Dysfunctional Uterine Bleeding

GENERAL INFORMATION:

What is it? Dysfunctional (dis-FUNGK-shun-al) uterine (U-ter-in) bleeding is abnormal uterine bleeding that is caused by a problem with your hormones. It may also be called "DUB". With DUB, you may have bleeding from your uterus (womb) at times other than your normal monthly period. Your monthly periods may last longer or shorter, and bleeding may be heavier or lighter than usual. DUB happens most often in women over 45 years old, in teenagers, and in very overweight women.

What is menstruation? Menstruation (men-stroo-AY-shun) is the time each month that a woman's uterus discharges blood. Menstruation usually lasts five to seven days and is also called a "monthly period" or "period". Beginning your period is a sign that you are becoming a woman and able to have a baby. The menstrual cycle is the time between one period and the next. This cycle is controlled by your hormones. Hormones are special chemicals made by your body that control how different parts of your body work. Estrogen (ES-troh-jen) and progesterone (proh-JES-te-rohn) are the two main female hormones. These hormones tell your uterus to have a monthly period.

What is the female reproductive system? A woman's reproductive system includes the uterus and cervix, fallopian tubes, ovaries, and vagina. When the reproductive system starts working, usually between ages 12 and 16, a woman begins having monthly periods. Monthly periods may also begin at an earlier or later age.

• The uterus is the organ where a baby grows during pregnancy. It is also called the womb. The cervix is the opening at the bottom of the uterus. Every month the uterus gets ready to support a baby by growing a thick, bloody lining. If you do not get pregnant, the lining is not needed. The lining that slides off the uterus is the blood that comes out during your monthly period.
  
  
• The ovaries are two organs on each side of the uterus. The ovaries make the hormones estrogen and progesterone. Your ovaries also make and release a female sex cell or egg each month. This is called ovulation (ov-u-LAY-shun). About 10 to 14 days later you will have your monthly period if your egg was not fertilized.
  
  
• You have two fallopian tubes . The egg travels from the ovary into a fallopian tube and then to the uterus. The unfertilized egg is then shed during the monthly period. This means that you are not pregnant.

What causes dysfunctional uterine bleeding? DUB may be caused by having too much or too little estrogen. You may have abnormal bleeding if an ovary does not release an egg during ovulation. Sometimes other conditions cause abnormal menstrual bleeding. These conditions include infection, problems during pregnancy, tumors, and some long-term health problems.

What are the signs and symptoms of dysfunctional uterine bleeding?

• Bleeding or spotting between periods.
  
  
• Bleeding that starts twelve months or longer after you have been through menopause. Menopause is the time when a woman stops having periods and cannot get pregnant anymore.
  
  
• The amount of bleeding during your period is heavier (more) or lighter (less) than usual.
  
  
• The number of days that you bleed during your regular period is longer than usual, or more than seven days. Also, if the number of days that you bleed is shorter than usual, or less than two days.
  
  
• The time between your monthly periods is shorter or longer than usual. A woman's monthly period is normally between 21 and 35 days apart.

How is dysfunctional uterine bleeding diagnosed?

• Your caregiver will do a pelvic exam to check your vagina, uterus, ovaries, and tubes. Your caregiver may do a hysteroscopy (his-ter-AH-skoh-pee). During this procedure, the caregiver inserts a small tube with a camera on the tip into your uterus. The caregiver will look at the endometrium (en-doh-MEE-tree-um). The endometrium is the inside lining of your uterus.
  
  
• Caregivers may do a biopsy. A biopsy is a procedure where a small piece of tissue from the endometrium is taken and sent to a lab for tests. Your caregiver may do an ultrasound of your pelvis. An ultrasound uses sound waves to show pictures of your uterus, ovaries, tubes, and vagina on a TV-like screen. You may also need a pap smear (sample of cervical tissue), cultures to rule out infection, and blood tests.

How is dysfunctional uterine bleeding treated?

• Medicines: Caregivers may give you the following medicines to treat your dysfunctional uterine bleeding:
  
  
  • Hormones: These medicines help to decrease your bleeding by making your monthly periods more regular. Sometimes this medicine may be given as an oral contraceptive (kon-trah-SEP-tiv), or birth control pills.
    
    
  • Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDS. Nonsteroidal (non-ster-OID-al) anti-inflammatory (an-te-in-FLAM-ah-tohr-ee) medicine decreases pain and uterine bleeding. This medicine can be bought with or without a caregiver's order. Always follow your caregiver's advice for taking this medicine. Do not take aspirin or medicines that contain aspirin. Aspirin may make the bleeding worse.
    
    
  • Iron Medicine: Bleeding a lot may cause you to lose iron. If this happens, you may feel tired all the time. Replacing the iron can make you feel better. Taking iron may make you constipated (KON-stih-pay-ted). Constipation is when you pass hard bowel movements (BMs) or have few BMs. Ask your caregiver for ways to avoid or treat constipation. Iron may also make your BMs turn dark or black.
  
  
• Surgery and procedures: Caregivers may decide to do surgery if medicines do not work or cannot be used. You may need an abdominal or vaginal hysterectomy (his-te-REK-toh-mee). A hysterectomy is surgery done to remove your uterus. You may need procedures such as endometrial (en-doh-MEE-tree-al) ablation (ab-LAY-shun), or dilation and curettage to control your bleeding.

Do's and Do nots:

• Do try to decrease the stress in your life. Stress may make your uterine bleeding worse. Learn new ways to relax such as deep breathing, music, meditation, exercise, and relaxing your muscles. Talk to someone about things that upset you.
  
  
• Do use heat to decrease your pain and cramps. Try a heating pad (turned on low), a hot water bottle, or sit in a warm water bath. Do this for 15 to 20 minutes out of every hour as long as you need it. Do not sleep on the heating pad or hot water bottle, because this may cause a bad burn.
  
  
• Do eat a variety of healthy foods including fruits, vegetables, breads, dairy products, meat and fish. Eating healthy foods may help you feel better and have more energy. You may need to eat a diet that is high in iron. Examples of high iron foods are leafy green vegetables, meat, liver, eggs, and whole-grain breads and cereals.
  
  
• Do keep a calendar of your menstrual cycles. Also keep track of how much blood you lose during your period. Count the number of tampons or pads you fill with blood each day.
  
  
• Do not try to lose weight until the abnormal bleeding has stopped. The amount of iron in your blood should be normal before losing weight. Talk to your caregiver before starting a weight loss program.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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