Dysfunctional Uterine Bleeding (DUB) is defined as abnormal uterine bleeding without any clinically detectable organic, systemic, or iatrogenic cause (such as tumors, infections, or pregnancy complications).
Etiology (Causes)
1. Local Endometrial Causes
- Disturbance in endometrial blood circulation
- Alteration in endometrial prostaglandin balance
- Hormonal imbalances in the hypothalamo-pituitary-ovarian axis
2. Emotional Causes
- Stress and Anxiety
- Sexual Problems
3. Hormonal Imbalance
- Anovulatory Cycles
- Disturbed hormonal balance (Endocrinology dysfunction)
4. Abnormal Bleeding Due to Coagulopathies
- Polymenorrhagia (Frequent and heavy bleeding)
- Polymenorrhea (Menstrual cycle <21 days, remains constant in frequency)
- Hypomenorrhea (Scanty bleeding, short duration)
- Menorrhagia (Excessive bleeding at normal intervals)
- Metrorrhagia (Irregular and intermenstrual bleeding)
- Oligomenorrhea (Infrequent menstruation >35 days apart)
Pathophysiology
- Absence of progesterone leads to atrophic endometrial changes
- Irregular shedding of endometrium due to fluctuating estrogen levels
- Gradual estrogen decrease causes excessive bleeding
- Sudden progesterone withdrawal leads to increased bleeding
- Endometrial hyperplasia due to unopposed estrogen stimulation
Clinical Features
- Heavy menstrual bleeding interfering with daily life
- Fatigue and pallor due to anemia
- Irregular cycles with unpredictable bleeding patterns
- Intermenstrual spotting
Investigations
- Complete Blood Count (CBC) – To detect anemia
- Hormonal Assays – FSH, LH, Prolactin, Thyroid function tests
- Pelvic Ultrasound – Detects endometrial thickening, polyps, fibroids
- Endometrial Biopsy – To rule out endometrial hyperplasia or malignancy
- Hysteroscopy – Direct visualization of the endometrial cavity
Management & Treatment
1. Medical Management
- NSAIDs (Mefenamic Acid, Ibuprofen) – To reduce pain and blood loss
- Hormonal Therapy
- Combined Oral Contraceptive Pills (OCPs)
- Progesterone Therapy (Medroxyprogesterone Acetate)
- Gonadotropin-releasing hormone (GnRH) analogues
- Iron Supplements – For anemia correction
2. Surgical Management
- Dilatation and Curettage (D&C) – Diagnostic and therapeutic
- Endometrial Ablation – To destroy the endometrial lining
- Hysterectomy – In refractory cases not responding to medical treatment
Keynote Symptoms of Dysfunctional Uterine Bleeding (DUB)
- Irregular, excessive, or prolonged menstrual bleeding without any organic cause
- Heavy blood loss leading to anemia, pallor, and weakness
- Clots in menstrual flow with severe lower abdominal pain
- Intermenstrual spotting or unpredictable bleeding patterns
- Hormonal imbalances, especially estrogen dominance
1. Sabina
Indications:
- Excessive bright red uterine bleeding with large clots
- Profuse bleeding that worsens with the slightest movement
Keynote Symptoms:
- Severe pain radiating from the sacrum to the pubis.
- Bleeding aggravated by motion.
- Heavy, gushing flow with dark red clots.
- Worse from warmth, exertion, and motion.
- Strong bearing-down sensation in the uterus.
2. Phosphorus
Indications:
- Frequent, prolonged, and painless uterine bleeding
- Menstrual bleeding that is bright red and non-clotting
Keynote Symptoms:
- Bleeding tendency from nose, gums, and uterus.
- Extreme thirst for cold water.
- Weakness, dizziness, and anemia due to excessive blood loss.
- Sensitive, emotional nature with anxiety.
- Worse from lying on the left side.
3. Trillium Pendulum
Indications:
- Severe menorrhagia with faintness and extreme exhaustion
- Heavy menstrual bleeding due to fibroids or hormonal imbalance
Keynote Symptoms:
- Gushing bright red bleeding that stops and starts again.
- Weakness and sensation as if the hips and back will break.
- Worse from motion and exertion.
- Better by lying down and applying pressure.
- Fainting spells due to blood loss.
4. Ferrum Metallicum
Indications:
- Heavy menstrual bleeding leading to anemia and fatigue
- Weakness, paleness, and dizziness after excessive blood loss
Keynote Symptoms:
- Profuse, prolonged bleeding with extreme fatigue.
- Alternating redness and paleness of the face.
- Increased appetite despite weakness.
- Cold sensitivity and exhaustion.
- Worse from exertion or standing for long periods.
5. Millefolium
Indications:
- Passive, painless uterine bleeding with bright red blood
- Postmenopausal or post-traumatic uterine hemorrhage
Keynote Symptoms:
- Profuse, painless bleeding with bright red blood.
- Nosebleeds accompany menstrual bleeding.
- Worse from exertion or overexertion.
- No clot formation in menstrual flow.
- Better in the open air.
