Dysfunctional Uterine Bleeding (DUB)

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Treatment

DUB is usually painless and is generally not a problem unless the woman is upset by the bleeding or is trying to conceive.

Hormone therapy typically involves oral contraceptives or progesterone therapy to regulate bleeding patterns. Treatment depends on the patient's age and the severity and timing of the bleeding.

Removal of the endometrium
If hormone therapy is not effective, the endometrium may be removed. Endometrial ablation is usually the method of choice, although some patients choose a hysterectomy or D & C.

Endometrial ablation
Endometrial ablation is the removal or destruction of the entire endometrium as well as a superficial layer of the underlying smooth muscle (myometrium). The procedure may be done using a laser (e.g., Nd:YAG laser), a thermal balloon, a hysteroscope, or a resectoscope.

Endometrial ablation is about 80% successful in reducing heavy periods and may eliminate menstruation altogether. Advantages of the procedure over hysterectomy include:

• it is safer, less invasive, and does not require a surgical incision
• it is less expensive
• it requires a shorter hospital stay
• women can resume normal activity within days, compared to 4 to 6 weeks

Thermal balloon
The thermal balloon procedure involves inserting a balloon into the uterine cavity, filling the balloon with fluid, and heating the fluid to destroy endometrial tissue.

Hysteroscopy
A hysteroscope is a thin, telescopic instrument that is inserted through the cervix into the uterus. The instrument has a camera and a light attached so the inside of the uterus can be viewed on a screen. When an endoscope is used to view the inside of the uterus, the procedure is called a diagnostic hysteroscopy. An operative hysteroscopy involves using a hysteroscope with surgical instruments attached to cut and remove tissue.

Resectoscopy
Resectoscopy involves using hysteroscope with a wire loop attached. The wire carries an electric current to cut and coagulate (solidify) the endometrial tissue. This procedure is also known as electrocoagulation.

Hysterectomy
Hysterectomy involves removing the uterus. Hysterectomies include subtotal hysterectomy (removal of the uterus, but not the cervix) and total hysterectomy (removal of the uterus and the cervix). The procedure can be performed through the vagina, through an incision in the abdomen, or laparoscopically (through a small incision in the abdomen). (More about hysterectomy)

D & C
D & C (dilation and curettage) 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. The long-term benefits of this procedure are unclear, and it is often performed in conjunction with hysteroscopy.

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