Dysfunctional Uterine Bleeding
Semyatov S., M.D., Ph.d
Department of Obstetrics and Gynecology
Dysfunctional Uterine Bleeding (DUB) -
abnormal bleeding caused by hormonal
abnormalities in the absence of pregnancy,
tumor, infection, coagulopathy.
It is often associated with anovulation,
continuos ovarian estrogen production and a
DUB may result from disorders of:
•The central nervous system;
•From the effects of exogenous or endogenous
•Systemic metabolic disorders (hyper,-
hypotheroidism, hepatic dysfunction and
various chronic diseases).
Signs and Symptoms:
•Continuous uterine bleeding (may last for
A full general examination
Papanicolaou smear test
US exam (endometrium, ovaries)
A diagnostic curettage
1. Complications of pregnancy (abortion, ectopic gestation,
bleeding corpus luteum, hydatidiform mole,
2. Organic lesions of:
- the corpus: myoma, carcinoma, polyps, hyperplasia of
- cervix: chronic cervicitis, carcinoma, polyps;
- ovary: functional ovarian cysts and functioning neoplasms;
- oviducts: carcinoma;
- vagina: carcinoma.
Treatment: Overall Approach
– Restoration of Menstrual Cycle and Fertility
– Regularize and control menstrual bleeding
– Prevention of DUB
1. The age of the patient, her fertility and her desire for
2. The degree of anaemia.
3. The response to curettage, which is performed
primarily as an aid to diagnosis, may be
? Minimizes Retrograde Menstruation
Lower Fertility Rates than Other Medical
Choose OCPs with Least Estrogenic
Effects, Maximal Androgenic / Progestin
May be as Effective as GnRH-a for Pain Control
MPA 10 mg/day, DP 150 mg Semi-Monthly
May be Taken Long-Term
Side-Effects: AUB, Mood Swings, Weight Gain,
Suppresses LH / FSH
200 mg daily for 4-6 months
Causes Endometrial Regression, Atrophy
Not recommended in young women
Side-Effects: Weight Gain, Masculinization,
Occ. Permanent Vocal Changes….
50-150 mg daily from 5 to 9 day of
Complications: multiple pregnancy,
hyperstimulation of ovaries.
Reduces the capillary fragility.
Reduces menorragia by 50%.
500 mg 4 times a day started from 5 day
prior to the anticipated start of the period to
10 days after.
Nonsteroidal anti-inflammatory drugs
Mefenamic acid 500 mg for 5-6 days
controls menorrhagia in 70% cases of
Side effects: nausea, vomiting, dyspepsia,
diarrhoea, headache, auto-haemolytic
Combined oral contraceptive pills
More effective than oestrogen and progesteron
Reduces blood loss by 50% and eliminates
Tranexamic acid, epsilon-amino-caproic acid,
1-2 g 4 times a day for 6-7 days during
menstruation - with 50% success.
Side effects: nausea, vomiting, diarrhoea,
headache, visual disturbances, intracranial
is used as a last drug when others fail.
Depot injection 3.6 mg monthly for 4-6 month
- nearly 100% successful.
Side effects: anti-oestrogenic effect for more
than 6 monhts can cause menopausal
symptoms and osteoporosis.
1. D&C - removal of endometrium’s hyperplasia
D&C will be required in young women, if
hormonal therapy failed.
30-40% may be cured by curettage alone.
2. Hysterectomy - in older women with severe
menorrhagia; recurrent irregular uterine
bleeding that is unresponsive to progestin
The ovaries should be conserved in women
below the age of 50 yrs.
3. Hysteroscopic endometrial ablation by
radio-frequency induced ablation (RITEA) -
thermal destruction of endometrium at 66°C.
85% get cured.
balloon therapy - hot fluid is used which
causes superficial burn.