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dysfunctional uterine bleeding (DUB)
Also see vaginal bleeding.
Etiology: hormonal irregularity
Clinical manifestations:
- any vaginal bleeding that occurs outside the normal menstrual cycle
Laboratory:
- pregnancy test
- Pap smear for cervical cancer
- serum TSH
- serum prolactin
- complete blood count (CBC): platelet count
- PT/PTT
- bleeding time
Special laboratory:
- endometrial biopsy
a) indicated if etiology unknown
b) endometrial hyperplasia, endometrial cancer
Radiology:
- pelvic ultrasound
a) etiology unknown
b) pelvic exam suggests a structural abnormality
Differential diagnosis:
1) bleeding disorder
- von Willebrand's disease
2) cervical polyp, cervical cancer
3) endometrial polyp, endometrial cancer
4) fibroids
Management:
1) combination of oral contraceptive with cyclic progestin or progesterone-releasing intrauterine device if anovulation
2) NSAIDs inhibit endometrial prostaglandings & decrease bleeding
2) surgery
a) bleeding is excessive
b) refractory to medical therapy
c) cervical polyp, cervical cancer
d) endometrial polyp, endometrial cancer
e) fibroids
General
vaginal bleeding; abnormal uterine bleeding; anovulatory bleeding
References
- Stedman's Medical Dictionary 27th ed, Williams &
Wilkins, Baltimore, 1999
- Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16.
American College of Physicians, Philadelphia 2006, 2009, 2012
- Casablanca Y.
Management of dysfunctional uterine bleeding.
Obstet Gynecol Clin North Am. 2008 Jun;35(2):219-34
PMID: 18486838