dysfunctional uterine bleeding

Last edited 09/2018 and last reviewed 12/2022

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 (2).

• it is a diagnosis of exclusion not an excuse for inadequate investigation.
• occurs more commonly in adolescents and perimenopausal women (3).

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 hemostasis (the ‘‘coagulopathies’’) (1).

Dysfunctional uterine bleeding is one of the menstrual terminologies which were recommended to be discarded by the FIGO (2).

Reference:

• (1) Fraser IS et al. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29(5):383-90. 
• (2) Munro MG et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13
• (3) Maness DL et al. How best to manage dysfunctional uterine bleeding. J Fam Pract. 2010;59(8):449-58