Dysfunctional Uterine Bleeding is a condition that is characterized by irregular uterine bleeding. In certain cases it may involve frequent periods that may occur well within the 21 day gap of a normal menstrual cycle. In others, it may involve menstrual cycles that have gaps of 35 days or more in between. Dysfunctional uterine bleeding is also characterized by periodic cycles that last for more than 7 days.
The exact cause for dysfunctional uterine bleeding is unknown. However, several studies on the subject have linked the condition to hormonal changes (or) imbalances in the body. Changes in the hormonal levels in the body are also known to cause dysfunctional uterine bleeding in some women. In certain rare cases, changes in certain body chemicals can also trigger the condition.
A common misconception is that dysfunctional uterine bleeding can be caused by issues like fibroids, blood clots in the uterus, vaginal bleeding, miscarriages, or even cancerous polyps etc. The truth, however, is that dysfunctional uterine bleeding has nothing to do with these conditions. And while it may not be that dangerous a condition to treat/manage, it can be quite annoying to handle.
Understanding the basic reason behind Dysfunctional Uterine Bleeding
During every menstrual cycle, the ovaries in the uterus would release an egg which would travel down the uterine cavity into the vagina and then be discarded by the body along with the endometrial lining. The entire process from the creation of the egg to its journey through the uterus is termed as ovulation.
Dysfunctional Uterine Bleeding occurs when there is a delay or lapse in ovulation. Failure to ovulate will lead to significant hormonal changes in the body. And in some cases, these hormonal changes could cause vaginal bleeding (unexpected).
Studies have revealed the dysfunctional uterine bleeding can also occur with normal ovulation (rarely). The exact cause for the condition in this case would remain unknown until further tests are carried out.
Risk Factors Associated with Dysfunctional Uterine Bleeding
Certain risk factors would increase a woman’s chances of developing dysfunctional uterine bleeding. These include anovulatory cycles in adolescence (irregular periodic cycles during menarche and up to 2 years afterwards), peri-menopause (attributed to reducing ovarian function), obesity (leading to endometrial overgrowth and irregular bleeding patterns), polycystic ovarian syndrome and habits like smoking (cigarette smoke has an anti-estrogenic effect which could cause abnormal uterine bleeding) etc.
Common Symptoms of Dysfunctional Uterine Bleeding
Dysfunctional Uterine Bleeding is usually recognized by the occurrence of one or more of the symptoms mentioned below.
Irregular Menstrual Cycles
The normal menstrual cycle can stretch from anywhere between 31-35 days. In case of teens, the cycle would be 31-45 days long. A case of dysfunctional uterine bleeding is considered if the periods occur within 21 days or fail to occur within 35 days of the normal menstrual cycle.
Prolonged Menstrual Bleeding
In a normal menstrual period, vaginal bleeding would occur from anywhere between 4-6 days (maximum 7 days). Dysfunctional uterine bleeding is characterized by the abnormal menstrual bleeding that exceeds 7 days without showing signs of receding.
Heavy Menstrual Bleeding
Dysfunctional Uterine Bleeding usually causes heavy-severe menstrual bleeding, often characterized by the increased presence of blood clots during shedding. Severe bleeding would also force the individual in question to change her tampon or pad within 2 hours or less.
Diagnosis of Dysfunctional Uterine Bleeding
In most cases, dysfunctional uterine bleeding is diagnosed after ruling out other possible medical anomalies that could be contributing to the condition. The condition is established only when the tests for conditions like miscarriages, fertility issues, fibroids and blood clots etc. come out negative.
These would include routine blood tests, urine tests, pelvic exams, ultrasounds and even tissue biopsies (from the uterus) that would be taken to test for the possibility of these conditions. If after thorough testing, the doctor finds no plausible explanation for the symptoms, he/she would term the condition as dysfunctional uterine bleeding.
Treatment Options for Dysfunctional Uterine Bleeding
Since the exact cause for dysfunctional uterine bleeding is unknown, the treatment options for the same would vary depending on factors like the severity of the condition (usually determined by the hemoglobin levels in the body) and the result needed after treatment. Accordingly, the treatment would differ for those who wish to stop their monthly periods, reduce bleeding or normalize their monthly cycles. The same treatment would not work on all women as well.
Mild cases of Dysfunctional Uterine Bleeding
Mild cases of the condition are usually treated with the ‘wait and watch’ approach. Accordingly, the doctor would ask the woman in question to keep track of her menstrual cycles for a couple of months to see if the condition disappears on its own. This is usually the case for teens who experience irregular menstrual bleeding for a few months after attaining puberty, and women who experience abnormal vaginal bleeding as and when they near menopause.
In these cases, the doctor would most likely prescribe NSAIDs (non steroidal anti-inflammatory drugs) like ibuprofen that would help reduce menstrual bleeding and offer relief from painful menstrual cramps. Iron and multivitamin supplements are also prescribed to compensate for excessive menstrual bleeding.
Moderate cases of Dysfunctional Uterine Bleeding
Moderate cases of dysfunctional uterine bleeding are usually nearly anemic. Therefore, the treatment would be aimed at controlling the menstrual cycle and reducing excessive menstrual bleeding. The drugs prescribed for these cases would usually be birth control pills or progestin pills (on a daily basis) that alter the hormonal levels in the body in order to reduce bleeding and preventing menstrual cramps. Iron pills would also be recommended on a daily basis.
Drugs like gonadotropin inducers can also help stop menstruation and estrogen production. However, they come with serious side effects and are prescribed only on rare circumstances.
Severe cases of Dysfunctional Uterine Bleeding
Women suffering from severe dysfunctional uterine bleeding would usually be very anemic and would tend to develop symptoms like nausea, dizziness, pale skin, heart palpitations and low blood pressure etc.
Severe cases of the condition can be treated with a short term course of high dosage estrogen which would help stop very heavy bleeding. Levonorgestrel IUDs can also help curb heavy menstrual bleeding by releasing a progesterone emulating hormone into the uterus.
Severe cases of dysfunctional uterine bleeding that do not respond to any form of treatment would need to be surgically treated by either removing the endometrial lining of the uterus (called ‘endometrial ablation’) or removing the uterus altogether (called ‘hysterectomy’). A person with severe dysfunctional uterine bleeding would also require blood transfusions on a regular basis until the condition is stabilized.
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