Sunday, September 13, 2009

Dysfunctional uterine bleeding( DUB)

Dysfunctional Uterine Bleeding (DUB) is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable organic pathology, and is the most common cause of functional abnormal uterine bleeding. Diagnosis must be made by exclusion, since organic pathology must first be ruled out. It can be classified as ovulatory or anovulatory, depending on whether ovulation is occurring or not

Ovulatory DUB happens with the involvement of ovulation, and may represent a possible endocrine dysfunction, resulting in menorrhagia or metrorrhagia. Mid-cycle bleeding may indicate a transient estrogen decline, while late-cycle bleeding may indicate progesterone deficiency


Anovulatory cycle DUB happens without the involvement of ovulation. The etiology can be psychological stress, weight (obesity, anorexia, or a rapid change), exercise, endocrinopathy, neoplasm, drugs, or it may be otherwise idiopathic.

Assessment of anovulatory DUB should always start with a good medical history and physical examination. Laboratory assessment of hemoglobin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, T4, thyroid stimulating hormone (TSH), pregnancy (by βhCG), and androgen profile should also happen. More extensive testing might include an ultrasound and endometrial sampling.


Management of dysfunctional uterine bleeding predominantly consists of reassurance, though mid-cycle estrogen and late-cycle progestin can be used for mid- and late-cycle bleeding respectively. Also, non-specific hormonal therapy such as combined estrogen and progestin can be given.

The goal of therapy should be to arrest bleeding, replace lost iron to avoid anemia, and prevent future bleeding.

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