Dysfunction Uterine Bleeding (DUB)

It affects 22-30%of women and common in day to day clinical practice.

Diagnosis of DUB is usually made by exclusion of organic disease of the genital tract or systemic organic disease.

DUB is a groups of disorders characterized by dusfunction of any part of the reproductive system (uterus, ovary) or pituitary, hypothalamus, higher centres .

Definition- It is regular excessive bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, pregnancy.

It is caused by hormonal imbalance and most commonly occurs during puberty and menopause.No abnormality detected on pelvic examination is suggestive of the diagnosis.

Classification-

On the basis of age=

1)Pubertal or adolescent DUB- usually women less than 20yrs, incidence-4%

2) Reproductive DUB-Seen in women from 20 to 40 yrs, incidence-57%

3) Perimenopausal DUB- women aged above 40yrs, incidence-39%

4) Postmenopausal DUB- incidence around 10%

On the basis of pathology

Primary DUB:

  There is no detectable disease in the genital tract or elsewhere in the body.

   It is dus to dysfunction in the menstrual or ovarian cycle or uterine-ovarian-pituitary-hypothalamic axis.

Secondary DUB:

   Disorder outside the genital tract

   The cause of uterine bleeding like hypothyroidism, IUCD, Hormones for contraception etc.

On the basis of mentrual cycle

Anovulatory DUB:

   Cause is continuous estradiol production without corpus luteum formation and progesterone productions.

Ovulatory DUB:

Occurs most commonly after the adolescent years and before the perimenopausal years.

Occurs in 10%ovulatory women

Cause is prolonged life of the corpus luteum 

Association with a normal appearing secretary endometrium

Causes

Ovulatory disorder

Other cause:  

    Hormonal abnormalities

    Medication-Antiplatelet drugs

    Excessive exercise or weight loss

    Obesity

     Stress or illness

Clinical features

Irregular, abnormally frequent, prolonged,or excessive of uterine bleeding

Pale skin -Iron deficiency anaemia

Dizziness, fainting, weakness

Low Blood pressure, Tachycardia

Pain

Passing of clots

Diagnosis-

It is helpful to exclude others disease and find out the cause of DUB

Menstrual history

Symptomatic history

Exinatioon

Investigation

Treatment: