, and
reduces bleeding during your period. An NSAID works best when you start taking
it 1 to 2 days before you expect pain to start. If you don't know when your
period will start next, take your first dose of an NSAID as soon as bleeding or
premenstrual pain starts. Take regular doses of the NSAID, as directed.
Irregular menstrual bleeding can lead to low levels of iron in the blood.
This condition is known as
anemia. You can prevent
anemia by increasing the amount of iron in your diet.
Medications
Treating
dysfunctional uterine bleeding (DUB) with medicines
has fewer risks but doesn't always work as well as surgical treatment. If you
plan to become pregnant in the future, or if you are nearing the time when your
menstrual periods will stop (menopause), you may want to try
medicines first.
Goals of medicine treatment
The goal of medicine
treatment for dysfunctional uterine bleeding is to reduce or eliminate blood
loss. This can be done in one or both of the following ways:
- Reducing the
endometrium's rate of blood
loss
- Regulating or eliminating the menstrual cycle by changing
hormonal levels
Medication choices
There are several hormone therapies for managing
dysfunctional uterine bleeding. These treatments help reduce bleeding and
regulate the menstrual cycle:
- Birth control pills (synthetic
estrogen and progesterone). Daily birth control pills
prevent pregnancy. They also reduce the amount of heavy menstrual bleeding by
about half.2 In other words, when you take birth
control pills, your menstrual bleeding can be half as heavy as it was before
you took the pills. But when you stop taking the pills, irregular bleeding or
perimenopausal symptoms may return.
- Progestins pills (synthetic
progesterone). In some women, progestins can control
endometrial growth and bleeding. You usually take progestins 10 to 12 days
every month.
- The
levonorgestrel intrauterine device (IUD). A doctor
inserts this birth control device into your uterus through your vagina. It
stays in your body for up to 5 years and releases levonorgestrel, a form of
progesterone, into the uterus.
- Estrogen. In some severe or urgent cases, estrogen may
be used to reduce bleeding.
- Hormone suppressors such as
gonadotropin-releasing hormone analogues (GnRH-As).
GnRH-As are rarely used. These drugs reduce estrogen production, making
your body think it is in menopause. This reduces or stops menstrual periods for
as long as you take the medicine. Side effects with GnRH-As are common.
A medicine called tranexamic acid (such as Cyklokapron) is sometimes used for women who have bleeding that is heavier than normal. This medicine is not a hormone. It prevents bleeding by helping blood to clot. Talk to your doctor to find out if this option is right for you.
What to think about
Intravenous
estrogen therapy is typically used when severe blood loss
must be quickly stopped.
Surgery
Surgery is generally reserved for treating
dysfunctional uterine bleeding (DUB) that can't be
controlled with medicine.
Surgery choices
The following procedures are used to treat dysfunctional
uterine bleeding.
- Hysteroscopy can be used to diagnose
and treat dysfunctional uterine bleeding at the same time. A lighted viewing
instrument called a hysteroscope is inserted through the
vagina and cervix and into the
uterus. When areas of bleeding are located,
biopsies can be taken and then the areas of bleeding
can be treated with either a laser beam or electric current
(electrocautery).
- Hysterectomy is the removal of the
uterus. It may be done when a sample of the uterine lining (endometrial biopsy) shows abnormal
cell changes or cancer, when uterine bleeding is uncontrollable, or when the
cause of chronic bleeding cannot be found and treated. A hysterectomy is a
major surgery with risks of complications. Recovery from surgery can take 4 to
8 weeks, depending on the type of hysterectomy done. If the
ovaries are also removed, you may need to take
long-term
estrogen replacement therapy after surgery.
- Endometrial ablation is a minimally invasive
alternative to hysterectomy when other medical treatments fail or when you or
your doctor have reasons for not using other treatments. Endometrial ablation
scars the uterine lining, so it is not a treatment option if you are planning
to become pregnant.
What to think about
Hysteroscopy may be done to
rule out serious uterine conditions:
- Before long-term treatment with medicines or
surgical treatment for dysfunctional uterine bleeding.
- When uterine
bleeding has continued despite non-surgical treatment.
Hysterectomy may be used as surgical treatment for dysfunctional
uterine bleeding when:
- Dysfunctional uterine bleeding does not respond to medicine or other treatment.
- Childbearing is completed and you do not wish to try treatment with medicine.
- Symptoms of dysfunctional uterine bleeding outweigh the risks and discomforts of surgery.
Regrowth of the endometrium may occur after you have endometrial ablation.
Other Places To Get Help
Organizations
| Society of Obstetricians and Gynaecologists of Canada
(SOGC) |
| 780 Echo Drive |
| Ottawa, ON K1S 5R7 |
| Phone: | 1-800-561-2416
(613) 730-4192 |
| Fax: | (613) 730-4314 |
| Email: | helpdesk@sogc.com |
| Web Address: | www.sogc.org |
| |
The mission of SOGC is to promote optimal women's
health through leadership, collaboration, education, research, and advocacy in
the practice of obstetrics and gynaecology. |
|
| Canadian Women's Health Network |
| 419 Graham Avenue |
| Suite 203 |
| Winnipeg, MB R3C 0M3 |
| Phone: | 1-888-818-9172
(204) 942-5500 |
| Fax: | (204) 989-2355 |
| Email: | cwhn@cwhn.ca |
| Web Address: | www.cwhn.ca |
| |
The Canadian Women's Health Network (CWHN) is a network
of individuals, groups, organizations, and institutions. CWHN promotes
information sharing, education, and advocacy for women's health and equality,
and provides resources and information on women's health issues. In addition,
it runs a clearinghouse of women-centred, health-related resources. The Web
site also includes new research articles, information sheets, and press
releases. |
|
References
Citations
- Fritz MA, Speroff L (2011). Abnormal uterine bleeding. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 591–620. Philadelphia: Lippincott Williams and Wilkins.
- Lobo RA (2007). Abnormal uterine bleeding: Ovulatory
and anovulatory dysfunctional uterine bleeding, management of acute and chronic
excessive bleeding. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 915–931. Philadelphia: Mosby
Elsevier.
Other Works Consulted
- American College of Obstetricians and Gynecologists
(2007, reaffirmed 2009). Endometrial ablation. ACOG Practice Bulletin No. 81. Obstetrics and Gynecology, 109(5): 1233–1248.
- American College of Obstetricians and Gynecologists
(2011). Intrauterine device. ACOG Practice Bulletin No. 121. Obstetrics and Gynecology, 118(1): 184–196.
- Duckitt K, Collins S (2008). Menorrhagia, search date
October 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Goldstein SR (2008). Abnormal uterine bleeding. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 664–671. Philadelphia: Lippincott Williams and
Wilkins.
- Hillard P (2007). Benign diseases of the female
reproductive tract. In JS Berek, ed., Berek and Novak's Gynecology, 14th ed., pp. 431–504. Philadelphia: Lippincott Williams and
Wilkins.
- Kalan MJ (2010). Abnormal and dysfunctional uterine bleeding:
Treatment. In T Goodwine et al.,
eds., Management of Common Problems in Obstetrics and Gynecology, 5th ed., pp. 261–266. Chichester: Wiley-Blackwell.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Primary Medical Reviewer | Andrew Swan, MD, CCFP, FCFP - Family Medicine |
|---|
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
|---|
| Last Revised | March 9, 2012 |
|---|
