26 July 2017

Abnormal Bleeding and Less Aggressive Approaches to Dysfunctional Uterine Bleeding

Many women experience dysfunctional uterine bleeding (DUB) which is abnormal bleeding and can be a symptom of several different factors from adolescent to the senior years.  Dysfunctional uterine bleeding is characterized by irregular bleeding from the uterus.  In most cases, this problem is related to changes in hormone levels. Dysfunctional uterine bleeding is often triggered when women do not ovulate. This causes changes in hormone levels and in many cases can lead to unexpected vaginal bleeding.

Risk factors associated with the development of DUB include the following:

    Adolescence is a time when DUB can present.   Anovulatory cycles occur in about 55% of female adolescents at the beginning of menstruation and typically continue until 2 years after onset of menstruation.  Anovulatory bleeding is common among adolescents due to the immaturity of the hypothalamic-pituitary-ovarian axis, the process of emitting hormones. 

    Perimenopause DUB in perimenopausal or pre-menopause women is related to declining ovarian function and hormonal imbalances. 

    Obesity can cause DUB resulting from altered estrogen-to-progesterone ratios and increased marginal conversion of androgens to estrogens. The estrogen-driven endometrial production eventually leads to endometrial overgrowth and abnormal bleeding patterns.  Weight loss in obese patients presumably restores regular menstrual cycles by decreasing the adipose tissue available for conversion of androgens to estrogen

    Cigarette smoking can add to the number of women with DUB.  Women who smoke cigarettes have a 47% risk of experiencing abnormal uterine bleeding due to the antiestrogenic effect or (no estrogenic activity) of cigarette smoke.  Data has found that on average, smokers were 47% more likely to have spotting or bleeding compared to nonsmokers.

Medicinal intervention may be needed for women who are feeling discomfort or weak. For any woman with DUB who experiences heavy flow, iron replacement is vital. In some instances, relief of fatigue is the patient’s only goal; in these cases, iron replacement therapy may be all that is needed. Of the other medical approaches, some are effective only for anovulatory DUB, some are useful only with ovulatory DUB, and still others may be effective for both. 

Cyclooxygenase inhibitors (nonsteroidal antiinflammatory agents [NSAIDs]) such as naproxen (1,000 mg per day in divided doses), and ibuprofen (600 to 1200 mg per day) have been shown to be effective in reducing the menstrual volume in women with ovulatory DUB by at least 20% to 40%.  Such an approach is extremely accessible to women and may be particularly helpful in patients with coexistent primary dysmenorrhea.

Progestins (synthetic progesterone) may be administered orally in continuous regimens, by injection, or via an intrauterine delivery system.  Progestins seem effective for anovulatory DUB, provided the endometrium is not otherwise exposed to progesterone.  Continuous local delivery of the progestin levonorgestrel via an intrauterine device (IUD) originally designed for reversible contraception has been evaluated in high quality trials and has been shown to reduce the volume of ovulatory DUB by over 80% at three months and 90% at one year.  As a result, this approach is especially useful for women with ovulatory DUB who wish to retain reproductive function.

Dilation and Currettage may be an option for those that do not respond effectively to medication. Dilation and Cutteridge is a procedure in which your doctor removes tissue from the inside of your uterus. Dilation and curettage is used to diagnose or treat various uterine conditions — such as heavy bleeding.

If you would like to receive further information about Dyfuntional Uterine Bleeding, please call Dr. Joanne Hinson at 801-364-4030.  Dr. Hinson has been serving women from all over Utah and neighboring states for over 25 years, and is here to serve your gynecological needs today.

Why Choose Dr. Hinson

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Passionate about her vision. Treating women as people, respecting their value as females, and as people.

25 years of OB/GYN experience, acting as the only doctor for most of her patients , treating other medical needs as well.

Emphasizes a partnership with the patient in her health care, strongly advocating her responsibility in her health.

Focused, nonjudgemental listener, effective communicator and educator.

Considers the patient's overall health, mental state, and social issues as possible factors contributing to her present problems.

Considers the female body as a whole, not just the pelvic region.

Committed to staying current with changing guidelines and treatment options.

Continuously updating skills with emphasis on minimally invasive and in-office procedures.

More About Dr. Hinson

For 25 years Dr. Joanne S. Hinson has provided compassionate healthcare to the women of Salt Lake City, Utah and beyond. From puberty to menopause, Dr Hinson provides the best personalized GYN services… caring for the whole woman.

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