Causes and symptoms

Dysfunctional uterine bleeding often occurs when the endometrium, or lining of the uterus, is stimulated to grow by the hormone estrogen. When exposure to estrogen is extended, or not balanced by the presence of progesterone, the endometrium continues to grow until it outgrows its blood supply. Then it sloughs off, causing irregular bleeding. If the bleeding is heavy enough and frequent enough, anemia can result.

Menorrhagia is representative of DUB. It is caused by many conditions including some outside the reproductive system. Causes of menorrhagia include:

• adenomyosis (a benign condition characterized by growths in the area of the uterus)
• imbalance between the hormones estrogen and progesterone
• fibroid tumors
• pelvic infection
• endometrial cancer (cancer of the inner mucous membrane of the uterus)
• endometrial polyps
• endometriosis (a condition in which endometrial or endrometrial-like tissue appears outside of its normal place in the uterus)
• use of an intrauterine device (IUD) for contraception
• hypothyroidism
• blood clotting problems (rare)
• lupus erythematosus
• pelvic inflammatory disease
• steroid therapy
• advanced liver disease
• renal (kidney) disease
• chemotherapy (cancer treatment with chemicals)

To diagnose dysfunctional uterine bleeding, many of the potential causes mentioned above must be eliminated. When all potential causes connected with pregnancy, infection, and tumors (benign or malignant) are eliminated, then menorrhagia is presumed to be caused by dysfunctional uterine bleeding.

Diagnosis

Diagnosis of any menstrual irregularity begins with the patient herself. The doctor will ask for a detailed description of the problem, and take a history of how long it has existed, and any patterns the patient has observed. A woman can assist the doctor in diagnosing the cause of abnormal uterine bleeding by keeping a record of the time, frequency, length, and quantity of bleeding. She should also tell the doctor about any illnesses, including long-standing conditions, like diabetes mellitus. The doctor will also inquire about sexual activity, use of contraceptives, current medications, and past surgical procedures.

Treatment

Treatment of DUB depends on the cause of the bleeding and the age of the patient. When the underlying cause of the disorder is known, that disorder is treated. Otherwise the goal of treatment is to relieve the symptoms to a degree that uterine bleeding does not interfere with a woman's normal activities or cause anemia.

Generally the first approach to controlling DUB is to use oral contraceptives that provide a balance between the hormones estrogen and progesterone. Oral contraceptives are often very effective in adolescents and young women in their twenties. NSAIDs (nonsteroidal anti-inflammatory drugs), like Naprosyn and Motrin, are also used to treat DUB.

When bleeding cannot be controlled by hormone treatment, surgery may be necessary. Dilation and curettage sometimes relieves the symptoms of DUB. If that fails, endometrial ablation removes the uterine lining, but preserves a woman's uterus. This procedure is sometimes be used instead of hysterectomy. However, as it affects the uterus, it can only be used when a woman has completed her childbearing years. The prescription of iron is also important to decrease the risk of enemia.

Until the 1980s, hysterectomy often was used to treat heavy uterine bleeding. Today hysterectomy is used less frequently to treat DUB, and then only after other methods of controlling the symptoms have failed. A hysterectomy leaves a woman unable to bear children, and, therefore, is limited largely to women who are unable to, or uninterested in, bearing children. Still, hysterectomy is a common treatment for long-standing DUB in women done with childbearing.

Alternative treatment

Alternative practitioners concentrate on good nutrition as a way to prevent heavy periods that are not caused by uterine fibroids, endometrial polyps, endometriosis, or cancer. Iron supplementation (100 mg per day) not only helps prevent anemia, but also appears to reduce menorrhagia in many women. Other recommended dietary supplements include vitamins A and C. Vitamin C improves capillary fragility and enhances iron uptake.

Vitamin E and bioflavonoid supplements are also recommended. Vitamin E can help reduce blood flow, and bioflavonoids help strengthen the capillaries. Vitamin K is known to play a role in clotting and is helpful in situations where heavy bleeding may be due to clotting abnormalities

Botanical medicines used to assist in treating abnormal bleeding include spotted cranesbill (Geranium maculatum ), birthroot (Trillium pendulum ), blue cohosh (Caulophyllum thalictroides ), witch hazel (Hamamelis virginiana ), shepherd's purse (Capsella bursa-pastoris ), and yarrow (Achillea millifolia ). These are all stiptic herbs that act to tighten blood vessels and tissue. Hormonal balance can also be addressed with herbal formulations containing phytoestrogens and phytoprogesterone.

Prognosis

Response to treatment for DUB is highly individual and is not easy to predict. The outcome depends largely on the woman's medical condition and her age. Many women, especially adolescents, are successfully treated with hormones (usually oral contraceptives). As a last resort, hysterectomy removes the source of the problem by removing the uterus, but this operation is not without risk, or the possibility of complications.

Prevention

Dysfunctional uterine bleeding is not a preventable disorder.

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