Dysfunctional Uterine Bleeding (DUB):
Dysfunctional Uterine Bleeding as name suggests is one of
the most common causes of abnormal vaginal bleeding in women
during their reproductive years. Although it can occur any time
throughout woman’s reproductive years, it generally occurs at the
beginning or end of it.
Normally women lose about 40-155 ml blood during their menstrual
cycle which occurs every 21 to 35 days. During the first four days
of menstrual cycle disintegration and sloughing of the
functionalis layer (endometrium) takes place. For next 8-9 days
follicular (proliferation) phase takes place in which estrogen
stimulation brings about endometrial proliferation. Follicle
Stimulating Hormones (FSH) helps ovarian follicles produce the
estrogen. During this phase, the complexity of spiral arteries
increases along with its length. Next, the ovarian follicle
ruptures and ovulation takes place followed by luteal phase in
which corpus luteum produces progesterone and estrogens in rest of
the days till next cycle starts.
Types of Dysfunctional Uterine Bleeding:
1) Metrorrhagia
2) Menorrhagia
3) Menometrorrhagia
4) Postcoital Bleeding
5) Polymenorrhea
6) Amenorrhea
7) Intermenstrual Uterine Bleeding (also known as Spotting)
8) Oligomenorrhea
What causes DUB?
There are quite a few causes of DUB:
Imbalance between Estrogen and Progesterone play an important role
in DUB development in women. A prolonged bleeding may result due
to improper built up of endometrial lining caused by low level of
estrogen. Women who consume oral contraceptive pills (OCPs) may
experience such problems.
In most of the cases, DUB in women is caused by Anovulatory Cycle
in which high estrogen are produced with no progesterone. The
functionalis layer keeps on developing until feedback causes a
drop in Follicle Stimulating Hormone (FSH). During this, the blood
supply outgrows leading the condition in parting of endometrium
slough. The type of DUB resulting is known as Menometrorrhagia.
Luteal phase deficiency is the second most common cause of DUB.
Luteal phase is shortened due to the insufficient progesterone
availability accompanied by the low, high or normal level of
estrogen. The problems which develop in this type of DUB are
almost same as those which are developed in Anovulatory Cycle.
The third type of DUB is developed in women above age 38. In this,
the quality and quantity of ovarian follicles produced fall to a
very low level. Due to this, the developed follicles are unable to
produce enough/sufficient estrogen to help trigger ovulation. The
estrogen production does not stop but late production results in
late cycle estrogen breakthrough bleeding.
Diagnosis
The diagnosis of DUB involves analyzing patient’s history
(everything about menstrual cycle, age, habits, medical history,
amount of bleeding, usage of contraceptives etc.), physical
condition, examination of uterus, carefully understanding the
available data and if the patient has enlarged uterus then in such
cases, doctor may need to confirm if it is related to DUB
development. As the symptoms experienced by the patient are
somewhat similar to early symptoms of endometrial cancer,
endocrinopathies, hyperprolactinemia, hypothyroidism,
hyperthyroidism, your doctor may also suggest you to undergo
certain tests to rule out/confirm possibility of other diseases.
Analysis of basal temperature helps understand the ovulation
timing and other things is also performed during diagnosis.
Treatment
Dysfunctional Uterine Bleeding in women is treated with the help
of medication, surgery and combination of both and depends on
several factors, such as patient’s condition, severity of
bleeding, fertility etc. Your doctor may start treatment with
dosage of intravenous estrogen or Oral conjugated estrogen in
specific amount needed. The treatment also needs to be
changed/decided based on the other factors such as any disease
patient is currently suffering from, after confirming the source
of bleeding, need of contraception, and need of surgery etc.
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