DYSFUNCTIONAL UTERINE BLEEDING (DUB)

Question 1

Dysfunctional Uterine Bleeding (DUB)

Answer 1

Arises from the endometrium of the uterus with no demonstrable organic cause
Results from endocrine abnormality, anovulation, or short ovulatory cycles
Estrogen stimulates growth of endometrium without stabilizing effect of progesterone

Question 2

DUB: Causes

Answer 2

• Adolescence: immature hypothalamic-pituitary system does not respond to positive feedback effect of estrogen
• Perimenopause: decrease in ovarian response to gonadotropin stimulation
• Reproductive years: stress, strenuous exercise, large weight change

Question 3

DUB: Differential Diagnosis

Answer 3

• DUB is a diagnosis of exclusion
• Consider ovulatory cycle and associated features (mid-cycle pain, dysmenorrhea, vaginal mucus changes)
• Consider the woman’s age, last menstrual period (LMP), birth control method, frequency of menses, amount of blood flow, duration, and menstrual pattern changes
• Ectopic pregnancy causes abdominal pain
• Several BC methods may trigger irregular bleeding (examples:)
  o Progesterone only – Nexplanon
  o Depo Provera – irregularities
  o Mirena IUD
• Women 35 years and older should be evaluated for cervical and uterine cancer
• Other causes of abnormal bleeding: fibroids, endometrial polyps, and adenomyosis

Question 4

DUB: Laboratory Testing

Answer 4

• Directed by H/P findings
• Consists of pregnancy test, H & H , platelet count, Pap if indicated
• Severe bleeding, (PT), (PTT), and bleeding time tests if indicated
• Prolactin level and thyroid function tests to rule out hyperprolactinemia and hypothyroidism

Question 5

DUB: Treatment

Answer 5

• Management directed toward controlling bleeding and preventing a recurrence
• Adolescents: observation for mild cases, medroxyprogesterone (not sexually active), or OCs if sexually active
• Reproductive years: based on woman’s desire for fertility or contraception