Dysfunctional uterine bleeding (also known as DUB uterine bleeding) is referred to as abnormal bleeding from the genitalia which often originates from within the uterus.

Dub uterine bleeding is thought to be caused by hormonal imbalances of which progesterone is one of the main hormones implicated as it causes dips in the level of alpha prostaglandins and increase the level of fibrinolytic enzymes (a tissue plasminogen activator) which in turn triggers abnormal uterine bleeding.

Dysfunctional uterine bleeding
Dysfunctional uterine bleeding

Dysfunctional uterine bleeding is classified based on whether ovulation is occurring at the time of occurrence or not thus classification into ovulatory dysfunctional bleeding and anovulatory bleeding. Majority (about 90%) of DUB bleeding is anovulatory while ovulatory DUB takes about 10% of all cases as it is hormone-based and fragile uterine blood tissues. Studies has shown that if ovulatory bleeding takes place in the middle of your cycle it is more related to dips in estrogen level, while if it is at the end or close to the end of the cycle, there is possibility of progesterone decline.

Anovulatory related dysfunctional uterine bleeding on the other hand is common in those who are close to their menopause and early puberty. Anovulatory abnormal uterine bleeding is mostly due to premature or delay in the full development of the female reproductive system in girls having early puberty.

Women who had problems developing a matured egg in their monthly cycles are at greater risk of experiencing abnormal uterine bleeding due to abnormal formation of the corpus luteum which further impacts the production of progesterone negatively. Estrogen takes the center stage, uterine tissues overgrow their boundary thus causing severe abnormal bleeding.

Dysfunctional uterine bleeding is thought to be triggered by a lot of risk factors and etiologies which are listed thus:

1. Obesity: Obesity is a risk factor for DUB but not necessarily one of the causes.

2. Pelvic inflammatory diseases

3. Endometriosis: This is a situation where uterine tissues outgrow their boundary thus causing compression within the uterus. This may lead to dips in progesterone production, increase of uterine pressure. Endometrial debris gets expelled during women’s menstrual flow, this may be seen as abnormal vaginal bleeding.

4. Polycystic ovarian syndrome (PCOS): One of the symptoms of PCOS is abnormal vaginal bleeding, however this is an atypical factor in the evaluation of Dysfunctional bleeding from the uterus.

5. Low-lying placenta (placenta previa); This is also an atypical cause of DUB, however, this might have to be ruled out during medical evaluation of DUBs.

6. Ovarian cysts: Ovarian cysts is a pus-filled sac growing on the ovaries. This may

7. Urethritis: This is the inflammation of the urethra which may spread to uterus through the adjoining female reproductive orifice. This may cause extra uterine bleeding.

8. Ovarian and cervical cancer: Cancer spreading to the uterus may change the structure of the endometrium such that it becomes hyperplastic thus leading to the proliferation of the endometrium and bleeding from the uterus.

9. Thyroid gland issues: Hypothyroidism (insufficient production of thyroxine) is one of the risk factors for uterine bleeding.

Uterine bleeding may be idiopathic i.e. unknown causes. The best way to evaluate and diagnose DUB effectively is to rule out atypical causes, however, other examinations such as TSH (throid stimulating hormone levels, complete blood count (CBC), pregnancy test, prolactin levels, urine tests, hormonal assay profile, coagulation test, liver function test, FSH (follicle stimulating hormone) estradiol levels, cervical cancer screening etc. may be used to rule out and carry out effective diagnosis for proper treatment. Medical issues such endometriosis is not treatable, however, endometrial sampling may be used to rule out cancers of the reproductive system.

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