dysfunctional uterine bleeding (DUB)

Introduction

Also see vaginal bleeding.

Etiology

hormonal irregularity

Clinical manifestations

• any vaginal bleeding that occurs outside the normal menstrual cycle

Laboratory

• pregnancy test
• Pap smear for cervical cancer
• serum TSH
• serum prolactin
• complete blood count (CBC): platelet count
• PT/PTT
• bleeding time

Diagnostic procedures

• endometrial biopsy
  • indicated if etiology unknown
  • endometrial hyperplasia, endometrial cancer
  • premenopausal women >=45 years should undergo endometrial biopsy
  • premenopausal women <45 years with increased risk for endometrial cancer:
    • unopposed estrogen (polycystic ovary syndrome, obesity)
    • tamoxifen use
    • Lynch syndrome or Cowden syndrome
    • reproductive factors (early menarche, nulliparity)

Radiology

• pelvic ultrasound
  • etiology unknown in a postmenopausal woman*
  • pelvic exam suggests a structural abnormality

* structural abnormality usually associated with abnormal pelvic exam

Differential diagnosis

• bleeding disorder
  • von Willebrand's disease
• cervical polyp, cervical cancer
• endometrial polyp, endometrial cancer
• fibroids

Management

• combination of oral contraceptive with cyclic progestin or progesterone-releasing intrauterine device if anovulation
• NSAIDs inhibit endometrial prostaglandings & decrease bleeding
• surgery
  • bleeding is excessive
  • refractory to medical therapy
  • cervical polyp, cervical cancer
  • endometrial polyp, endometrial cancer
  • fibroids

More general terms

• vaginal bleeding; abnormal uterine bleeding; anovulatory bleeding