Dysfunctional uterine bleeding

Dysfunctional Uterine Bleeding

Over the past decade many ill defined and confusing terms have been used to describe menstrual symptoms and causes of abnormal menstrual bleeding (1). The International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Working Group have strongly recommended that certain terminologies be abandoned because of their controversial, confusing, and poorly defined usage (1).

The term dysfunctional uterine bleeding (DUB) has been used previously to define a diagnosis where there was no systemic or locally definable structural cause for the abnormal bleeding (1).

• it is a diagnosis of exclusion not an excuse for inadequate investigation.
• occurs more commonly in adolescents and perimenopausal women (2).

However, the underlying mechanisms of DUB are being increasingly researched and defined and can no longer be regarded as a diagnosis of exclusion. Furthermore it is now recommended that the diagnoses encompassed within dysfunctional uterine bleeding can be classified under three definable headings:

• disorders of endometrial origin - disturbances of the molecular mechanisms responsible for regulation of the volume of blood lost at menstruation)
• disorders of the hypothalamic-pituitary-ovarian axis
• disorders of haemostasis (the ‘‘coagulopathies’’) (1)

Dysfunctional uterine bleeding is one of the menstrual terminologies which were recommended to be discarded by the FIGO (1).

References:

1. Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018 Dec;143(3):393-408
2. Maness DL et al. How best to manage dysfunctional uterine bleeding. J Fam Pract. 2010;59(8):449-58