Dysfunctional Uterine Bleeding and its Management Strategy

Abstract

Dysfunctional uterine bleeding (DUB) is a diagnosis of exclusion. An adequate
examination of the abdomen and the pelvis and uterine curettage, hysteroscopy or at
least an endometrial biopsy is essential to exclude organic disease of the uterus. It
occurs most frequently at the extremes of menstrual life, but it can develop at any
intervening time.
The objectives of treatment are to control the acute bleeding, avert future episodes,
and prevent a serious long-term consequence of anovulation, endometrial cancer. The
mainstay of treatment has been medical therapy although surgical intervention is
required in some cases. If the bleeding is severe and / or recurrent or the medical
treatment fails, re-evaluation is needed.
Adolescent DUB is due to immaturity of the hypothalamus and pituitary and menstrual
cycles may be anovulatory. In teenage girls organic disease is rare and DUB usually
gets resolved spontaneously. That's why they are treated expectantly and curettage is
often delayed.
In the middle years of reproductive life (20-39yrs), benign organic disease is common,
and curettage is usually performed to exclude complications of pregnancy and other
disease. Conservative therapy is usually indicated, though hysterectomy may be
indicated if bleeding is severe or recurrent and patient has completed her family.
Perimenopausal DUB is due to the decreased number of ovarian follicles and their
increased resistance to gonadotrophin stimulation, there is a possibility of malignancy.
So, these women should always be investigated by curettage or hysteroscopy without
delay. Although conservative therapy may be tried as a temporizing measure,
hysterectomy is often indicated.

Key Words: Dysfunctional uterine bleeding, curettage, hysteroscopy, and progestogen.