Dysfunctional uterine bleeding (DUB)
Cervical or endometrial polyps
Complications of hormone therapy
Serious disorders not to be missed
abortion or miscarriage
Endometrial hyperplasia Infection:
Pelvic congestion syndrome
Thyroid disorder (hypothyroidism), other endocrine
Is the patient trying to tell me something?
Consider exaggerated perception. Note association with anxiety and depression.
This should be detailed to determine the exact amount of bleeding (e.g. number of tampons and pads used and the degree of saturation). Follow a menstrual calendar over 3+ months. Take a drug history, especially smoking. Questions need to be directed to rule out pregnancy or pregnancy complications, trauma of genital tract, medical disorders (e.g. bleeding disorder, endocrine disorders, cancer of the genital tract and complications of the OCP).
General physical to rule out anaemia, evidence of a bleeding disorder and any stigmata of relevant medical or endocrine disease. Specific examinations include:
Careful selection is based on history, patient’s age, abnormal pelvic examination findings and suspicion of disease.
Hysteroscopy and D&C remain the gold standard for abnormal uterine bleeding.
Self-reporting of heaviness of bleeding is unreliable.
Acute ‘flooding’ most often occurs in pubertal girls prior to regular ovulation.
Ovulatory DUB is the most common single cause.
Peak incidence of ovulatory DUB is late 30s and 40s (35–45 years)
Peak for anovulatory DUB is 12–16 years and 45–55 years (i.e. puberty and menopause).