- Dysfunctional uterine bleeding
Name = Dysfunctional uterine bleeding
ICD9 = ICD9|626.8
Dysfunctional Uterine Bleeding (DUB) is the most common cause of functional abnormal uterine bleeding, which is abnormal genital tract bleeding based in the
uterusand found in the absence of demonstrable organic pathology.Diagnosis must be made by exclusion, since organic pathology must first be ruled out.It can be classified as "ovulatory" or "anovulatory", depending on whether ovulationis occurring or not.
Ovulatory DUB happens with the involvement of ovulation, and may represent a possible
endocrinedysfunction, resulting in menorrhagiaor metrorrhagia.Mid-cycle bleeding may indicate a transient estrogendecline, while late-cycle bleeding may indicate progesteronedeficiency.
Anovulatory cycleDUB happens without the involvement of ovulation.The etiology can be psychologicalstress, weight ( obesity, anorexia, or a rapid change), exercise, endocrinopathy, neoplasm, drugs, or it may be otherwise idiopathic.
Assessment of anovulatory DUB should always start with a good
medical historyand physical examination.Laboratory assessment of hemoglobin, luteinizing hormone(LH), follicle stimulating hormone(FSH), prolactin, T4, thyroid stimulating hormone(TSH), pregnancy(by βhCG), and androgenprofile should also happen.More extensive testing might include an ultrasoundand endometrial sampling.
Management of dysfunctional uterine bleeding predominantly consists of reassurance, though mid-cycle
estrogenand late-cycle progestincan be used for mid- and late-cycle bleeding respectively.Also, non-specific hormonal therapy such as combined estrogen and progestin can be given.
The goal of therapy should be to arrest bleeding, replace lost
ironto avoid anemia, and prevent future bleeding.
* [http://www.merck.com/mrkshared/mmanual/home.jsp Merck Manual] : [http://www.merck.com/mrkshared/mmanual/section18/chapter235/235e.jsp Abnormal Uterine Bleeding]
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