Dysfunctional Uterine Bleeding

Dysfunctional Uterine Hemorrhage, Retained Menstruation, Suppression of Menstruation

What is Dysfunctional Uterine Bleeding?

Dysfunctional uterine bleeding occurs at irregular intervals and is the result of abnormal levels of hormones produced by the hypothalamus and pituitary glands and the ovaries. It most commonly occurs in adolescent girls and women over 45 years of age. The hormonal imbalance occurs when the ratio of estrogen to progesterone varies from the normal. This can also occur with prolonged estrogen or progesterone use.

How is it diagnosed?

History: The individual may describe bleeding that is outside of the usual time for menses. Pertinent history includes duration of bleeding, amount of flow, presence of clots, pain, relationship to last menstrual period, history of recent illnesses, and all medications taken in the previous several months.

Physical exam: A pelvic exam will be done with or without a general physical. The reproductive organs will be examined for any bleeding areas, pregnancy, tumors or other problems.

Tests: Cervical smears, complete blood count (CBC), sedimentation rate, blood glucose, clotting time, thyroid function and pregnancy tests may be done. A pelvic ultrasound, hysterosalpingography or MRI may be done to evaluate for the presence of tumors. A biopsy, curettage or aspiration of the inside lining of the uterus may be required.

How is it treated?

Treatment depends on the exact cause and may consist of estrogen or progestin therapy. Oral contraceptives may help to regulate the menstrual cycle. A dilation and curettage (D&C) may be needed if hormone therapy fails. If surgery is needed all bleeding may be stopped with medication for one to three months to build up the woman's hemoglobin count. Nonsteroidal anti-inflammatory drugs are sometimes required. Laser or electrocautery is sometimes used to control bleeding within the uterus.

MEDICINES

Premarin (Conjugated Estrogens), Alesse (Levonorgestrel), Apri (Desogestrel), Aygestin (Norethindrone), Ovral (Norgestrel)

Activity

  • Stay as active as possible, depending on the underlying condition.
  • Use heat to relieve pain: Place a heating pad or hotwater bottle on the abdomen or back. Take a hot bath for 10 to 15 minutes as often as needed.

What might complicate it?

Dysfunctional uterine bleeding can cause anemia. Ovulation may not occur and may result in infertility.

Predicted outcome

Hormonal balance can usually be achieved with therapy. Infertility may need to be addressed with fertility drugs if pregnancy is desired.

Alternatives

Other possible diagnoses include von Willebrand's disease, tumors of the reproductive organs, pelvic infections, endometriosis, endometrial polyps, and uterine or ectopic pregnancy or miscarriage.

Appropriate specialists

Gynecologist.

Notify your physician if

  • You or a family member has abnormal uterine bleeding.
  • The following occur during treatment:
    • Bleeding becomes excessive (saturating a pad or tampon more often than once an hour).
    • Signs of infection develop, such as fever, a general ill feeling, headache, dizziness or muscle aches.

Last updated 7 August 2011


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