This topic is for women who
want to learn about or have been diagnosed with dysfunctional uterine bleeding
(DUB). It is related to abnormal changes in
hormone levels. If you don't know what kind of
bleeding you have, see the topic
Abnormal Vaginal Bleeding.
Dysfunctional uterine bleeding is irregular bleeding from the
uterus. For example, you may get your
period more often than every 21 days or farther apart
than 35 days. Your period may last longer than 7 days. It is not serious, but
it can be annoying and can disrupt your life.
In most cases, this
problem is related to abnormal changes in hormone levels. It is not caused by other medical conditions, such as
fibroids, cancer, or blood clotting problems. Your
doctor will rule out these and other causes of vaginal bleeding to confirm that
you have dysfunctional uterine bleeding.
Dysfunctional uterine bleeding is usually caused by abnormal changes in hormone
levels. In some cases the cause of the bleeding isn't known.
Normally one of your
ovaries releases an egg during your menstrual cycle.
This is called
ovulation. Dysfunctional uterine bleeding is often
triggered when women don't ovulate. This causes abnormal changes in hormone levels and
in some cases can lead to unexpected vaginal bleeding.
also get this condition even though they ovulate, although this is less common.
Experts don't fully understand this type of vaginal bleeding. It may be caused
by changes in certain body chemicals.
You may have dysfunctional
uterine bleeding if you have one or more of the following symptoms:
Talk to your doctor if you have had irregular vaginal
bleeding for three or more menstrual cycles or if your symptoms are affecting
your daily life.
Your doctor must first rule out all other causes of vaginal bleeding
before diagnosing dysfunctional uterine bleeding. These causes include
miscarriage and problems with pregnancy. Vaginal bleeding may also be caused by
common conditions, such as uterine fibroids.
Your doctor will ask
how often, how long, and how much you have been bleeding. You may also have a
pelvic exam, urine test, blood tests, and possibly an
ultrasound. These tests will help your doctor check for other causes of your
symptoms. He or she may also take a tiny sample (biopsy) of
tissue from your uterus for testing.
You have dysfunctional
uterine bleeding if, after testing, your doctor finds no other diseases or
conditions that are causing your symptoms.
There are many things you can
do to treat dysfunctional uterine bleeding. Some are meant to return the
menstrual cycle to normal. Others are used to reduce bleeding or to stop
monthly periods. Each treatment works for some women but not others. Treatments
If you also have menstrual pain or heavy bleeding, you
can take regular doses of a nonsteroidal anti-inflammatory drug (NSAID), such
In some cases, doctors use
watchful waiting, or a wait-and-see approach. It may
be okay for a teen or for a woman nearing
menopause. Some teens have times of irregular vaginal
bleeding. This usually gets better over time as hormone levels even out. Women
in menopause can expect their periods to stop. They may choose to wait and see
if this happens before they try other treatments.
Learning about dysfunctional uterine bleeding:
Health Tools help you make wise health decisions or take action to improve your health.
Dysfunctional uterine bleeding (DUB) is irregular vaginal bleeding that is not caused by a
serious medical condition.
Normally one of your
ovaries releases an egg during your
menstrual cycle. This is called ovulation. Most women who have dysfunctional uterine
bleeding get it when their ovaries don't release an egg. This can be caused by
abnormal hormone changes. When your hormone levels are out of
balance, they can affect the
lining in your uterus, causing bleeding. Dysfunctional
uterine bleeding is common before age 20 and after age 40.
Some women have dysfunctional uterine bleeding
even though they ovulate. Experts don't fully understand this type of vaginal
bleeding. It may be caused by changes in certain body chemicals.
dysfunctional uterine bleeding (DUB) include:
Most menstrual blood is lost in the first 3 days of the
period. So excessive blood loss is possible without having
exceptionally long periods.
The symptoms of DUB can also be signs
of another, more serious
condition with similar symptoms. If your abnormal
vaginal bleeding is undiagnosed, see your doctor.
Dysfunctional uterine bleeding (DUB) occurs most often before age 20 and after age 40.
No matter what your age, see your doctor
if you have irregular vaginal bleeding.
Risk factors (things that increase your
dysfunctional uterine bleeding (DUB) include:
Some women have dysfunctional uterine bleeding even though
they have no risk factors.
If you have not been diagnosed with
dysfunctional uterine bleeding (DUB), see the topic
Abnormal Vaginal Bleeding to find out whether you
should see your doctor.
Any big change in
menstrual pattern or amount of bleeding that affects your daily life requires
evaluation by a doctor. This includes menstrual bleeding for three
or more menstrual cycles that:
Watchful waiting is a wait-and-see approach. If
you have been diagnosed with dysfunctional uterine bleeding, you may consider
watchful waiting when:
Talk to your doctor if you have not had a menstrual
period for more than 3 months.
Health professionals who can do an initial evaluation of a
vaginal bleeding problem include:
If you need to be seen for further evaluation or surgery,
your doctor may refer you to a gynecologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor must first
rule out all
other medical causes of vaginal bleeding before
dysfunctional uterine bleeding (DUB).
First, your doctor will:
If your symptoms are severe, your doctor
suspects a serious medical problem, or you are considering a certain treatment,
you may also have one or more other tests, such as:
Endometrial cancer risk increases with
age. Also known as uterine cancer, it is most common in women over age 50,
menopause. But endometrial cancer can also
develop earlier, during perimenopause or in women who have had abnormal
bleeding for many years.
Dysfunctional uterine bleeding (DUB) can usually be
managed with medicine to reduce bleeding and/or hormone therapy to either stop
or regulate menstrual periods. Surgical treatment is reserved for bleeding that
can't be controlled with medicine or hormone therapy.
bleeding is usually treated on an emergency basis with a short course of
estrogen therapy. If that isn't effective in rare
dilation and curettage (D&C) may be done to clear
the uterus of tissue. When needed, a
blood transfusion is used to quickly restore needed
If you are treated for severe uterine bleeding, you
and your doctor can then choose a treatment that is safe for the
Your age, the cause of
your condition, and any future plans for pregnancy will impact the treatment
choices available to you.
Gonadotropin-releasing hormone analogues (GnRH-As) are
rarely used now. These drugs reduce estrogen production, making your body think
it is in menopause. This reduces or stops menstrual periods for as long as you
take the medicine. After you stop taking the medicine, your symptoms will come
back unless you are close to menopause. Side effects with GnRH-As are common.
A medicine called tranexamic acid (such as Lysteda) is sometimes used for women who have bleeding that is heavier than normal. This medicine is not a hormone. It prevents bleeding by helping blood to clot. Talk to your doctor to find out if this option is right for you.
For more information about treatment options,
If you are thinking of getting treatment for
dysfunctional uterine bleeding, evaluate the following:
The answers to these questions will help you and your
doctor select the treatment plan that is best for you.
Usually dysfunctional uterine bleeding (DUB) results from
unpredictable hormonal changes, so it cannot be prevented. But
being overweight can affect your hormone production, which increases your risk for irregular menstrual bleeding. If you are overweight, losing weight
may help prevent dysfunctional uterine bleeding.
You can use home treatment for some
problems related to
dysfunctional uterine bleeding (DUB).
menstrual pain and heavy bleeding, you can use a
nonsteroidal anti-inflammatory drug (NSAID), such as
over-the-counter ibuprofen. This type of medicine lowers
prostaglandins, which cause menstrual pain, and
reduces bleeding during your period. An NSAID works best when you start taking
it 1 to 2 days before you expect pain to start. If you don't know when your
period will start next, take your first dose of an NSAID as soon as bleeding or
premenstrual pain starts. Take regular doses of the NSAID, as directed.
Irregular menstrual bleeding can lead to low levels of iron in the blood.
This condition is known as
anemia. You can prevent
anemia by increasing the amount of iron in your diet.
dysfunctional uterine bleeding (DUB) with medicines
has fewer risks but doesn't always work as well as surgical treatment. If you
plan to become pregnant in the future, or if you are nearing the time when your
menstrual periods will stop (menopause), you may want to try
The goal of medicine
treatment for dysfunctional uterine bleeding is to reduce or eliminate blood
loss. This can be done in one or both of the following ways:
There are several hormone therapies for managing
dysfunctional uterine bleeding. These treatments help reduce bleeding and
regulate the menstrual cycle:
estrogen therapy is typically used when severe blood loss
must be quickly stopped.
Surgery is generally reserved for treating
dysfunctional uterine bleeding (DUB) that can't be
controlled with medicine.
The following procedures are used to treat dysfunctional
Hysteroscopy may be done to
rule out serious uterine conditions:
Hysterectomy may be used as surgical treatment for dysfunctional
uterine bleeding when:
Regrowth of the endometrium may occur after you have endometrial ablation.
The American Academy of Family Physicians offers information on adult and child health conditions and healthy living. Its website has topics on medicines, doctor visits, physical and mental health issues, parenting, and more.
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers.
CitationsFritz MA, Speroff L (2011). Abnormal uterine bleeding. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 591–620. Philadelphia: Lippincott Williams and Wilkins.Lobo RA (2007). Abnormal uterine bleeding: Ovulatory
and anovulatory dysfunctional uterine bleeding, management of acute and chronic
excessive bleeding. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 915–931. Philadelphia: Mosby
Elsevier.Other Works ConsultedAmerican College of Obstetricians and Gynecologists
(2007, reaffirmed 2009). Endometrial ablation. ACOG Practice Bulletin No. 81. Obstetrics and Gynecology, 109(5): 1233–1248.American College of Obstetricians and Gynecologists
(2011). Intrauterine device. ACOG Practice Bulletin No. 121. Obstetrics and Gynecology, 118(1): 184–196.Duckitt K, Collins S (2008). Menorrhagia, search date
October 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.Goldstein SR (2008). Abnormal uterine bleeding. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 664–671. Philadelphia: Lippincott Williams and
Wilkins. Hillard P (2007). Benign diseases of the female
reproductive tract. In JS Berek, ed., Berek and Novak's Gynecology, 14th ed., pp. 431–504. Philadelphia: Lippincott Williams and
Wilkins. Kalan MJ (2010). Abnormal and dysfunctional uterine bleeding:
Treatment. In T Goodwine et al.,
eds., Management of Common Problems in Obstetrics and Gynecology, 5th ed., pp. 261–266. Chichester: Wiley-Blackwell.
January 27, 2012
Kirtly Jones, MD - Obstetrics and Gynecology & Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
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