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Vaginal bleeding - hormonal

Definition

Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the vagina that is due to changes in hormone levels. It is bleeding that is NOT caused by:

Your doctor will rule out other possible causes of irregular bleeding. In most women, abnormal uterine bleeding is caused by a hormone imbalance.

DUB is more common in teenagers or in women who are approaching menopause.

DUB is unpredictable. The bleeding may be very heavy or light and can occur often or randomly.

Alternative Names

Anovulatory bleeding; Bleeding - dysfunctional uterine; DUB; Abnormal uterine bleeding-hormonal; Menorrhagia - dysfunctional; Polymenorrhea - dysfunctional; Metrorrhagia - dysfunctional

Causes

Every woman's menstrual cycle, or period, is different.

About every month, the levels of female hormones in a woman's body rise and fall. Estrogen and progesterone are two hormones that play an important role in ovulation. This is the time when the ovaries release an egg.

Dysfunctional uterine bleeding most commonly occurs when the ovaries do not release an egg. Changes in hormone levels cause your period to be later or earlier and sometimes heavier than normal.

Symptoms

Symptoms of dysfunctional uterine bleeding may include:

Other symptoms caused by changes in hormone levels may include:

A woman may feel tired or fatigued if she is loses too much blood over time. This is a symptom of anemia.

Exams and Tests

Your health care provider will do a pelvic exam and may do a Pap test. Other tests that may be done include:

Your provider may recommend the following:

Treatment

Young women up to age 18 may be treated with low-dose combination birth control pills.

In other women, treatment may include one or more of the following:

Women over age 40 and older may have the option to receive cyclic progestin or cyclic hormone therapy.

A health care provider may recommend iron supplements for women with anemia.

If you want to get pregnant, you may be given medication to stimulate ovulation.

Women with severe symptoms that do not get better with other treatments may consider the following procedures if they no longer want to have children:

Outlook (Prognosis)

Hormone therapy usually relieves symptoms. Treatment may not be needed if you do not develop anemia due to blood loss.

Possible Complications

Complications that may occur:

When to Contact a Medical Professional

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

References

ACOG Practice Bulletin No. 110: Noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-18. PMID: 20027071 Available at: www.ncbi.nlm.nih.gov/pubmed/20027071.

Committee on Practice Bulletins - Gynecology. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol. 2013 Jul;122(1):176-85. PMID: 23787936 Available at: www.ncbi.nlm.nih.gov/pubmed/23787936.

Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009;113:1104-1116. PMID: 19384127 Available at: www.ncbi.nlm.nih.gov/pubmed/19384127.

Lobo RA. Abnormal Uterine Bleeding : Ovulatory and Anovulatory Dysfunctional Uterine Bleeding: Management of Acute and Chronic Excessive Bleeding. In: Lentz GM, Lobo RA, Gershenson GM, Katz VL, eds., Comprehensive Gynecology, 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 37.

Middleton LJ, Champaneria R, Daniels JP, Bhattacharya S, Cooper KG, Hilken NH, et al. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010 Aug 16;341:c3929. PMID: 20713583 Available at: www.ncbi.nlm.nih.gov/pubmed/20713583.


Review Date: 12/28/2014
Reviewed By: Irina Burd, MD, PhD, Assistant Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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