Dysfunctional Uterine Bleeding
Author: Millie A Behera, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG
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Dysfunctional uterine bleeding (DUB) is irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy. It reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. The bleeding is unpredictable in many ways. It may be excessively heavy or light and may be prolonged, frequent, or random.
About 1-2% of women with improperly managed anovulatory bleeding eventually may develop endometrial cancer.
Essential update: New ACOG treatment guidelines for abnormal uterine bleeding
The American College of Obstetricians and Gynecologists recently issued updated guidelines for the treatment of abnormal uterine bleeding caused by ovulatory dysfunction. They include the following recommendations[53] }:
Surgery should be considered only in patients in whom medical treatment has failed, cannot be tolerated, or is contraindicated
Endometrial ablation is not acceptable as a primary therapy, because the procedure can hamper the later use of other common methods for monitoring the endometrium
Regardless of patient age, progestin therapy with the levonorgestrel intrauterine device should be considered; contraceptives containing a combination of estrogen and progesterone also provide effective treatment
Low-dose combination hormonal contraceptive therapy (20-35 μg ethinyl estradiol) is the mainstay of treatment for adolescents up to age 18 years
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