From the Guidelines
Dysfunctional uterine bleeding (DUB) is primarily caused by non-structural etiologies, including ovulatory dysfunction, coagulopathies, and primary endometrial disorders, as well as structural causes such as endometrial polyps, adenomyosis, leiomyoma, and endometrial hyperplasia.
Causes of DUB
- Non-structural causes:
- Ovulatory dysfunction
- Coagulopathies
- Primary endometrial disorders, such as molecular deficiencies in the regulation of endometrial hemostasis
- Iatrogenic etiologies, including exogenous gonadal steroids and intrauterine devices 1
- Structural causes:
- Endometrial polyps
- Adenomyosis
- Leiomyoma (fibroids)
- Endometrial hyperplasia
- Malignancy (endometrial or myometrial) 1
Specific Conditions
- Adenomyosis: a cause of abnormal uterine bleeding with or without the presence of fibroids, and can be treated with uterine artery embolization (UAE) 1
- Endometriosis: can coexist with fibroids and cause abnormal bleeding, and surgical methods can be performed simultaneously 1
- Uterine leiomyomas (fibroids): can cause bleeding symptoms, and can be managed with medical therapy, such as oral contraceptive medication or gonadotropin-releasing hormone (GnRH) agonists or antagonists 1
From the Research
Definition and Causes of Dysfunctional Uterine Bleeding (DUB)
- Dysfunctional uterine bleeding (DUB) is defined as excessive or prolonged uterine bleeding in premenopausal women that is not caused by pelvic pathology, medications, systemic disease, or pregnancy 2.
- DUB is a diagnosis of exclusion, and other conditions such as uterine fibroids, endometrial polyps, and systemic diseases should be excluded by appropriate investigations 3.
- The pathophysiology of DUB is largely unknown, but it can occur in both ovulatory and anovulatory menstrual cycles 3.
Hormonal and Ovulatory Factors
- A progesterone-deficient anovulatory state is a common cause of DUB 2.
- Anovulatory bleeding can also be associated with chronic anovulation, which can result in abnormal bleeding and increase the risk of endometrial cancer 4.
- Disordered prostaglandin metabolism within the endometrium explains most cases of DUB in ovulatory women 5.
Treatment Options
- Treatment options for DUB include hormonal therapies, non-hormonal therapies, and surgery 2, 3.
- Medical treatments include nonsteroidal anti-inflammatory drugs, antiprostaglandins, tranexamic acid, progestogen-releasing intrauterine devices, combined oral contraceptive pills, and other hormonal therapies 2, 3, 6.
- Surgical treatments include endometrial ablation and hysterectomy 2, 3, 6.