Treatment Options for Dysfunctional Uterine Bleeding
This information was developed as part of an educational program made possible by an unrestricted educational grant from Ethicon Women's Health & Urology.
What is dysfunctional uterine bleeding?
Dysfunctional uterine bleeding (also called DUB) is a term for vaginal bleeding that either occurs between a woman’s normal menstrual periods or in abnormally large amounts during her period. The bleeding that happens between periods can be heavy or light. Very heavy bleeding during a period and/or bleeding that lasts more than 7 days is called menorrhagia (say: men-o-raj-e-ah). Women who have menorrhagia may, for example, bleed enough to soak through 1 or more tampons or sanitary pads every hour.
What causes DUB?
In most cases, women who have DUB do not ovulate (release an egg from their ovaries) during their menstrual cycle. This causes a hormone imbalance where the estrogen in your body makes your endometrium (the lining of your uterus) grow until it gets too thick. When your body gets rid of this lining during your period, the bleeding will be very heavy. A hormone imbalance may also cause your body not to know when to shed the endometrium. This can cause irregular bleeding between your periods.
DUB caused by a hormone imbalance is most common among teenagers who are just starting their periods or women who are going through menopause.
In some women, fibroids (benign tumors) or polyps (fleshy growths) of the uterus can also cause menorrhagia. In rare cases, DUB can be caused by endometrial cancer (cancer of the lining of uterus) or cancer of the uterus.
DUB caused by a hormone imbalance is most common among teenagers who are just starting their periods or women who are going through menopause.
In some women, fibroids (benign tumors) or polyps (fleshy growths) of the uterus can also cause menorrhagia. In rare cases, DUB can be caused by endometrial cancer (cancer of the lining of uterus) or cancer of the uterus.
What are the treatment options?
There are several treatment options for DUB, depending on the cause of your bleeding, your age and whether you want to get pregnant in the future. Your doctor will help you decide which treatment is right for you. Some of the DUB treatment options include the following:
Birth Control Pills
Birth control pills contain hormones that can stop the lining of your uterus from getting too thick. They can also help keep your menstrual cycle regular and reduce cramping.
Combination birth control pills are a common treatment for DUB. They contain the hormones estrogen and progestin, and are taken daily. Combination pills slightly increase the risk of heart disease, high blood pressure and blood clots. If you smoke or have a medical history of any of these conditions, your doctor may prescribe a progestin-only pill (also called the mini-pill).
Progestin-only pills can cause side effects including breast tenderness, bloating, headaches, mood swings and spotting (light vaginal bleeding between periods). You should tell your doctor if any side effects become a problem for you.
Both types of birth control pills can be taken for an extended period of time to control DUB. Both types help prevent pregnancy if you take them as directed, but they don’t protect you from sexually transmitted infections (STIs).
Intrauterine Device
If birth control pills don’t control your bleeding, your doctor may suggest an intrauterine device (IUD). An IUD is a small, plastic device that your doctor inserts into your uterus through your vagina to prevent pregnancy. One type of IUD, a hormone-releasing IUD, also significantly reduces DUB. Side effects of IUDs may include weight gain, breast tenderness and bloating.
Surgery
If you don’t want to get pregnant in the future, and if birth control pills or the IUD don’t work, 2 surgical options are available to treat DUB: hysterectomy and endometrial ablation.
Hysterectomy is surgery that removes the uterus. If you have a hysterectomy, you won’t have any more periods and you won’t be able to get pregnant. Hysterectomy is major surgery that requires general anesthesia (puts you in a sleep-like state) and a hospital stay. It may require a long recovery period. Talk to your doctor about the risks and benefits of hysterectomy.
Endometrial ablation is a surgical procedure that destroys the lining of the uterus. Unlike a hysterectomy, it does not remove the uterus. Endometrial ablation may stop all menstrual bleeding in some women. However, some women still have light menstrual bleeding or spotting after endometrial ablation. A few women have regular menstrual periods after the procedure. Women who have endometrial ablation still need to use some form of birth control even though, in most cases, pregnancy is not likely after the procedure.
Your doctor can do endometrial ablation in several different ways. Newer endometrial ablation techniques do not require general anesthesia or a hospital stay. The recovery time after this procedure is usually shorter than recovery time after a hysterectomy.
Birth Control Pills
Birth control pills contain hormones that can stop the lining of your uterus from getting too thick. They can also help keep your menstrual cycle regular and reduce cramping.
Combination birth control pills are a common treatment for DUB. They contain the hormones estrogen and progestin, and are taken daily. Combination pills slightly increase the risk of heart disease, high blood pressure and blood clots. If you smoke or have a medical history of any of these conditions, your doctor may prescribe a progestin-only pill (also called the mini-pill).
Progestin-only pills can cause side effects including breast tenderness, bloating, headaches, mood swings and spotting (light vaginal bleeding between periods). You should tell your doctor if any side effects become a problem for you.
Both types of birth control pills can be taken for an extended period of time to control DUB. Both types help prevent pregnancy if you take them as directed, but they don’t protect you from sexually transmitted infections (STIs).
Intrauterine Device
If birth control pills don’t control your bleeding, your doctor may suggest an intrauterine device (IUD). An IUD is a small, plastic device that your doctor inserts into your uterus through your vagina to prevent pregnancy. One type of IUD, a hormone-releasing IUD, also significantly reduces DUB. Side effects of IUDs may include weight gain, breast tenderness and bloating.
Surgery
If you don’t want to get pregnant in the future, and if birth control pills or the IUD don’t work, 2 surgical options are available to treat DUB: hysterectomy and endometrial ablation.
Hysterectomy is surgery that removes the uterus. If you have a hysterectomy, you won’t have any more periods and you won’t be able to get pregnant. Hysterectomy is major surgery that requires general anesthesia (puts you in a sleep-like state) and a hospital stay. It may require a long recovery period. Talk to your doctor about the risks and benefits of hysterectomy.
Endometrial ablation is a surgical procedure that destroys the lining of the uterus. Unlike a hysterectomy, it does not remove the uterus. Endometrial ablation may stop all menstrual bleeding in some women. However, some women still have light menstrual bleeding or spotting after endometrial ablation. A few women have regular menstrual periods after the procedure. Women who have endometrial ablation still need to use some form of birth control even though, in most cases, pregnancy is not likely after the procedure.
Your doctor can do endometrial ablation in several different ways. Newer endometrial ablation techniques do not require general anesthesia or a hospital stay. The recovery time after this procedure is usually shorter than recovery time after a hysterectomy.
Written by Barbara Apgar, MD, MS.
Source
This information was developed as part of an educational program made possible by an unrestricted educational grant from Ethicon Women's Health & Urology.
Created: 07/07