Dysfunctional uterine bleeding (AUB, formerly, abnormal uterine bleeding) is abnormal vaginal bleeding based in the uterus, found in the absence of demonstratable structural or organic pathology.

• Usually due to hormonal disturbances, as:
  • Reduced levels of progesterone causes decreased prostaglandin F2alpha, thus causing menorrhagia
  • Incresed levels of TPA (tissue plasminogen activator, i.e. a fibrinolytic enzyme), leads to more fibrinolysis

• Ovulatory (10%), where ovulation is occurring, but progesterone secretion is prolonged because estrogen is low. This causes irregular shedding of the uterine lining and break-through bleeding. It results in menorrhagia or metorrhagia. Mid-cycle bleeding indicates a transient estrogen decline, and a late-cycle bleed indicates progesterone deficiency
• Anovulatory (more common, occurring in 90%), common at the extremities of reproductive age (i.e. early puberty, and perimenopause). In these cases, women don't develop and release a mature egg (i.e. ovulate). Thus, the corpus luteum (i.e. mound of tissue that produces progesterone) doesn't form. Thus, estrogen is produced continuously, causing an overgrowth of the uterus lining. Period is delayed in such cases, and when it occurs menstruation can be very heavy and prolonged. Anovulatory AUB can cause a delay in the full maturation of the reproductive system in teenagers. It can be caused by psychological stress, weight (obesity, anorexia, or rapid changes), exercise, endocrinopathy, neopaslm, or drugs

• Dx of exclusion, ruling out organic pathology

• Hemoglobin
• LH
• FSH
• Prolactin
• T4, TSH
• bhCG → pregnancy
• Androgen profile
• U/S
• Endometrial sampling

• ABC's:
  • Arrest bleeding
  • Replace lost iron, to avoid anemia
• Hormonal contraception, specifically:
  • Progesterone, specifically, progestin through the late-cycle, for late-cycle bleeding
  • Estrogen through the mid-cycle, for mid-cycle bleeding
  • Combined high-dose estrogen and high-dose progestin
• Hysterectomy (i.e. surgical removal of the uterus)