Dysfunctional uterine bleeding is abnormal uterine bleeding that, after examination and ultrasonography, cannot be attributed to the usual causes (structural gynecologic abnormalities, cancer, inflammation, systemic disorders, pregnancy, complications of pregnancy, use of oral contraceptives or certain drugs). Treatment is usually with hormonal therapy, such as oral contraceptives.
Dysfunctional uterine bleeding (DUB), the most common cause of abnormal uterine bleeding, occurs most often in women > 45 (> 50% of cases) and in adolescents (20% of cases).
About 90% of cases are anovulatory; 10% are ovulatory.
Chronic bleeding may cause iron deficiency anemia. If DUB is due to chronic anovulation, infertility may also be present.
Compared with typical menses, bleeding may occur more frequently (< 21 days apart—polymenorrhea), last longer or involve more blood loss (> 7 days or > 80 mL—menorrhagia, or hypermenorrhea), or occur frequently and irregularly between menses (metrorrhagia).
Ovulatory DUB tends to cause excessive bleeding during regular menstrual cycles. Women may have other symptoms of ovulation, such as premenstrual symptoms, breast tenderness, midcycle cramping pain (mittelschmerz), a change in basal body temperature with ovulation and sometimes dysmenorrhea. Anovulatory DUB occurs at unpredictable times and in unpredictable patterns and is not accompanied by cyclic changes in basal body temperature.
Thyroid-stimulating hormone levels are usually measured, and prolactin levels are measured, even when galactorrhea is absent, because thyroid disorders and hyperprolactinemia are common causes of abnormal bleeding.
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