Dysfunctional uterine bleeding (DUB) is abnormal vaginal bleeding not due to a physical (anatomical) cause that occurs in women in their reproductive years. Usually, patients with DUB have menstrual cycles that are longer than usual, which allows the lining of the uterus to be exposed to estrogen for long periods of time. Anovulatory cycles are common for the first year after menarche (when menstrual periods first start) and later in life as women approach menopause (the cessation of menstrual periods). Approximately 20% of cases occur in adolescents and 40% in women over 40 years old. Obesity, excessive exercise, and emotional stress may be risk factors for DUB.

Causes

Dysfunctional uterine bleeding often occurs when the endometrium, or lining of the uterus, is stimulated to grow by the hormone estrogen. When exposure to estrogen is extended, or not balanced by the presence of progesterone, the endometrium continues to grow until it outgrows its blood supply. Then it sloughs off, causing irregular bleeding. Approximately 20% of cases of DUB occur in adolescents and 40% in women over 40. Obesity, excessive exercise, and emotional stress may be risk factors for DUB. Menorrhagia is the term for excessive bleeding with a normal interval. Metrorrhagia is bleeding that is irregular or too frequent. Menometrorrhagia is excessive bleeding at irregular intervals.

Symptoms

Common symptoms are-

* Vaginal bleeding between periods

* Abnormal menstrual periods

* Variable menstrual cycles

* Variable menstrual flow ranging from scanty to profuse

* Infertility

* Mood swings

* Hot flashes

* Vaginal tenderness

* Hirsuitism -- excessive growth of body hair in a male pattern

Treatment

For other young women whose bleeding is heavier and more irregular, birth control pills may make bleeding more regular and provide birth control at the same time. Patients who can't take birth control pills or who do not need birth control may be treated with a monthly dose of progesterone (such as medroxyprogesterone acetate) to bring on a regular period.

Women whose symptoms are severe and resistant to medical therapy may choose surgical treatments including endometrial ablation (a procedure that burns or removes the lining of the uterus) or hysterectomy.

In older women who may be approaching menopause, treatment may be elected to offset symptoms. Women may choose from treatments such as hormone supplementation or surgery. Regardless of the primary treatment, the patient may need iron replacement or transfusions of packed cells or whole blood, as indicated, because of anemia caused by recurrent bleeding.