 Dysfunctional Uterine Bleeding (DUB) is

defined as an abnormal or excessive uterine

bleeding in the absence of demonstrable
structural or organic pathology.
 During the reproductive life of a female

Which is
controlled by
Endometrium undergoes a cycle of
pituatry and
-proliferation
ovarian
-differentiation and
hormones in a
-shedding
prrecise and
in preparation for implantation of an embryo.
well regulated
manner

Any abnormality in it

DUB
 “It is a diagnosis of exclusion!!!”
Therefore it must be differentiated from other
organic causes of uterine bleeding such as:
Chronic Endometritis
Endometrial Polyp
Submucosal Leiomyomas
Endometrial Neoplasms
• Menorrhagia (hypermenorrhea):
prolonged (>7 days) and/or excessive (>80cc) uterine bleeding
occurring at REGULAR intervals.
• Metorrhagia:
uterine bleeding occurring at completely irregular but frequent
intervals, the amount being variable.
• Menometorrhagia:
uterine bleeding that is prolonged AND occurs at completely
irregular intervals.
• Polymenorrhea:
uterine bleeding at regular intervals of less than 21 days.
• Oligomenorrhea:
uterine bleeding at regular intervals from 35 days to 6 months.
• Amenorrhea:
absence of uterine bleeding for > 6 months.
• Postmenopausal bleeding:
uterine bleeding that occurs more than 1 year after the last
menses in a woman with ovarian failure.
• Intermenstrual bleeding:
bleeding of variable amounts occurring between regular
menstrual periods.
 Anovulatory cycle
 Inadequate luteal phase
 Endometrial changes induced by oral
contraceptives
 Menopausal and postmenopausal changes
 Account for about 90% cases of DUB
 Anovulatory cycles occur:

1-at extremes of reproductive age, such as menarche and perimenopause

women do not properly develop and release a mature egg

corpus luteum that produces progesterone, does not form

as a result, estrogen is produced continuously

causing an overgrowth of the uterus lining without the

counteractive effect of progestational phase that regurarly follows
ovulation

menstraution is delayed and when it occurs it is heavy and

(cont.)
prolonged
2-Less commonly:
a. endocrine disorders
thyroid disease
adrenal disease
pituatry tumors
b. primary lesion of ovary
functioning ovarian tumors
polycystic ovaries
c. generalized metabolic disturbances
obesity
malnutrition
3-Others:
a. chronic systemic disease
b. psychological stress exercise
c. idiopathic.
 10% of cases
 occur in women who are ovulating, but
 progesterone secretion is prolonged because
estrogen levels are low.
 causing irregular shedding of the uterine lining
and break-through bleeding.
 Occurs due to inadequate corpus luteum function

Low progesterone

 Manifests clinically as:

infertility with increased bleeding or amenorrhea
 Oral contraceptives contain

Synthetic ovarian hormones

Endometrial changes

Inactive glands amid stroma with large cells with

abundant cytoplasm

Discontinuation of therapy

Reverts the endometrium to normal

 Characterized by anovulatory cycles

Uninterrupted estrogen production

Endometrial changes:
Mild hyperplasia
And cystic dilation of glands

Ovarian atrophy/failure

Loss of stimulus

Cystic dilation remains

But ovarian stroma and glandular epithelium

atrophy

Cystic atrophy results!

Thank You For
Listening..