Dr. M.J. Bazos, MD Patient Handout

About Your Diagnosis
Dysfunctional uterine bleeding (DUB) is irregular bleeding during a menstrual cycle that is caused by hormonal irregularities. The most common hormonal irregularity occurs because the ovary did not ovulate (the ovary did not produce an egg during that particular cycle). This is called an “anovulatory cycle.” Anovulation is very common. Many women have one or two anovulatory cycles each year. Sometimes the anovulation will cause irregular bleeding. You may have bleeding between normal periods; bleeding can last from one period to the next, or for a prolonged period. If you have abnormal bleeding, it is important to determine that other causes of abnormal bleeding are not responsible for the irregularity. Other causes include uterine fibroids (myomas, benign tumors of the uterus), endometrial polyps, cervical abnormalities, miscarriage of an early pregnancy, or uterine cancer (this mostly applies only to perimenopausal and postmenopausal women). If other causes are not found and the periods return to normal after the abnormal bleeding occurs, then DUB is diagnosed. In the majority of cases, DUB is self-limiting so no treatment is necessary. If bleeding has been continuous since the previous period or there is bleeding between periods, the abnormal bleeding will usually stop after the next period. If it is a prolonged period, usually the period will stop without treatment. However, sometimes the bleeding is very heavy and does not slow down; this type of DUB requires treatment.

Living With Your Diagnosis
Dysfunctional uterine bleeding can occur in many different ways. Sometimes the bleeding is continuous from one period to the next; other times it may be a flow or it may be just spotting. The DUB may occur as intermittent bleeding between periods—that is, bleed for a few days, stop for a few days, then bleed again— until the next period. Other times, DUB will be a prolonged period; instead of bleeding for 4 or 5 days, the period lasts for 10–14 days. Sometimes the period will be heavier with clots. You may have increased premenstrual symptoms during a cycle in which you are having DUB. These symptoms include increased breast tenderness, feeling bloated, and increased irritability.

Treatment
Most DUB is self-limiting, so no treatment is necessary. The abnormal bleeding will stop after the next period. However, sometimes the bleeding can be very heavy and can cause significant blood loss. In these cases, treatment is necessary to prevent serious blood loss. In most cases, the flow can be reduced by taking a hormone. One of the more commonly used hormones is Provera. Also, birth control pills (two or three pills taken daily) can be used temporarily to control heavy DUB. In occasional cases, a minor procedure called “dilatation and curettage” (D&C) is necessary to control the bleeding. During a D&C the lining of the uterus, the endometrium, is scraped out. This helps the uterus to shed the endometrium all at once so the bleeding stops. Side effects from progestins include feeling bloated, breast tenderness, lower backache, irritability, and mild depression. However, usually the progestin has to be taken for only 7–10 days, so although the side effects may be difficult to tolerate, it is only for a short while. Taking two or three birth control pills a day can cause mild nausea. If vomiting occurs, then another way of controlling the DUB will have to be prescribed.

The DOs
• If a medication is prescribed, do take it as directed.

The DON’Ts
• Don’t stop the medication early (even if the bleeding stops) unless directed by your health care provider.

When to Call Your Doctor
• If your period lasts longer than 7 or 8 days.
• If your period is much heavier than usual, i.e., soaking through maxi pads or super tampons every 2 hours, or passing large (walnut size or larger) clots.
• If you have bleeding between periods.
• If the bleeding doesn’t slow down or stop as expected.
• If you are bleeding heavily and are feeling dizzy or weak. These may be symptoms of severe anemia, so you should have your blood cell count checked.
• If there is any chance you could be pregnant.