International Study & Research Centre on Homoeopathy

D U B

What is dysfunctional uterine bleeding?

Dysfunctional uterine bleeding (DUB) is irregular uterine bleeding that occurs in the absence of pathology or medical illness. It reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. The bleeding is unpredictable in many ways. It might be excessively heavy or light, prolonged, frequent, or random.

DUB is the most common cause of abnormal vaginal bleeding during a woman's reproductive years. Dysfunctional uterine bleeding can have a substantial financial and quality-of-life burden. It affects women's health both medically and socially.

Why does it occur?

The normal menstrual cycle is 28 days and starts on the first day of menses. During the first 14 days (follicular phase) of the menstrual cycle, the endometrium thickens under the influence of estrogen. In response to rising estrogen levels, the pituitary gland secretes follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which stimulate the release of an ovum at the midpoint of the cycle. The residual follicular capsule forms the corpus luteum.

After ovulation, the luteal phase begins and is characterized by production of progesterone from the corpus luteum. Progesterone matures the lining of the uterus and makes it more receptive to implantation. If implantation does not occur, in the absence of human chorionic gonadotrophin (HCG), the corpus luteum dies, accompanied by sharp drops in progesterone and estrogen levels. Hormone withdrawal causes vasoconstriction in the spiral arterioles of the endometrium. This leads to menses, which occurs approximately 14 days after ovulation when the ischemic endometrial lining becomes necrotic and sloughs.

Terms frequently used to describe abnormal uterine bleeding:

• Menorrhagia - Prolonged (>7 d) or excessive (>80 mL daily) uterine bleeding occurring at regular intervals
• Metrorrhagia - Uterine bleeding occurring at irregular and more frequent than normal intervals
• Menometrorrhagia - Prolonged or excessive uterine bleeding occurring at irregular and more frequent than normal intervals
• Inter-menstrual bleeding - Uterine bleeding of variable amounts occurring between regular menstrual periods
• Mid-cycle spotting - Spotting occurring just before ovulation, typically from declining estrogen levels
• Postmenopausal bleeding - Recurrence of bleeding in a menopausal woman at least 6 months to 1 year after cessation of cycles
• Amenorrhea - No uterine bleeding for 6 months or longer

Dysfunctional uterine bleeding is a diagnosis of exclusion. It is ovulatory or anovulatory bleeding, diagnosed after pregnancy, medications, iatrogenic causes, genital tract pathology, malignancy, and systemic disease have been ruled out by appropriate investigations. Approximately 90% of dysfunctional uterine bleeding cases result from anovulation, and 10% of cases occur with ovulatory cycles.

Anovulatory dysfunctional uterine bleeding results from a disturbance of the normal hypothalamic-pituitary-ovarian axis and is particularly common at the extremes of the reproductive years. When ovulation does not occur, no progesterone is produced to stabilize the endometrium; thus, proliferative endometrium persists. Bleeding episodes become irregular, and amenorrhea, metrorrhagia, and menometrorrhagia are common. Bleeding from anovulatory dysfunctional uterine bleeding is thought to result from changes in prostaglandin concentration, increased endometrial responsiveness to vasodilating prostaglandins, and changes in endometrial vascular structure.

In ovulatory dysfunctional uterine bleeding, bleeding occurs cyclically, and menorrhagia is thought to originate from defects in the control mechanisms of menstruation. It is thought that, in women with ovulatory dysfunctional uterine bleeding, there is an increased rate of blood loss resulting from vasodilatation of the vessels supplying the endometrium due to decreased vascular tone, and prostaglandins have been strongly implicated. Therefore, these women lose blood at rates about 3 times faster than women with normal menses.

Causes:

Every woman's menstrual cycle, or period, is different. On average, a woman's period occurs every 28 days. Most women have cycles between 24 and 34 days apart. It usually lasts 4 - 7 days. Young girls may get their periods anywhere from 21 to 45 days or more apart. Women in their 40s will often notice their period occurring less often. About every month, the levels of female hormones in a woman's body rise and fall.

Estrogen and progesterone are two very important hormones. These hormones play an important role in ovulation, the time when the ovaries release an egg. Dysfunctional uterine bleeding (DUB) most commonly occurs when the ovaries do not release an egg. Changes in hormone levels cause your period to be later or earlier and sometimes heavier than normal.

How is DUB recognized?

Symptoms of dysfunctional uterine bleeding (DUB) include:

• Vaginal bleeding that occurs more often than every 21 days or farther apart than 35 days (a normal teen menstrual cycle can last up to 45 days).
• Vaginal bleeding that lasts longer than 7 days (normally lasts 4 to 6 days).
• Blood loss of more than 80 ml (3 fl oz) each menstrual cycle [normally about 30 ml (1 fl oz)]. If you are passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered severe.

Most menstrual blood is lost in the first 3 days of the period. So excessive blood loss is possible without having exceptionally long periods.

EXAMS AND TESTS:

The health care provider will do a pelvic examination and may perform a Pap smear. Tests that may be done include:

• Complete blood count (CBC)
• Blood clotting profile
• Hormone tests
  • FSH
  • LH
  • Male hormone (androgen) levels
  • Prolactin
  • Progesterone
• Pregnancy test
• Thyroid function tests
• Pap smear and culture to look for infection

Your health care provider may recommend the following:

• Biopsy to look for infection, pre-cancer, or cancer, or to help decide on hormone treatment
• Hysteroscopy, performed in the doctor's office, to look into the uterus through the vagina.
• Transvaginal ultrasound to look for problems in the uterus or pelvis.

Complications :

• Infertility
• Severe anemia due to a lot of blood loss over time
• Increased risk for endometrial cancer

Conventional Treatments

Young women within a few years of their first period are often not treated unless symptoms are very severe, such as heavy blood loss causing anemia.

In other women, the goal of treatment is to control the menstrual cycle. Treatment may include:

• Birth control pills or progesterone only pills
• Intrauterine device (IUD) that releases the hormone progestin
• Painkillers taken just before the period starts

The health care provider may recommend iron supplements for women with anemia. However, when other measures fail, a surgery to remove the uterus is often advised.

How can Homeopathy help?

Homeopathy can help with a wide range of different hormonal problems, including DUB. With homeopathic treatment modalities, you see the difference between homeopathy and other approaches for treatment of Menstrual Problems. After the right remedy we expect to see everything getting better in the person's life.

Homeopathic remedies often bring relief, and also prevent further problems and complications in the process of effecting a long lasting cure. Menstrual problems that are chronic or severe are best addressed with the guidance of an experienced practitioner: a constitutional homeopathic remedy can help to bring balance to a person’s system on many levels.