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DYSFUNCTIONAL UTERINE BLEEDING (DUB)

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  1. abnormal bleeding with no organic cause (diagnosis of exclusion)
  2. rule out: blood dyscrasias, thyroid dysfunction, malignancy, PCOD,endometriosis, PID, fibroids, unopposed estrogen, or polyps

Adolescent Age Group

 

  • DUB due to immature hypothalamus with irregular LH, FSH, estrogen and progesterone pattern  

Reproductive Age Group

 

  • DUB due to an increase or decrease in progesterone level

Perimenopausal Age Group

 

  • DUB due to increased ovarian resistance to LH and FSH 

 

Treatment

  1. if anemic, iron supplement
  2. mild DUB
    • BCP 1 tab tid for 10 days then 1 tab od for 4-6 months or
    • medroxyprogesterone acetate (Provera) 5-10 mg od on first 10-14 days of each month
  3. severe DUB
    • replace fluid losses
    • medroxyprogesterone acetate (Provera) 10 mg for next 7-10 days
    • acute, severe DUB: estrogen (Premarin) 25 mg IV q4-6h
  4. surgical
    • endometrial biopsy (for diagnosis)
    • D&C
    • endometrial ablation after pretreatment with danazol or GnRH agonists
    • hysterectomy

Mid-Cycle Spotting

 

  • may be physiologic due to mid-cycle fall of estradiol

Premenstrual Spotting

 

  • may be due to progesterone deficiency, endometriosis, adenomyosis and fibroids
DYSFUNCTIONAL UTERINE BLEEDING (DUB) DYSFUNCTIONAL UTERINE BLEEDING (DUB) Reviewed by Radiology Madeeasy on August 22, 2010 Rating: 5
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