The Management of Dysfunctional Uterine Bleeding

Abnormal uterine bleeding is one of the most common reasons for women to seek for care. Dysfunctional uterine bleeding describes the spectrum of abnormal bleeding patterns in the abscence of a medical illness or pelvic pathology. It is responsible for about half of the women with abnormal uterine bleeding in reproductive age (Ewenstein, 1996). It mainly presents as menorrhagia, hence, the term generally refers to heavy, prolonged and frequent bleeding of uterine origin which is not due to any recognisable cause (Farrell, 2004). It is a debiliating disorder both medically and socially. In addition, it is the commonest cause of iron deficinecy in the developed world and of chronic illness in the developing world (Royal College of Obstetrics and Gynaecology [RCOG], 1998). The number of menses experienced by women in their lifetimes increased as a result of the reduction of family size leading to shorter periods of childbearing and lactational amenorrhoea. As a consequence, abnormal menstruation is especially a problem of the twentieth century (Farquhar & Brown, 2009). The prevelance of abnormal uterine bleeding in reproductive age group ranges from 9% to 30% (Coulter et al.,1991). One in 20 women aged 30-49 in the UK consult their General Practitioner each year with menorrhagia, and it accounts for 12% of all gynaecology referrals (Vessey t al., 1992). Dysfunctional uterine bleeding is a diagnosis of exclusion. Menstrual history and physical examination are the mainstay of evaluation of cases. Laboratory tests, imaging studies and histologic examinations may be indicated, as well. Its management is complicated and variable according to the case. Although hysterectomy was the first option in the 1960s, medical treatment and less invasive surgical procedures have evolved recently. The aim of this chapter is to discuss the diagnostic steps and new treatment modalities of dysfunctional uterine bleeding based on a review of the literature.