Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the vagina that is due to changes in hormone levels.
Alternative NamesAnovulatory bleeding; Bleeding - dysfunctional uterine; DUB; Abnormal uterine bleeding; Menorrhagia - dysfunctional; Polymenorrhea - dysfunctional; Metrorrhagia - dysfunctional
Causes, incidence, and risk factorsThe menstrual cycle, or period, is not the same for every woman. On average, menstrual flow occurs every 28 days (most women have cycles between 24 and 34 days apart), and lasts 4 - 7 days.
The menstrual cycle of young girls who are just starting to have their periods can range from 21 to 45 days or more apart. Women in their 40s will often notice their menstrual cycles occurring less often.
During a normal menstrual cycle, levels of different female hormones made by your body go up and down. Estrogen and progesterone are two very important hormones.
Ovulation is the part of the normal menstrual cycle when an egg is released from the ovaries. The most common cause of dysfunctional uterine bleeding is when your ovaries do not release an egg. When this occurs, the hormone levels in your body are not the same, causing your period to be later or earlier and heavier than normal.
Other changes in hormones may also cause changes in your period.
See also: Menstrual periods - heavy, prolonged or irregular for information on other causes of vaginal bleeding.
SymptomsA woman with dysfunctional uterine bleeding may notice the following changes in her menstrual cycle:
Other symptoms caused by changes in hormone levels are:
A woman may feel tiredness or fatigue if she is losing too much blood over time and becomes anemic.
Signs and testsThe health care provider will do a pelvic examination.
Lab tests may include:
The following procedures may be done:
Young women within a few years of their first period are often not treated unless symptoms are very severe, such as heavy blood loss causing anemia.
In other women, the goal of treatment is to control the menstrual cycle.
The health care provider may recommend iron supplements for women with anemia.
If you want to get pregnant, you may be given medication to stimulate ovulation.
Women whose symptoms are severe and do not respond to medical therapy may need surgical treatments including:
Hormone therapy usually relieves symptoms. As long as there is no problem with anemia (low blood count), no treatment is needed.
ComplicationsCall your health care provider if you have unusual vaginal bleeding.
ReferencesLobo RA. Abnormal uterine bleeding: Ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 37.
Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009;113:1104-1116.
Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008;35:219-234.
Damlo S. ACOG guidelines on endometrial ablation. Am Fam Physician. 2008;77:545-549.
Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the vagina that is due to changes in hormone levels.
Alternative NamesAnovulatory bleeding; Bleeding - dysfunctional uterine; DUB; Abnormal uterine bleeding; Menorrhagia - dysfunctional; Polymenorrhea - dysfunctional; Metrorrhagia - dysfunctional
Causes, incidence, and risk factorsEvery woman's menstrual cycle, or period, is different. On average, a woman's period occurs every 28 days. Most women have cycles between 24 and 34 days apart. It usually lasts 4 - 7 days.
Young girls may get their periods anywhere from 21 to 45 days or more apart. Women in their 40s will often notice their period occurring less often.
About every month, the levels of female hormones in a woman's body rise and fall. Estrogen and progesterone are two very important hormones. These hormones play an important role in ovulation, the time when the ovaries release an egg.
Dysfunctional uterine bleeding (DUB) most commonly occurs when the ovaries do not release an egg. Changes in hormone levels cause your period to be later or earlier and sometimes heavier than normal.
See also: Vaginal bleeding
SymptomsSymptoms of dysfunctional uterine bleeding may include:
Other symptoms caused by changes in hormone levels may include:
A woman may feel tired or have fatigue if she is loses too much blood over time. This is a symptom of anemia.
Signs and testsThe health care provider will do a pelvic examination and may perform a Pap smear. Tests that may be done include:
Your health care provider may recommend the following:
Young women within a few years of their first period are often not treated unless symptoms are very severe, such as heavy blood loss causing anemia.
In other women, the goal of treatment is to control the menstrual cycle. Treatment may include:
The health care provider may recommend iron supplements for women with anemia.
If you want to get pregnant, you may be given medication to stimulate ovulation.
Women with severe symptoms that do not get better with other treatments may consider the following procedures if they no longer want to have children:
Hormone therapy usually relieves symptoms. Treatment may not be needed if you do not develop anemia due to blood loss.
ComplicationsCall your health care provider if you have unusual vaginal bleeding.
ReferencesLobo RA. Abnormal uterine bleeding: Ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 37.
Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009;113:1104-1116.
Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008;35:219-234.
Damlo S. ACOG guidelines on endometrial ablation. Am Fam Physician. 2008;77:545-549.
ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-18.
Middleton LJ, Champaneria R, Daniels JP, Bhattacharya S, Cooper KG, Hilken NH, et al. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010 Aug 16;341:c3929. doi: 10.1136/bmj.c3929.
Reviewed ByReview Date: 07/25/2011
David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.
DUB means dysfunctional uterine bleeding.
The exogenous progesterone effect, aka pill endometrium, occurs when a female takes a contraceptive consisting of progesterone. This causes a ripening of the endometrium consisting of increased stroma, plumping of cells (pseudodecidua), and edema. The major difference between this and the secretory phase is that the glands are small and atrophic because they lack a priming by estrogen, therefore the endometrium will break down regularly and you will get DUB (dysfunctional uterine bleeding).
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