Abnormal Bleeding

Dysfunctional Uterine Bleeding - Topic Overview
Is this topic for you?
This topic is for women who want to learn about or have been diagnosed with dysfunctional uterine bleeding (DUB). It is related to changes in hormone levels. If you don't know what kind of bleeding you have, see the topic Abnormal Vaginal Bleeding.

What is dysfunctional uterine bleeding?
Dysfunctional uterine bleeding is irregular bleeding from the uterus. For example, you may get your period more often than every 21 days or farther apart than 35 days. Your period may last longer than 7 days. It is not serious, but it can be annoying and disrupt your life.

In most cases, this problem is related to changes in hormone levels. It is not caused by other medical conditions, such as miscarriage, fibroids, cancer, or blood clotting problems. Your doctor will rule out these and other causes of vaginal bleeding to confirm that you have dysfunctional uterine bleeding.

What causes dysfunctional uterine bleeding?
Dysfunctional uterine bleeding is usually caused by changes in hormone levels. In some cases the cause of the bleeding isn't known.

Normally one of your ovaries releases an egg during your menstrual cycle. This is called ovulation. Dysfunctional uterine bleeding is often triggered when women don't ovulate. This causes changes in hormone levels and in some cases can lead to unexpected vaginal bleeding.

Women can also get this condition even though they ovulate, although this is less common. Experts don't fully understand this type of vaginal bleeding. It may be caused by changes in certain body chemicals.

What are the symptoms?
You may have dysfunctional uterine bleeding if you have one or more of the following symptoms:

You get your period more often than every 21 days or farther apart than 35 days. A normal adult menstrual cycle is 21 to 35 days long. A normal teen cycle is 21 to 45 days.
Your period lasts longer than 7 days (normally 4 to 6 days).
Your bleeding is heavier than normal. If you are passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered severe and you should call your doctor.
Talk to your doctor if you have had irregular vaginal bleeding for three or more menstrual cycles or if your symptoms are affecting your daily life.

How is dysfunctional uterine bleeding diagnosed?
Your doctor must first rule out all other causes of vaginal bleeding before diagnosing dysfunctional uterine bleeding. These causes include miscarriage and problems with pregnancy. Vaginal bleeding may also be caused by common conditions, such as uterine fibroids.

Your doctor will ask how often, how long, and how much you have been bleeding. You may also have a pelvic exam, urine test, blood tests, and possibly an ultrasound. These tests will help your doctor check for other causes of your symptoms. He or she may also take a tiny sample (biopsy) of tissue from your uterus for testing.

You have dysfunctional uterine bleeding if, after testing, your doctor finds no other diseases or conditions that are causing your symptoms.

How is it treated?
There are many things you can do to treat dysfunctional uterine bleeding. Some are meant to return the menstrual cycle to normal. Others are used to reduce bleeding or to stop monthly periods. Each treatment works for some women but not others. Treatments include:

Hormones, such as a progestin pill or daily birth control pill (progestin and estrogen). These hormones help control the menstrual cycle and reduce bleeding and cramping.
A short course of high-dose estrogen. Estrogen is a hormone that is often used to stop dangerously heavy bleeding.
Use of the levonorgestrel IUD, which releases a progesterone-like hormone into the uterus. This reduces bleeding while preventing pregnancy.
Rarely used medicines that stop estrogen production and menstruation, such as gonadotropin-releasing hormones. These drugs can cause severe side effects but are used in special cases.
Surgery, such as endometrial ablation or hysterectomy, when other treatments do not work.
If you also have menstrual pain or heavy bleeding, you can take regular doses of a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen.

In some cases, doctors use watchful waiting, or a wait-and-see approach. It may be okay for a teen or for a woman nearing menopause. Some teens have times of irregular vaginal bleeding. This usually gets better over time as hormone levels even out. Women in menopause can expect their periods to stop. They may choose to wait and see if this happens before they try other treatments.