DYSFUNCTIONAL

UTERINE
BLEEDING
Gem Ashby MD
OB/GYN
Cancer Support Services is committed through a
spirit of volunteerism to the care of persons with
cancer and to bring comfort and support to the
affected relatives and dependents.
DYSFUNCTIONAL UTERINE BLEEDING
DUB
• Bleeding is heavier (passing large clots, soaking
through a sanitary pad or tampon every hour for 2 - 3
hours in a row)

• Bleeding or spotting that occurs between periods

• Time between menstrual periods changes with each

cycle

• Bleeding lasts for more days than normal

CAUSES OF DUB

• GYN cancers
• Anovulation
• Fibroids
• Polyps
• Systemic illness
 WORK UP FOR DUB

• History and exam

• Blood work/PAP smear
• Pelvic US
• Endometrial biopsy
• D&C, hysteroscopy
A: Cervical cancer
B: Endometrial(Uterine) cancer
C: Ovarian cancer

Which two cause DUB?

Which one has been linked to a viral

infection?

Which one is often diagnosed at a very late

stage?
CERVICAL CANCER
• Cervical cancer is the second most frequent cancer
in women in the world

• Third greatest cause of death from cancer in women

• 90% of cervical cancer is cause by HPV

• Of the estimated more than 270 000 deaths from

cervical cancer every year, more than 85% occur in
developing countries

Stats from WHO

 CERVICAL CANCER AND DUB
• Early cervical cancer is frequently asymptomatic

• The most common symptoms at presentation are:

• Abnormal bleeding
• Postcoital bleeding
• Vaginal discharge that may be watery, mucoid, or purulent
and malodorous
 TREATMENT OF CERVICAL

• Surgery to remove the cancer

• Radiation therapy, which uses high-dose X-rays or implants in

the vaginal cavity to kill cancer cells. It is used for certain
stages of cervical cancer. It is often used in combination with
surgery

• Chemotherapy, which uses medicines to kill cancer cells.

Chemotherapy may be used to treat advanced cervical cancer
ENDOMETRIAL CANCER
• Endometrial cancer is cancer of the lining of the uterus
 ENDOMETRIAL CANCER
• Endometrial cancer is rare in women under the age of 45

• The average chance of a woman being diagnosed is about one

in 37

• This cancer is slightly more common in white women, but

black women are more likely to die from it
RISK FACTORS FOR ENDOMETRIAL
CANCER
• Being obese. Fat cells make extra estrogen, but the body doesn't
make extra progesterone to balance it out

• Taking estrogen without taking a progestin

• Polycystic ovary syndrome. This can cause you to produce too

much estrogen and not enough progesterone

• Having type 2 diabetes

• Never having been pregnant

 ENDOMETRIAL CANCER AND
DUB
The most common symptoms include:

• DUB
• BLEEDING AFTER MENOPAUSE
• Pain during sex
• Pelvic pain
 TREATMENTS
• Surgery to remove the uterus (and cervix), ovaries, and
fallopian tubes (hysterectomy with bilateral salpingo-
oophorectomy)

• Surgery to remove lymph nodes

• Radiation therapy to kill cancer cells

• Progestin hormone therapy to block cancer growth

• Chemotherapy to kill cancer cells

 ANOVULATION

• Anovulation is the absents of ovulation

 ANOVULATION
• Polycystic ovarian syndrome
• Peri-menopause
• Thyroid dysfunction (either hyperthyroidism or
hypothyroidism)
• Extremely high levels of stress
 ANOVULATION
TREATMENT
Hormonal manipulation
OCP’s
Nuvaring
Depo Provera
Nexplanon
Mirena IUD
 FIBROIDS

• The most common pelvic tumor in women

• They are benign tumors arising from the

smooth muscle cells of the myometrium

• They can cause DUB, pain, voiding

dysfunction and may also have reproductive
effects (e.g, infertility, adverse pregnancy
outcomes)
 FIBROID TREATMENTS
• There's no single best approach to uterine fibroid
treatment; many treatment options exist
 FIBROID TREATMENTS

• Hormonal Manipulation (OCP, Nuvaring, Depo Provera,

Nexplanon, Mirena)

• Gonadotropin-releasing hormone (Gn-RH) agonists

• Medications called Gn-RH agonists (Lupron, Synarel,
others) treat fibroids by putting you into a temporary
postmenopausal state. With the decreased estrogen many
fibroids tend to shrink
 FIBROID TREATMENTS

• Uterine artery embolization

• Small particles (embolic agents) are injected into the arteries
supplying the uterus, cutting off blood flow to fibroids, causing
them to shrink and die

• SHOULD NOT BE DONE if the patient wants more children !!!

 FIBROID TREATMENTS
• Laparoscopic, robotic or open myomectomy
• In a myomectomy, your surgeon removes the fibroids,
leaving the uterus in place
 FIBROID TREATMENTS

• Endometrial ablation and resection of submucosal fibroids

• A specialized instrument inserted into your uterus; uses
heat, microwave energy, hot water or electric current to
destroy the lining of your uterus, either ending
menstruation or reducing your menstrual flow

• Ablations DO NOT remove the fibroids

• SHOULD NOT be done if the patient wants more children

ABLATION
FIBROID TREATMENTS
HYSTERECTOMY

• Abdominal
• Vaginal
• Laparoscopic
• Robotic
 FIBROID TREATMENTS
HYSTERECTOMY

• A hysterectomy is an operation to remove a woman's uterus

• Definitions:
• In a supracervial or subtotal hysterectomy, a surgeon
removes only the upper part of the uterus, keeping the
cervix in place

• A total hysterectomy removes the whole uterus and cervix

• The ovaries may also be removed -- a procedure called

oophorectomy -- or may be left in place
 POLYPS

• Overgrowth of cells in the lining of the uterus (endometrium)

• Are usually noncancerous (benign), although some can be

cancerous or can eventually turn into cancer (precancerous
polyps)
POLYPS
 TREATMENT FOR POLYPS
• Hormonal Manipulation (OCP, Nuvaring, Depo Provera,
Nexplanon, Mirena)

• Surgical removal: D&C hysteroscopy

• A camera is used to look inside the uterus and then the polyp is
scraped out
• An ablation can be done at the same time
 AUB

Causes Treatment
• GYN cancers Surgery
• Anovulation Hormonal Contraception
• Fibroids Lupron, Surgery/UAE
• Polyps Surgery

• Systemic illness Treatment based on

affected organ system
 THANK YOU

• Wright, Jason and Solange Wyatt. The Washington Manual Obstetrics

and Gynecology Survival Guide. Lippincott Williams and Wilkins,
2003. ISBN 0-7817-4363-X

• Bravender T, Emans SJ (June 1999). "Menstrual disorders.

Dysfunctional uterine bleeding". Pediatr. Clin. North Am. 46 (3):
545–53, viii. PMID 10384806.

• ^ "Dysfunctional Uterine Bleeding".

http://www.sh.lsuhsc.edu/fammed/OutpatientManual/DUB.htm.
Retrieved 2010-01-23.