Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding

What is menstruation?

Menstruation, or having periods, is part of the female reproductive cycle.

While the average interval between periods is 28 days, many women will have cycles that are either longer or shorter than this.

During a period, the lining of the womb, which is no longer required if a pregnancy has not occurred, is shed and bleeding occurs through the vagina. This bleeding usually lasts between three and seven days.

What is dysfunctional uterine bleeding?

This is abnormal or irregular bleeding that is not caused by an infection, a tumour or pregnancy.

It usually occurs at the beginning or end of the reproductive stage of a woman's life, ie. at puberty or the menopause. This is due to the fact that the production of hormones may be erratic at these times.

Dysfunctional uterine bleeding is diagnosed only after other causes of uterine bleeding have been ruled out.

What causes dysfunctional uterine bleeding?

Dysfunctional uterine bleeding is caused by the erratic production of hormones. That is why it is more commonly associated with puberty and the menopause.

The endometrium (lining of the womb) is stimulated to grow by the hormone oestrogen. If this is not balanced by the presence of progesterone, the endometrium may continue to grow until it outgrows its blood supply. At this point it breaks away and is discharged, causing irregular and sometimes heavy bleeding.

If this bleeding is very heavy and very frequent, anaemia can result.

Menorrhagia (abnormally long periods) is often a symptom of dysfunctional uterine bleeding. There may also be an irregular bleeding pattern.

Other causes of abnormal bleeding patterns, such as endometriosis, fibroids or pelvic inflammatory disease (PID) must be outruled before it can be assumed that the menorrhagia is due to dysfunctional uterine bleeding.

How is dysfunctional uterine bleeding treated?

By definition, dysfunctional uterine bleeding is only said to exist when other causes of abnormal bleeding have been ruled out. Therefore, treatment usually consists of relieving the symptoms of the bleeding so that it does not interfere with a woman's normal life or cause anaemia. This may include taking medications such as the oral contraceptive pill and possibly taking iron supplements to reduce the chances of developing anaemia.

In some cases, surgery may be required. In the past, hysterectomy (surgical removal of the womb) was the only surgical option to relieve heavy bleeding in older women. Nowadays, there are a number of options short of hysterectomy, such as endometrial ablation where the lining of the womb (the endometrium) may be removed using a telescopic instrument inserted through the vagina and neck of the womb (cervix).

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