Dysfunctional uterine bleeding is the most common abnormality of a woman’s menstrual cycle. Ordinarily the first day of the period would be 28 days (26 to 30 range) apart. In more than 70% of cases there has not been an ovulation in the ovary (no egg release) in that cycle that causes a dysfunctional bleeding. More than 50 % happen in women that are older than 45 years, 20% in adolescents.
As there is a persistent ovarian follicle where estrogen is produced when ovulation does not occur, the lining of the uterus grows more than usual. This leads to a heavy menstrual period that might be late or irregular (on and off). Women with such conditions as polycystic ovary disease (PCOD) or endometriosis often have dysfunctional uterine bleeding.
Treatment might be quite different depending on the age of the woman, the underlying disease process and the severity of bleeding. If the bleeding is mild to moderate the physician might decide to use the birth control pill for the bleeding. The effect often sets in within 12 to 24 hours. This will also regulate the periods.
Should this fail to stop the bleeding, a D&C (dilatation of the cervical canal and curretage of the uterus) is usually done. This method has the advantage that it stops the bleeding reliably and it provides the physician with lining material from the uterine cavity, which can be sent to the pathologist for analysis. The downside is the risks of the anesthetic, of uterine perforation and uterine infection as there is an internal wound in the uterus for a few days. If there is an anovulatory period (meaning no egg was released) and the woman would like to get pregnant, then clomiphene citrate (brand name: Clomid) can be given or else human chorionic gonadotropin. Usually these specialized treatments are given and supervised by a gynecologist/obstetrician. If obesity is present a dietary plan to reduce sugar and starch consumption will help to shed some weight and will normalize blood insulin levels. In cases of polycystic ovaries, where often there is also syndrome of insulin resistance present at the same time, treatment of insulin resistance will help balance the female hormones and thyroid dysfunction. Every case needs to be investigated by the specialist on its own merit.
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