Dysfunctional uterine bleeding is abnormal uterine bleeding that has no identifiable cause. It affects around 40 in 1000 women and is common in adolescents and women approaching menopause. It occurs due to disruptions in the normal hormonal cycle. Diagnosis involves examinations and tests to rule out other causes. Treatment may include medication, endometrial ablation, or hysterectomy in severe cases. Recent research is exploring the safety and effectiveness of thermal balloon endometrial ablation compared to other procedures.

1. Dysfunctional Uterine Bleeding
Chanak Trikhatri

2. Definition
Dysfunctional uterine bleeding is condition where
there is abnormal uterine bleeding without any
pathological manifestation in genital tract and does
not have a known organic cause. Irregular uterine
bleeding that occurs in the absence of recognizable
pelvic pathology, general medical disease, or
pregnancy. It reflects a disruption in the normal
cyclic pattern of ovulatory hormonal stimulation to
the endometrial lining.

4. Incidence
• Incidence: 40/1000
• It is usually common in adolescents and
women approaching menopause.
• 20% of cases occur in adolescent females, and
as many as 50% of women aged 40-50 years
experience DUB.

5. Classification of DUB
• Primary (DUB): There is no detectable disease in
the genital tract or else where in the body. It is
due to dysfunction in the menstrual or ovarian
cycle or uterine-ovarian-pituitary-hypothalamic
axis.
• Secondary (DUB): Disorder outside the genital
tract cause of uterine bleeding like
hypothyroidism, IUCD, hormones for
contraception or other use,

6. Etiology of Primary DUB
• Disturbance in eicosanoids fibrinolytic and lysosomal
enzyme system
• Ischemia and cell death
• Arachidonic acid
• PGF2 (Prostaglandin Alfa 2) vasoconstrictor and weak
platelet aggregator
• PGE2 (prostaglandin E 2) vasodilator and platelet ant
aggregator
• Thromboxane A2 (TXA2) potent vasoconstrictor and
platelet aggregator

7. Cont
• Anovulation (lack of ovulation)
• Pituitary Cancer
• Hypothalamic disorder
• In case of adolescents, DUB can happen
because they often do not ovulate as their
pituitary-ovarian axis matures.
• In case of Premenopausal women, it can
happen due to irregular ovulation because of
their decreasing ovarian hormone production.

8. Secondary DUB
• Hormones : low dose progesterone
underdevelopment of spiral arterioles
degeneration of large venules
• large doses of progesterone produce superficial
dilated venules with atrophy of endometrium
• IUCD: ulceration of endometrium and increased
vascularity
• Bleeding disorder, thrombocytopenia, factor
2,5,7,10 def
• Hypothyroidism: direct effect of thyroxin

9. Pathophysiology

11. Normal menstrual cycle
• Mean cycle length 28 days
• At age 40 20-27 days
• Duration 2-7 days
• Excessive 8days or longer
• MBL 40 ml

12. Clinical Feature
• Breast tenderness
• Nausea
• Urinary frequency
• Fatigue
• Excessive vaginal bleeding with severe pain or
cramping
• Excessive vaginal bleeding with the passage of
tissue
• Weight gain (Polycystic Ovarian Syndrome)

13. Cont
• Adolescent and teen age : anovulatory
immaturity of hypothalamus
• Adults: Ovulatory, rule out PID fibroids
complications of pregnancy
• Perimenopausal: Anovulatory ,rule out
fibroids ca cervix and endometrium

14. Cont
• Regular cyclical : ovulatory for short
duration ,rule out fibroids and PID
• Irregular or acyclic: anovulatory, rule out ca
cervix or endometrium
• Intermenstrual : ovulatory fall in estrogen
secretion following ovulation ,rule out cx
polyp sub mucous fibroid and cervical
carcinoma

15. Diagnosis
• History : Age, parity, fertility , occupation
• Amount duration and pattern of bleeding
associated gynecological problem dysmenorrheal
infertility or menopausal symptoms bleeding
disorders or thyroid dysfunction contraception
future pregnancies possible hysterectomy social
and personal background
• Abdominal and pelvic examination
• Physical Assessment

16. Investgation
• Hysteroscopy
• Human chorionic gonadotropin (HCG)
• Complete blood count (CBC)
• Papanicolaou test (Pap smear)
• Endometrial sampling
• Thyroid functions and prolactin
• Liver functions
• Coagulation studies/factors
• Other hormone assays, as indicated

17. Medical Management
• Non Pharmacological management: Hot/cold
application temporary relief for pain
• Bed rest
• Proper Nutrition
• Oral iron therapy
• Treatment of secondary disease
• Medical therapy : NSAID, antifibrinolytics,
Transxemic acid, Prostaglandin inhibitors,
Hormone therapy COC progesterone estrogens
androgens and danazol

18. Surgical Management
• Endometrial ablation
• Hysterectomy
• Radiotherapy
• Transcervical Resection
• Uterine curettage

19. Nursing Diagnosis
• Pain related to DUB
• Fear related to abnormal health status
• Risk for deficient fluid volume related to fever
• Fatigue due to blood loss
• Sexual dysfunction related to altered body function
associated with uterine bleeding

20. Nursing Management
• Encourage patient to comply the medication to reduce
discomfort and pain
• Explain importance of iron-rich foods to supplement iron.
• Explain methods of quantifying blood loss and reporting to
health-care provider.
• Assist in and teach patient pain-relieving techniques to
promote self-sufficiency in managing pain.
• Assess meaning of dysfunction for patient to explore self-
concept issues.
• Encourage patient to express her feelings to increase
understanding of individual coping style.

21. Recent Research and Advancement
Safety and Effectiveness of Cavaterm TM
Thermal Balloon Endometrial Ablation in
Women With Dysfunctional Uterine Bleeding
Compared to Transcervical Resection of the
Endometrium (TCRE)

22. Reference
Behera MA, Price TM. Dysfunctional uterine bleeding. Medscape Drugs & Diseases [serial online].
September 29, 2014;Accessed April 20, 2015. Available at
http://emedicine.medscape.com/article/257007-overview
Center watch, (2008), https://www.centerwatch.com/clinical-trials/listings/external-
studydetails.aspx?StudyID=NCT00549159&CatID=730
Nazar, N., (2013), Dysfunctional uterine bleeding. Health & medicine.
http://www.slideshare.net/naz777ni/dysfunctional-uterine-bleeding-26616203
Smeltzer, Suzanne C, and Bare Brenda G (2000). Medical Surgical Nursing (9th
). Philadelphia:
Lippincott William & Wilkins.2000.