Dysfunctional uterine bleeding

Question 1

Define dysfunctional uterine bleeding.

Answer 1

Abnormal uterine bleeding (AUB) is the term used to describe any symptomatic variation from normal menstruation in terms of regularity, frequency, volume, or duration. It also includes inter-menstrual bleeding. This differs from dysfunctional uterine bleeding (DUB), which is diagnosed by excluding pregnancy, iatrogenic causes, systemic conditions, and genital tract pathology.

Question 2

Explain the aetiology/risk factors of dysfunctional uterine bleeding.

Answer 2

PALM-COEIN

Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia

Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not otherwise classified

Question 3

What are the risk factors for dysfunctional uterine bleeding?

Answer 3

Women at the extremes of reproductive age
Polycystic ovary syndrome
Endocrine disorders
Other anovulatory disorders
Obesity

Question 4

Summarise the epidemiology of dysfunctional uterine bleeding.

Answer 4

Common, affects 14%-25% of women of reproductive age.

Question 5

Recognise the presenting symptoms of dysfunctional uterine bleeding.

Answer 5

Uterine bleeding

Question 6

Identify appropriate investigations for dysfunctional uterine bleeding and interpret the results.

Answer 6

Pregnancy test

FBC

Speculum + cytology

Coag panel

Question 7

Generate a management plan for dysfunctional uterine bleeding.

Answer 7

Can give Mirena coil or other contraception for heavy bleeding

Question 8

Identify the possible complications of dysfunctional uterine bleeding and its management. Summarise the prognosis for patients with dysfunctional uterine bleeding.

Answer 8

Iron deficiency anaemia

Endometrial hyperplasia and potential endometrial cancer

Once regular cycles are established, prognosis is good