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Dysfunctional uterine bleeding (DUB)

Alternative names

Anovulatory bleeding; Bleeding - dysfunctional uterine; DUB


DUB is abnormal vaginal bleeding which occurs during menstrual cycles where ovulation did not take place (no egg was produced).

Causes, incidence, and risk factors

Anovulatory or dysfunctional uterine bleeding is a diagnosis of exclusion. This means that it is determined ONLY after other causes of abnormal uterine bleeding (such as systemic diseases, medications, early pregnancy disorders, eating disorders , gynecological infections, structural anomalies, or tumors) have been ruled out.

Anovulatory cycles are common for the first year after menarche (when menstrual periods first start) and later in life as women approach menopause (the cessation of menstrual periods). Approximately 20% of cases occur in adolescents and 40% in women over 40 years old. Obesity, excessive exercise, and emotional stress may be risk factors for DUB.


  • vaginal bleeding between periods
  • menstrual periods, abnormal
  • variable menstrual cycles
    • usually less than 28 days between menstrual periods
  • variable menstrual flow ranging from scanty to profuse
  • infertility
  • mood swings
  • hot flashes
  • vaginal tenderness
  • hirsutism -- excessive growth of body hair (in a male pattern)

Signs and tests

A pelvic examination will be performed.

Tests to evaluate women with DUB usually include:

  • CBC
  • serum HCG (to rule out pregnancy)
  • thyroid function tests specific hormonal regulation tests
    • Prolactin
    • Androgen levels
    • FSH - follicle stimulating hormone
    • LH - luteinizing hormone

Diagnostic procedures that may be performed include:

  • endometrial biopsy
  • D and C ( dilatation and curettage )
  • pelvic ultrasound
  • hysteroscopy


Young women within several years of menarche (the initial menstrual period) are not treated unless symptoms are exceptionally severe (such as heavy blood loss causing anemia ).

In women of childbearing age, treatment is aimed at achieving regular menstrual cycles with normal patterns. Oral contraceptives or progestogen therapy are frequently used for this purpose. If anemia is present, iron-supplementation is recommended. If pregnancy is desired, ovulation induction may be attempted with medication.

Women whose symptoms are severe and resistant to medical therapy may choose surgical treatments including endometrial ablation (a procedure that burns or removes the lining of the uterus) or hysterectomy.

In older women who may be approaching menopause , treatment may be elected to offset symptoms. Providers may choose from a variety of regimens including estrogen and progesterone supplementation and/or surgery (such as a hysterectomy ).

Expectations (prognosis)

Hormonal regulation is usually successful in alleviating symptoms. Induced ovulation, in women desiring pregnancy, is successful in approximately 80% of cases.


  • infertility resulting from lack of ovulation
  • severe anemia as a result of prolonged or heavy menstrual bleeding
  • prolonged buildup of the uterine lining without adequate menstrual bleeding may be a factor in the development of endometrial cancer

Calling your health care provider

Call your health care provider if you have unusual vaginal bleeding .

Update Date: 5/3/2002

Peter Chen, M.D., Department of Obstetrics & Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT