Facts about Causes and Symptoms for Dysfunctional Uterine Bleeding

What is this Condition?

Dysfunctional uterine bleeding refers to abnormal bleeding from the endometrium (surface lining of the uterus) that occurs without recognizable organic lesions. Prognosis varies with the cause. Dysfunctional uterine bleeding is the reason for almost 25% of all gynecologic surgeries.

What Causes it?

Dysfunctional uterine bleeding usually results from an imbalance in hormonal-endometrial interactions, in which estrogen constantly stimulates the endometrium. Disorders that cause sustained high estrogen levels include polycystic ovary syndrome, obesity, immaturity of the hypothalamic-pituitary-ovarian mechanism (in sexually mature teenagers), and failure to ovulate (in women in their late 30s or early 40s).

What are its Symptoms?

Dysfunctional uterine bleeding usually causes episodes of vaginal bleeding between periods; it may also cause heavy or prolonged periods (longer than 8 days) or shorten the menstrual cycle to less than 18 days. Such bleeding is unpredictable and can cause anemia.

How is it Diagnosed?

Blood tests help determine the need for blood or iron replacement.

Diagnostic studies must rule out other causes of excessive vaginal bleeding, including cancer, polyps, incomplete abortion, pregnancy, and infection.

How is it Treated?

The primary treatment, high-dose estrogen-progestogen combination therapy (oral contraceptives), is designed to control endometrial growth and reestablish a normal menstrual cycle. These drugs are usually administered four times daily for 5 to 7 days, even though bleeding usually stops in 12 to 24 hours.

In women over age 35, endometrial biopsy is necessary before thE start of estrogen therapy, to rule out endometrial cancer. Progestogen therapy is a necessary alternative in some women, such as those susceptible to the side effects of estrogen (thrombophlebitis, for example).

If drug therapy is ineffective, a D&C serves as a supplementary treatment that removes a large portion of the bleeding endometrium.

Also, a D&C can help determine the original cause of hormonal imbalance and can aid in planning further therapy.

Regardless of the primary treatment, the woman may need iron replacement or transfusions of packed cells or whole blood because of anemia caused by recurrent bleeding.