Dysfunctional uterine bleeding


    • Iirregular uterine bleeding that occurs in the absence of pathology or medical illness

    • Diagnosis of exclusion

Risk Factors

Differential diagnosis

    • Pregnancy



    • Disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining

    • Usually is associated with anovulatory menstrual cycles but also can present in patients with oligo-ovulation

    • Possibilities:

      • Estrogen breakthrough bleeding

      • Estrogen withdrawal bleeding

      • Oral contraceptives, progestin-only preparations, or postmenopausal steroid replacement therapy

      • Failure to mount an ovulatory luteinizing hormone (LH) surge in response to rising estradiol levels (adolescents)

Clinical features

    • Uunpredictable or episodic heavy or light bleeding despite a normal pelvic examination

      • Without moliminal symptoms

    • Nothing else!


    • Constant, noncycling estrogen levels stimulate endometrial growth

    • Proliferation without periodic shedding causes the endometrium to outgrow its blood supply

    • Tissue breaks down and sloughs from the uterus

    • Subsequent healing of the endometrium is irregular and dyssynchronous



a) conservative

b) medical

c) surgical


    • Single episodes of anovulatory bleeding generally carry a good prognosis

    • Increased risk for iron deficiency anemia

    • Flow can be copious enough to require hospitalization for fluid management, transfusion, or intravenous hormone therapy

    • Chronic unopposed estrogenic stimulation of the endometrial lining increases the risk of both endometrial hyperplasia and endometrial carcinoma