Dysfunctional Uterine Bleeding (DUB)

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Diagnosis

Medical history
The medical history involves gathering detailed information about the menstrual pattern. For most women, the interval between, the duration of, and the amount of menstrual flow stay relatively constant through the reproductive years. It may be helpful to keep a "menstrual diary" for several months preceding the office visit to monitor differences in the normal menstrual pattern.

Other helpful information includes a list of medications and nonprescription drugs, a sexual history (including pregnancy and contraception information), symptoms of infection and disease (including gynecologic disorders), recent surgery, and a history of injury to the area.

Weight loss, eating disorders, stress, and excessive exercise can cause anovulation, leading to DUB, so the medical history should involve these aspects of the woman's lifestyle.

Physical and pelvic examinations
The physical examination focuses on medical conditions that may cause DUB. The doctor examines the thyroid, breasts, liver, and skin for ecchymotic lesions (large, irregular, discolored areas of the skin) and hirsutism (excessive hair growth in unusual places). Obesity may also be a factor.

The pelvic examination involves evaluating the external and internal organs to identify the source and degree of bleeding, determine the size and shape of the uterus, and detect abnormalities.

Laboratory tests
Laboratory tests include a pregnancy test (for women who may be pregnant), a complete blood count, and Pap smear. Other tests may also be done, depending on the circumstances and the differential diagnosis.

Imaging tests
Some women require a pelvic or transvaginal ultrasound. Ultrasound produces an image of the endometrium that may make it easier to diagnose certain conditions, such as leiomyomas (benign, fibrous tumors that occur in 40% of women by age of 40 and may cause abnormal bleeding).

Diagnosis may involve a technique known as a sonohysterography, which involves injecting a saline solution into the uterine cavity while the transvaginal ultrasound is performed. Saline enhances the ultrasound pictures by acting as a contrast medium, making abnormal structures more visible, and opens up the uterus and separates the uterine walls, making the endometrium easier to see.

Women over age 35
In women older than 35, the endometrial cells are examined under a microscope to rule out endometrial hyperplasia and cancer. This is usually done using endometrial biopsy, an outpatient procedure that involves inserting a narrow tube into the uterus through the vagina and suctioning out a small amount of tissue from several areas of the uterine wall. The procedure takes only minutes.

Endometrial biopsy is the most widely used and most effective diagnostic test for detecting precancerous and cancerous cells on the endometrium. A procedure known as a D & C (dilation and curettage) may be used in certain circumstances and involves dilating the cervix and inserting an instrument called a curette into the uterus through the vagina. The curette is used to scrape the uterine wall and collect tissue. It is an outpatient procedure that takes about an hour and requires anesthesia.

The tissue is sent to a laboratory, examined under a microscope, and evaluated for cancerous or precancerous abnormalities. Please go to endometrial cancer for more information.

If the biopsy or D & C reveals no abnormality, the patient is treated for DUB, usually with hormones.

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