Dysfunctional Uterine Bleeding


What is Dysfunctional Uterine Bleeding?

Dysfunctional Uterine Bleeding or also known as DUB (with ICD 9 Code:  626.8) is the abnormal condition of the uterus where there is an irregular and abnormal bleeding and passing of blood in the vagina. [1][2][3] This condition can be caused by several factors and can lead to different kinds of complications. The DUB is are common in girls and children who have already undergone the phases of menstruation and menopausal stages.

Anatomy Of The Uterus

The female reproductive organ is composed of the vagina (outer organ), cervix (middle organ). Uterus, Fallopian tubes and the ovaries. The uterus is the fibrous female reproductive organ that encapsulated the baby or the fetus during the pregnancy phase. [7]


The uterus is divided into three (3) major muscles:

  • Endometrium – The innermost muscle layer of the uterus where the baby is implanted.
  • Myometrium – The middle most layer and is made of smooth muscle
  • Perimetrium – The outermost layer of the uterus and connects to the cervical area.

Signs & Symptoms

The patient will manifest the following: [1]

  • Excessive bleeding tendencies
  • Increase amount of blood during menstruation
  • Spotting in between menses or menorrhagia
  • Severe pain is noted
  • Sepsis or infections
  • Inflammation of the uterine lining
  • Fever
  • Hot flashes
  • Mood swings (due to hormonal imbalances)
  • Tenderness and drying of the vaginal area
  • Pallor (due to lack of iron or anemia)
  • Headache
  • Lower abdominal tenderness

Causes & Risk Factors

There are many possible risks and causes that can cause dysfunctional uterine bleeding, it can either be of the following: [5]

Dysfunctional Uterine Bleeding


Hormonal imbalances

The abnormal condition of uterus can affect the processes and phases of the release ovum inside the body. Affected ovas and egg cells will be having alterations in the production of hormones, thus imbalances are noted.

Obesity

The body will need to compensate for the number of weight and fats inside the body. Since the body has more room for more requirements, the hormones and distribution of nutrients can be altered.

Sex

Inadequate amout of sex can reduce the normal physiology of the uterus, can can also alter the production of hormones. Traumatic sex can cause trauma or damage if one of the woman is using IUDs as a contraception. Sexual transmitted diseases (STDs) and sexual transmitted infection (STIs) can also cause sepsis and damage to the lining of the uterus.

Miscarriage

Abortions and complications during childbirth and pregnancy can either give lacerations and trauma to the uterus. Increase miscarriages can cause sepsis and can cause damage to the linings of the uterus. It can either make it thin or not susceptible for implantation making it more susceptible to bleeding tendencies.

Fibroids

The uterus is made out of layers and muscles. Residues from menstruation phases or even after dilation and curettage (D & C) can cause damage to the muscles.

Stress

Stress and anxiety can affect the regulation of hormones in the body, thus having imbalances. It can either delay the production of hormones or can either increase the amount of hormones being released in the body.


Medications and drugs

Some drugs can also cause effects in other organs and can affect the hormones, too.

Diagnosis

The patient who suffers from dysfunctional uterine bleeding will need to undergo series of studies and examination such as: [6]

Laboratory Tests and Studies

  • Human chorionic gonadotropin (HCG) – to check any abnormalities on the uterine physiology and if the fetus is normal and cannot cause any alterations and complications during childbirth
  • Complete blood count (CBC) – the level of red blood cells in the blood can either be monitored and prevent losing too much amount.
  • Papanicolaou Test (Pap smear) – it is a test where a swab is being inserted inside the vagina and the specimen is acquired from the cervix to know if there are possible existence of polyps fibroids or tumors.
  • Endometrial sampling – a sample from the uterine muscle is being test for possible endometrial complications
  • Thyroid functions and prolactin – test of hormonal balance when it comes to the thyroid gland
  • Liver functions – SGOPT tests and exams
  • Coagulation studies/factors – to monitor the level of bleeding tendencies

Imaging Tests and Studies

  • Suboptimal pelvic examination
  • Pelvic ultrasonographic
  • Ultrasonography

Home Remedies

Chemotherapy has always been the first option when it comes to treating dysfunctional uterine bleeding but little that we know that there are also Natural Remedies to relieve the signs and symptoms of this particular disease. [4]

Iron Rich Food

The body is losing tons amount of Iron in the body because of abnormal bleeding. Eating iron rich food prevents the individual from suffering from anemia. Food rich in iron: Green leafy vegetables, eggs, iron-rich breads, red meats such as liver

Dietary Supplements

The amount of nutrients inside the body helps in the fast absorption of iron preventing the bleeding tendencies. Food that are rich in Vitamin C helps in the iron absorption and boosts immune system. Vitamin K on the other hand helps increasing coagulant agents in the body. Multivitamins are also encouraged to provide ease and increase recovery phase.


Herbal Remedy: Shepherd’s Purse, White Peony & Himalayan Styplon

  • Shepherd’s Purse – This herbal plant is an anti-hemorrhagic and astringent agent.
  • White Peony – It provides anti-spasmodic properties and activities.
  • Himalayan Styplon – Provides anti-inflammatory and demulcent actions

Chinese Remedies: Dong Quai

This chinese herb is best in toning uterine muscles, increasing blood circulation, regulating hormones and relieving pain.

Treatment

The patient will either undergo series of medications or surgical procedures (in severe cases): [5]

Medications and Drugs

NSAIDs – Nonsteroidal relieves pain and reduces the prostaglandin levels inside the uterus.
Tranexamic acid
Hormone therapy – To balance the hormonal requirements

  • Oral contraceptives
  • Progesterones

Other medications to treat DUB include:

  • Danazol: It decreases the amount of blood being released when the bleeding tendencies are noted.
  • Gonadotropin-releasing hormone (GnRH) agonists
  • Desmopressin

Surgical Procedures

  • Hysteroscopy – abdominal procedure that removes the uterus
  • Endometrial ablation – helps in preventing the loss of blood. It is a less invasive procedure that can be done through lasers, thermal and freezing.

Complications

If not addressed earlier, the patient may have the following complications: [1][2][3]


  • Hemorrhage or excessive amount of blood loss
  • Iron deficiency anemia (IDA)
  • Infertility (disruptive physiological function of the uterus)
  • Cancer or existence or tumors
  • Fibroids
  • Endometriosis

References & Sources:

  1. https://www.nlm.nih.gov/medlineplus/ency/article/000903.htm
  2. http://emedicine.medscape.com/article/257007-overview
  3. http://familydoctor.org/familydoctor/en/diseases-conditions/abnormal-uterine-bleeding/causes-risk-factors.html
  4. http://www.ladycarehealth.com/best-remedies-for-abnormal-uterine-bleeding/
  5. http://www.msdmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/dysfunctional-uterine-bleeding-(dub)
  6. http://emedicine.medscape.com/article/257007-overview#a3
  7. http://www.healthline.com/human-body-maps/uterus

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