What is Dysfunctional Uterine Bleeding (DUB)?
Dysfunctional uterine bleeding (DUB) is classified as any unusual blood loss from the uterus. It is also sometimes referred to as AUB (abnormal uterine bleeding).
Adolescent and premenopausal women are more likely to be affected by this disorder. It can be caused by a variety of factors, but is usually due to hormone imbalances.
Any type of bleeding while pregnant is not classified as DUB. Inform your doctor immediately if you are bleeding while pregnant. (1)
Your uterus, or womb, is the organ in which a fetus develops when you become pregnant. Every month, the uterus prepares for the fertilization of an egg and resultant pregnancy.
If no pregnancy occurs, uterine lining and mucus is shed during the menstrual cycle. A regular menstrual period usually lasts between three and five days. (2)
Conditions such as endometriosis and polycystic ovary syndrome can cause dysfunctional uterine bleeding.
Growths inside the uterus, such as fibroids, can also result in DUB. In addition, severe weight loss or gain, infections, or the use of hormonal birth control may provoke DUB.
Unusual bleeding can also be an early warning sign of certain cancers, such as ovarian or vaginal.
DUB can manifest in unpredictable ways. Bleeding could be frequent or random. Similarly, the bleeding may be excessive or light.
DUB can manifest as one or more of the following symptoms: (3)
Bleeding Between Periods
If you are bleeding in between your menstrual cycle, it is considered abnormal. Causes can range from harmless conditions to serious diseases, like cancer. (4)
If your period is consistently early or late, you have irregular periods. The average woman menstruates approximately every 28 days.
A difference of a few days is nothing to be concerned about. However, if less than 21 days or more than 35 days separate your periods, it is considered DUB. (5)
If your period lasts for over one week or is extremely heavy, it is DUB. Heavy periods require frequent changes of sanitary products (e.g. pads).
You may also notice the passing of large blood clots. If you regularly bleed through your clothing or onto bedding, despite changing frequently, this is DUB. (6)
Menopause usually occurs in women aged 45 or older. It is diagnosed when a woman has not had a period for over one year.
Bleeding after menopause is a type of dysfunctional uterine bleeding (DUB). Even if you bleed only a little, it is important to consult with your doctor.
Post-menopausal bleeding may be an early warning sign of certain cancers. (7)
Bleeding after sexual intercourse is not normal. It can be caused by vaginal dryness or something more serious, such as a sexually transmitted infection.
This type of dysfunctional uterine bleeding can also be caused by growths in the uterus or cervix. (8)
Dysfunctional uterine bleeding can be caused by different disorders and conditions. How it manifests may vary dramatically, depending on the individual.
Your age, health and the cause of your abnormal uterine bleeding all play a role in how the disorder will progress. For this reason, there are no definitive stages of dysfunctional uterine bleeding.
The diagnostic process to identify the cause of DUB is based on the PALM-COEIN system. It allows doctors to investigate all potential causes of DUB. (9)
PALM-COEIN is an abbreviation; each letter stands for a possible cause behind DUB. These are: (10)
A polyp is a growth which is usually harmless, but can be cancerous. A polyp growing in your uterus or cervix can cause DUB.
A polyp can be seen with an ultrasound scan of your uterus or by a hysteroscopy. A device inserted into your vagina allows doctors to examine your uterus and cervix.
Adenomyosis is a condition causing inner uterine lining to break past the uterus muscle wall. It can be diagnosed with an ultrasound or MRI scan.
Leiomyoma are fibroids growing inside the uterus or cervix. The majority of these growths are non-cancerous.
Uterine fibroids can be identified by an ultrasound scan of the uterus.
Malignancy and Hyperplasia
Hyperplasia is when new cells form in an organ, causing an increase in size. It can be a warning sign of cancer.
Malignancy refers to a cancerous growth which can cause dysfunctional uterine bleeding. This can be detected through a routine gynecological exam, such as a pap smear or biopsy. (11)
Coagulation disorders affect the blood’s ability to coagulate, or clot. This can cause excessive bleeding.
Your doctor will perform blood tests to determine if you have such a condition, like von willebrand’s disease. (12)
Disorders affecting your ovaries can cause DUB. Many cases are related to hormonal disorders, such as thyroid issues.
The ovaries are examined through pelvic ultrasound imaging. Your doctor may also perform a blood test to check your hormone levels. (13)
The endometrial tissue is the lining of your uterus. If similar tissue begins to grow outside the uterus, this is a condition called endometriosis.
Endometriosis is diagnosed with imaging tests, such as ultrasound and hysteroscopy. (14)
Periodically, medications or prescribed therapies can result adverse side effects or illnesses. These are classed as iatrogenic conditions, as are incorrectly performed surgeries and erroneous diagnoses. (15)
Hormonal birth control, steroids and antidepressants may also be responsible for dysfunctional uterine bleeding. Your doctor will review your medical history and any medication you take.
This category refers to disorders or diseases which are not classified within the PALM-COEIN system.
They include known conditions (i.e. chronic endometriosis) and disorders that have yet to be identified.
The treatment for dysfunctional uterine bleeding depends on the underlying reason and manifestation of symptoms.
Treatment options aim to manage symptoms long term. In some cases, the cause of DUB can be successfully eradicated.
These can include one or more of the following interventions: (16)
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Your doctor may recommend taking nonsteroidal anti-inflammatory drugs (NSAIDs) before or during your menstrual cycle.
NSAIDs are drugs that reduce inflammation and pain. They may alleviate menstrual cramps and heavy bleeding.
If an infection is the reason for your dysfunctional uterine bleeding, your doctor can prescribe antibiotics to address it.
Hormonal Birth Control
Hormonal birth control consists of devices and medication which prevent pregnancy using hormones. These include pills, vaginal rings and skin patches.
These forms of medication can help to regulate irregular periods and reduce menstrual bleeding.
Gonadotropin Releasing Hormone Agonists (GnRH Agonists)
GnRH agonists are a modified type of gonadotropin releasing hormone, which occurs naturally.
Gonadotropin releasing hormone plays a role in regulating your periods. These drugs are administered in the form of injections or nasal sprays. (17)
Surgery is an option if medication is unsuccessful at controlling dysfunctional uterine bleeding. Surgical procedures to treat the condition include:
Endometrial ablation is the surgical destruction of your uterus lining, to stop or significantly reduce bleeding.
The risks of severe complications during pregnancy are much higher after this procedure.
Uterine Artery Embolization
Uterine artery embolization aims to treat fibroids growing inside the uterus. The fibroids themselves can also be surgically removed.
Blood vessels inside the uterus are blocked to stop fibroid growth.
A hysterectomy is a major operation involving partial or total removal of the uterus. Generally, this procedure is only performed if all other alternatives are unsuccessful.
It is also a form of treatment for cancer of the uterus.This procedure results in permanent infertility.
What is dysfunctional uterine bleeding (DUB)? Dysfunctional uterine bleeding is defined as any abnormal blood loss from the uterus. It is typically a symptom of an underlying condition.
What are the signs of dysfunctional uterine bleeding (DUB)? The signs of DUB can include irregular or heavy periods. You may also bleed after having sex, between your periods, or after menopause.
How do you develop dysfunctional uterine bleeding (DUB)? Dysfunctional uterine bleeding is typically caused by a hormone imbalance. It can also be caused by weight changes, birth control or infection. Uterine polyps and fibroids as well as certain cancers can also provoke DUB.
How are you diagnosed for dysfunctional uterine bleeding (DUB)? DUB is usually diagnosed according to the PALM-COEIN system. Your doctor may perform imaging tests (e.g. ultrasound or MRI). You may also be asked to submit blood samples for testing.
What is the best treatment for dysfunctional uterine bleeding (DUB)? Treatment for DUB can include hormonal birth control, NSAIDs, antibiotics or gonadotropin releasing hormone agonists. Surgery may be required for more severe cases.
What are the long term complications of dysfunctional uterine bleeding (DUB)? DUB can result in anemia due to heavy blood loss. Certain conditions that cause dysfunctional uterine bleeding carry their own complications. Endometriosis increases a woman’s risk of miscarriage and preterm birth. (18, 19)
Is dysfunctional uterine bleeding (DUB) considered a disability? DUB in itself is not defined as a disability. However, if your doctor can provide evidence that the condition is preventing you from working, you may qualify. If your condition is severe, chronic or results in a potentially fatal complication (i.e. cancer), you may also be eligible. (20)
Is there any cure for dysfunctional uterine bleeding (DUB)? Depending on the cause, DUB can be either controlled or cured completely. For example, some uterine infections can be treated with antibiotics.
Is dysfunctional uterine bleeding (DUB) life threatening? DUB in itself is not a life threatening condition. However, some underlying causes (such as cancer of the reproductive organs) can be fatal.
Dysfunctional uterine bleeding (DUB) can be a debilitating condition because bleeding can occur at random and without warning. For women who bleed for more than one week at a time, it can be disruptive and unpleasant.
Heavy bleeding can require precautionary measures, for example, always keeping sanitary products on hand.
Unusual bleeding of any sort requires diagnosis and should not be ignored. It could be a simple infection or a symptom of a more severe condition or disease. (21)