Anovulatory bleeding

Definition

Dysfunctional uterine bleeding (DUB) is abnormal vaginal bleeding not due to a physical (anatomical) cause that occurs in women in their reproductive years (who have previously started menstruation and not reached menopause).  

Alternative Names

Causes

Dysfunctional uterine bleeding (DUB) is diagnosed after all other causes of abnormal uterine bleeding are ruled out. This includes infection, tumors, disease, early pregnancy disorders, or structure problems.

DUB may be caused by an imbalance of one of the hormones related to ovulation (estrogen or progesterone).

Approximately 20% of cases of DUB occur in adolescents and 40% in women over 40. Obesity, excessive exercise, and emotional stress may be risk factors for DUB.

Symptoms

• Vaginal bleeding between periods
• Abnormal menstrual periods
• Variable menstrual cycles (usually less than 28 days between menstrual periods)
• Variable menstrual flow ranging from scanty to profuse
• Infertility
• Mood swings
• Hot flashes
• Vaginal tenderness
• Hirsutism -- excessive growth of body hair in a male pattern

Exams and Tests

A pelvic examination will be performed.

Tests usually include:

• CBC
• Serum HCG (to rule out pregnancy)
• Thyroid function tests
• Hormone tests 
  • Androgen levels
  • FSH (follicle-stimulating hormone)
  • LH (luteinizing hormone)
  • Prolactin
  • Progesterone
• Blood clotting profile

The following procedures may be performed:

• Endometrial biopsy
• D and C (dilatation and curettage)
• Pelvic ultrasound
• Hysteroscopy

Treatment

Young women within a few years of their first period are not treated unless symptoms are exceptionally severe, such as heavy blood loss causing anemia

In other women, the goal of treatment is to control the menstrual cycle. Oral contraceptives or progestogen therapy are frequently used for this purpose. If the woman has anemia is present, iron supplements may be recommended.

If the woman wishes to get pregnant, medication may be given to stimulate ovulation.

Women whose symptoms are severe and resistant to medical therapy may need surgical treatments including endometrial ablation (a procedure that burns or removes the lining of the uterus) or hysterectomy.

In older women who may be approaching menopause, treatment may be include hormone supplementation or surgery to relieve symptoms.

Outlook (Prognosis)

Hormone therapy usually relieves symptoms.

Possible Complications

• Infertility resulting from lack of ovulation
• Severe anemia as a result of prolonged or heavy menstrual bleeding
• Prolonged buildup of the uterine lining without adequate menstrual bleeding (a possible factor in the development of endometrial cancer)

When to Contact a Medical Professional

Call your health care provider if you have unusual vaginal bleeding.

Rakel P, ed. Conn's Current Therapy 2005. 57th ed. Philadelphia, Pa: WB Saunders; 2005:1286-1288.

Stenchever A. Comprehensive Gynecology. 4th ed. St. Louis, Mo: Mosby; 2001:1082-1084.