If you’re having period problems – like vaginal bleeding in between your periods, extremely heavy periods, long periods that last longer than a week, and irregular periods with no known cause – you may have a condition called dysfunctional uterine bleeding.
This period problem is one of the most common causes of irregular periods and irregular vaginal bleeding.
What is Dysfunctional Uterine Bleeding?
Dysfunctional uterine bleeding is defined as abnormal vaginal bleeding that occurs in the absence of any major medical condition. To be diagnosed with this period problem, your irregular or heavy periods are not caused by miscarriage, cancer, fibroids, blood clothing disease, or any other illness that could cause abnormal vaginal bleeding. Once all of these are ruled out, your doctor will diagnose you with dysfunctional uterine bleeding.
Although this condition can affect any menstruating woman, you are more likely to experience dysfunctional uterine bleeding in your teenage years and in the years leading up to menopause.
Symptoms of Dysfunctional Uterine Bleeding
Dysfunctional uterine bleeding is one of the common causes of irregular periods. You may have this period problem if you have one or more of the following symptoms:
- You experience spotting or vaginal bleeding in between your periods.
- Periods occur frequently (less than 21 days apart), or they occur more than 35 days apart. (A healthy, regular menstrual cycle falls in between the 21 to 35 day range. For teenagers, your normal cycle can be between 21 and 45 days apart.)
- The length of time between periods varies from month to month.
- When you have your period, it lasts for more than 7 days.
- You have heavy periods. You go through a pad or tampon every hour for 2 to 3 hours in a row.
You should contact your gynecologist or doctor, if you notice any abnormal vaginal bleeding and you are worried. Although dysfunctional uterine bleeding is a nuisance, it’s often not a dangerous condition.
What Causes Dysfunctional Uterine Bleeding?
Like with other period problems, dysfunctional uterine bleeding is caused by an imbalance in your hormonal levels. In 90 percent of cases, it occurs in women who have anovulatory cycles (“not ovulating”). The other 10 percent of women with this condition do ovulate.
Anovulatory dysfunctional uterine bleeding occurs when there’s a disturbance in the hypothalamic-pituitary-ovarian axis – which refers to how the hypothalamus in the brain interacts with the pituitary gland and your ovaries to produce the hormones necessary for ovulation. This disturbance can cause low levels of progesterone – the hormone necessary to maintain and thicken the uterine lining in the second half of your menstrual cycle. Without enough progesterone to stabilize and thicken the uterine lining, the mucus membranes can be become fragile and slough off irregularly. As a result, you experience abnormal vaginal bleeding. You may have irregular periods, prolonged or heavy menstrual bleeding.
This type of dysfunctional uterine bleeding is common in the teenage years, right after the onset of your first period. This is because your hypothalamic-pituitary-ovarian axis is not mature yet, so your progesterone levels can be varied from month to month.
Anovulatory dysfunctional uterine bleeding also occurs during your perimenopause years, when your decreased estrogen levels are not high enough to stimulate the LH surge that occurs during ovulation. (Progesterone is produced by the corpus luteum, which is the follicle that the mature egg bursts out of. So when you don’t ovulate, the uterine lining does not thicken and you will have no period that month.)
Ovulatory dysfunctional uterine bleeding isn’t fully understood. No hormonal imbalance is found in the women who ovulate and still have dysfunctional uterine bleeding. They typically have normal levels of estrogen and progesterone. Experts theorize that changes in body chemicals, rather than a hormonal imbalance, can cause ovulating women to experience dysfunctional uterine bleeding. But again, this type of dysfunctional uterine bleeding isn’t well understood.
Treatment for Abnormal Vaginal Bleeding
Doctors often diagnose dysfunctional uterine bleeding after they perform a pelvic examination, Pap smear, complete blood count, thyroid function test, biopsy, and other tests to rule out any other medical conditions that may be causing your abnormal vaginal bleeding.
Women in their teen years are often not treated for irregular periods and dysfunctional uterine bleeding, because periods tend to become more regular as you age. If you’re in this age group and your blood loss is causing you to become anemic, you will be treated with iron supplements.
For other women, treatment for dysfunctional uterine bleeding typically involves finding a way to regulate your menstrual cycle. You may be asked to take hormonal birth control pills to control your menstrual cycle and to reduce the amount of bleeding and cramping you experience. Your doctor may recommend an intrauterine device (IUD), which release progesterone to reduce bleeding. (The IUD will also prevent pregnancy.) Sometimes, surgery (like a hysterectomy and endometrial ablation) is recommended when other treatments fail.
To help with heavy bleeding and menstrual pain, your doctor may recommend that you take regular doses of ibuprofen (Advil) or another nonsteroidal anti-inflammatory drug (NSAID).
Hormonal therapy typically resolves the symptoms of dysfunctional uterine bleeding. In some situations, your doctor may recommend that you try a “wait and see” approach. It’s highly recommended that women with this period problem talk to their doctor and healthcare provider about the best treatment in their individual case.