Dysfunctional Uterine Bleeding

In women with abnormal uterine bleeding, DUB is the cause in 50%.  It is a diagnosis made by exclusion (other pathological causes must be excluded- see Menorrhagia).

Most cases are associated with non-ovulatory bleeding (85%)

  • Occurs most commonly at extremes of reproductive age
    • In the young (teenagers), this usually resolves spontaneously without treatment (although treatment of severe menorrhagia may be required until this happens)
    • In the old (menopausal age), this may herald the menopause

Ovulatory DUB is more common in middle age

  • Causes regular heavy periods due to inadequate progesterone production of the corpus luteum

Investigations

see Menorrhagia

Treatment

  • Non-invasive
    • Non-hormonal (anti-fibrinolytics)- taken during bleeding to reduce loss
      • e.g. tranexamic acid
    • Non-hormonal (anti-prostaglandins)- taken during days of bleeding to reduce pain and loss
      • e.g. mefenamic acid
    • Hormonal-
      • Cyclical progestogen (norethisterone)- taken days 5-26
      • OCP
      • Mirena coil (extremely effective and does not have as many side effects- often used 1st line)
      • (GnRH analogues may be used – esp in endometriosis)
  • Invasive
    • Endometrial ablation (transcervical endometrial resection /rollerball/hysteroscopic)
    • Fibroid embolisation
  • Surgery
    • Hysterectomy

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