may include HOT FLASHES and mood swings.
Cramping and PAINare uncommon; these symp-
toms suggest a diagnosis other than DUB.
Because doctors consider DUB as a diagnosis of
exclusion—that is, a diagnosis the doctor reaches
after ruling out other possible causes for the
bleeding—the diagnostic path may include tests
for SEXUALLY TRANSMITTED DISEASES(STDS), BLOODtest
to check for PREGNANCY, and other blood tests to
measure estrogen, progesterone, and LUTEINIZING
HORMONE (LH). A key factor in establishing the
diagnosis of DUB is the absence of OVULATION,
which characterizes most DUB. The doctor may
also check other HORMONEblood levels such as thy-
roid hormones.
Treatment Options and Outlook
For most women the first course of treatment for
DUB is HORMONE THERAPYto restore the body’s nat-
ural estrogen–progesterone balance. For women
of childbearing age this might mean oral contra-
ceptives (birth control pills); for women near
MENOPAUSEthis might mean a hormone medication
such as conjugated estrogens with progesterone or
progesterone supplementation. The general thera-
peutic approach is to take hormone therapy until
the menstrual cycle returns to normal, typically
three to six months. Nonhormonal medications
that may relieve mild DUB include NONSTEROIDAL
ANTI-INFLAMMATORY DRUGS (NSAIDS). Because long-
term excessive bleeding commonly results in iron-
deficiency ANEMIA, the doctor may also prescribe
an iron supplement.
When the medication path is not sufficient, the
gynecologist may choose to perform endometrial
ablation, in which the gynecologist uses electro-
cautery, hot balloon, or surgical laser to burn
away the endometrial lining and the thin layer of
uterine tissue beneath it. This restores the inside
of the uterus to its base level so it can resume its
natural cycle of thickening and sloughing. Other
surgical options include DILATION AND CURETTAGE
(D&C), to gently scrap away the endometrial lin-
ing, and HYSTERECTOMY(removal of the uterus).
Though DUB is one of the most common reasons
for hysterectomy, hysterectomy is generally the
treatment of final choice for DUB, the treatment
gynecologists turn to when other treatment
options are not practical or are not successful.
Because hysterectomy is a major surgery with
numerous potential risks and permanently ends a
woman’s ability to become pregnant, it is an
option that requires careful consideration.Risk Factors and Preventive Measures
DUB occurs most often during the first and last
years of the menstrual cycle. Progesterone-only
methods of CONTRACEPTION may also precipitate
DUB. However, there are no known measures for
preventing DUB.
See also AMENORRHEA; DYSMENORRHEA; ECTOPIC
PREGNANCY; ENDOMETRIAL HYPERPLASIA; HYPERTHY-
ROIDISM; HYPOTHYROIDISM; MENSTRUATION; POLYCYSTIC
OVARY DISEASE(PCOD).dysmenorrhea Cramping, PAIN, abdominal bloat-
ing, and other discomforts associated with MEN-
STRUATION. Primary dysmenorrhea occurs without
underlying health conditions that cause such
symptoms and generally begins within two or
three years of MENARCHE(the onset of menstrua-
tion). Secondary dysmenorrhea occurs because of
underlying health conditions such as ENDOMETRIO-
SISor UTERINE FIBROIDSand typically begins later in
a woman’s life as these conditions develop. Con-
genital anomalies that affect the way menstrual
material flows from the body may also cause sec-
ondary dysmenorrhea that is present from menar-
che.
Doctors believe primary dysmenorrhea, which
is the more common form of dysmenorrhea,
results from the combination of hormonal actions
that reduce BLOODflow to the endometrium (lin-
ing of the UTERUSthat thickens in the first half of
the MENSTRUAL CYCLEto prepare the uterus for pos-
sible PREGNANCY) and initiate menstruation. As the
body’s balance of estrogen and progesterone shifts,
the uterus releases PROSTAGLANDINS and vaso-
pressin. These hormones cause the smooth MUSCLE
tissue of the uterus to contract, helping expel the
sloughed endometrial tissue that forms the men-
strual discharge. Prostaglandins also play a key
role in INFLAMMATIONand sensitize NERVEendings to
pain signals.Symptoms and Diagnostic Path
Dysmenorrhea presents a characteristic spectrum
of symptoms that occur in varying degrees amongdysmenorrhea 269