Dysfunctional Uterine Bleeding (DUB): What You Need to Know

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Dysfunctional uterine bleeding (DUB) is a term that describes abnormal bleeding from the uterus that is not related to any pelvic pathology, medications, systemic disease, or pregnancy. It is the most common cause of abnormal uterine bleeding, accounting for 90% of cases. DUB can affect women of any age, but it is more likely to occur during puberty and perimenopause, when hormonal changes are more frequent .

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Causes of DUB

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The main cause of DUB is an imbalance in the sex hormones oestrogen and progesterone, which regulate the menstrual cycle . When these hormones are out of sync, the lining of the uterus (endometrium) may grow excessively or shed irregularly, leading to abnormal bleeding patterns.

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Some medical conditions that can cause or contribute to hormonal imbalances and DUB are:

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• Polycystic ovary syndrome (PCOS): a disorder that causes the ovaries to produce excess androgens (male hormones) and disrupts ovulation .
• Endometriosis: a condition where the endometrium grows outside the uterus, such as on the ovaries or fallopian tubes .
• Uterine polyps: small benign growths that develop on the inner wall of the uterus .
• Uterine fibroids: noncancerous tumours that grow in or on the uterus .
• Sexually transmitted diseases (STDs): infections that cause inflammation in the reproductive organs, such as gonorrhoea and chlamydia .
• Pregnancy: abnormal bleeding can be an early sign of pregnancy or a complication such as ectopic pregnancy or miscarriage.

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Some medications that can also cause or worsen DUB are:

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• Hormonal birth control pills: these can affect the natural balance of oestrogen and progesterone and cause breakthrough bleeding or spotting between periods .
• Hormonal agents: these are drugs that alter the levels or actions of hormones in the body, such as spironolactone and tamoxifen.
• Blood thinners: these are drugs that prevent blood clots from forming, such as warfarin and aspirin.

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Symptoms of DUB

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The main symptom of DUB is bleeding outside of your normal menstrual cycle. This can include:

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• Heavy menstrual bleeding: bleeding more than 80 ml (about 5 tablespoons) or soaking a pad or tampon every hour for several hours.
• Prolonged menstrual bleeding: bleeding for more than 7 days .
• Irregular menstrual cycles: having periods less than 21 days or more than 35 days apart.
• Spotting: having light bleeding that is brown, pink, or light red in colour.
• Bleeding between periods: having any bleeding outside your regular cycle .
• Bleeding after menopause: having any bleeding after you have stopped having periods for 12 months or more.

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Other symptoms that may accompany DUB are:

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• Bloating
• Pelvic pain or pressure
• Anaemia (low red blood cell count)
• Dizziness
• Fainting
• Weakness
• Low blood pressure
• Increased heart rate
• Pale skin

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Diagnosis of DUB

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To diagnose DUB, your doctor will ask you about your medical history, menstrual history, medications, and symptoms. They will also perform a physical exam and a pelvic exam to check for any signs of infection, inflammation, or abnormal growths in your reproductive organs.

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Your doctor may also order some tests to rule out other causes of abnormal bleeding, such as:

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• Blood tests: these can measure your hormone levels, blood count, clotting factors, and pregnancy status.
• Pap smear: this is a test that collects cells from your cervix to check for any abnormalities or infections.
• Ultrasound: this is an imaging test that uses sound waves to create pictures of your uterus, ovaries, and fallopian tubes.
• Endometrial biopsy: this is a procedure that involves taking a small sample of tissue from your endometrium to examine it under a microscope.
• Hysteroscopy: this is a procedure that involves inserting a thin, lighted tube (hysteroscope) through your vagina and cervix to look inside your uterus.

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Treatment of DUB

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The treatment of DUB depends on the cause, severity, and frequency of your bleeding, as well as your age, reproductive plans, and personal preferences. Some of the possible treatment options are:

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• Hormonal therapy: this involves taking medications that contain oestrogen and progesterone or progestin (a synthetic form of progesterone) to regulate your menstrual cycle and reduce bleeding. These can be in the form of pills, injections, patches, vaginal rings, or intrauterine devices (IUDs).
• Nonsteroidal anti-inflammatory drugs (NSAIDs): these are painkillers that can also reduce inflammation and bleeding by inhibiting the production of prostaglandins, chemicals that stimulate uterine contractions. Examples are ibuprofen and naproxen.
• Tranexamic acid: this is a drug that helps prevent blood clots from breaking down, thereby reducing bleeding. It is taken as a tablet during your period.
• Iron supplements: these can help treat or prevent anaemia caused by heavy bleeding.
• Surgery: this is an option for women who have severe bleeding that does not respond to other treatments or who have uterine polyps or fibroids that cause symptoms. The type of surgery depends on the size, location, and number of the growths. Some examples are hysteroscopic resection, myomectomy, endometrial ablation, and hysterectomy.

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Complications of DUB

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DUB can have a negative impact on your physical and emotional health. Some of the possible complications are:

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• Anaemia: this is a condition where your body does not have enough red blood cells to carry oxygen to your tissues. It can cause fatigue, weakness, shortness of breath, and pale skin.
• Infertility: this is the inability to conceive or maintain a pregnancy. It can result from hormonal imbalances, endometriosis, uterine polyps or fibroids, or infections that damage your reproductive organs.
• Infection: this is a risk if you have untreated STDs or if you undergo surgery for DUB. It can cause fever, pain, discharge, and pelvic inflammatory disease (PID), which can lead to infertility or ectopic pregnancy.
• Depression: this is a mood disorder that causes persistent feelings of sadness, hopelessness, and loss of interest in activities. It can result from the stress, pain, and stigma associated with DUB.

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Contacting a Doctor

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You should contact a doctor if you have any of the following signs or symptoms:

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• Bleeding that is heavier or longer than usual
• Bleeding that occurs between periods or after sex
• Bleeding that occurs after menopause
• Bleeding that interferes with your daily activities or quality of life
• Bleeding that causes severe pain, dizziness, fainting, or weakness
• Bleeding that is accompanied by fever, discharge, or foul odour

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Your doctor can help you find the cause and the best treatment for your DUB.

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Sources

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- Debbo Africa: https://debbo.africa

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- Dysfunctional Uterine Bleeding (DUB): How It’s Diagnosed and Treated Healthline. https://www.healthline.com/health/dysfunctional-uterine-bleeding-dub

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- Dysfunctional uterine bleeding: Symptoms, causes, and more. Medical News Today. https://www.medicalnewstoday.com/articles/what-does-dysfunctional-uterine-bleeding-mean

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- Dysfunctional Uterine Bleeding (DUB). Gov. https://www.hss.gov.nt.ca/professionals/sites/professionals/files/resources/cpgpccn-urinary-women-health-gynecology-dysfunctional-uterine-bleeding.pdf