eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Dysfunctional Uterine Bleeding: Follow-up

Author: Nedra R Dodds, MD, Medical Director, Opulence Aesthetic Medicine
Coauthor(s): Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Jun 9, 2009

Follow-up

Further Outpatient Care

  • All patients with abnormal vaginal bleeding who are discharged from the ED receive follow-up from their primary care provider or gynecologist.

Inpatient & Outpatient Medications

  • Patients with bleeding heavy enough to decrease hematocrit may be given ferrous sulfate tablets (325 mg tid).
  • Hormone regimens, including combination oral contraceptives and cyclic progestins, should be continued for several months under the supervision of the consulting gynecologist.

Complications

  • Anemia
  • Adenocarcinoma of the uterus (if prolonged, unopposed estrogen stimulation)
  • Significant adverse effects of individual oral contraceptive preparations

Prognosis

  • Most patients do well once a diagnosis is established and an appropriate hormone regimen is started by a gynecologist. Hormonal regulation has a 90% cure rate among those with anovulatory bleeding.
  • Prognosis varies with pathophysiologic process.
  • In young women, most anovulatory cycles can be treated confidently and successfully with physiologically sound therapeutic regimens without surgical intervention.

Patient Education

  • Instruct patients to continue prescribed medications, although bleeding may still be occurring during the early part of the cycle. If the patient is taking a combination of estrogens for the first 25 days and a progesterone during the last 10 days of their cycle, they should be told to expect menses after cessation of the regimen.
  • Young patients with small amounts of irregular bleeding need reassurance and observation only prior to instituting drug regimen. Express to patients that pharmacologic intervention will not be necessary once menstrual cycles become regular.
  • Discuss ways patient can avoid prolonged stress and emotional turmoil.
  • For excellent patient education resources, visit eMedicine's Women's Health Center. Also, see eMedicine's patient education articles Vaginal Bleeding and Mittelschmerz.

Miscellaneous

Medicolegal Pitfalls

  • All patients should be examined for pregnancy complications, threatened or incomplete abortion, and ectopic pregnancy. DUB is a diagnosis of exclusion and should be considered only after other causes of abnormal vaginal bleeding have been investigated.
  • Patients older than 35 years or those with other risk factors for endometrial cancer should have endometrial biopsy within 1 week of starting hormonal manipulation.
 


More on Dysfunctional Uterine Bleeding

Overview: Dysfunctional Uterine Bleeding
Differential Diagnoses & Workup: Dysfunctional Uterine Bleeding
Treatment & Medication: Dysfunctional Uterine Bleeding
Follow-up: Dysfunctional Uterine Bleeding
References
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References

  1. [Guideline] James AH, Kouides PA, Abdul-Kadir R, Edlund M, Federici AB, Halimeh S, et al. Von Willebrand disease and other bleeding disorders in women: Consensus on diagnosis and management from an international expert panel. Am J Obstet Gynecol. May 28 2009;[Medline]. [Full Text].

  2. Bayer SR, DeCherney AH. Clinical manifestations and treatment of dysfunctional uterine bleeding. JAMA. Apr 14 1993;269(14):1823-8. [Medline].

  3. Herbst A, Mishell D, Stenchever M. Abnormal uterine bleeding. In: Comprehensive Gynecology. 2nd ed. Mosby-Year Book; 1992:1083-1097.

  4. Johnson CA. Making sense of dysfunctional uterine bleeding. Am Fam Physician. Jul 1991;44(1):149-57. [Medline].

  5. Physician's Desk Reference. 50th ed. Medical Economics Books; 1996.

  6. Pritchard JA, MacDonald PC, Gant NF. Complications of pregnancy. In: William's Obstetrics. 19th ed. McGraw-Hill Professional Publishing; 1993:819-820.

  7. Rosenfeld JA. Treatment of menorrhagia due to dysfunctional uterine bleeding. Am Fam Physician. Jan 1996;53(1):165-72. [Medline].

  8. Seamen C, Slovis C. Abnormal vaginal bleeding in the nonpregnant patient. Emerg Med Rep. 1996;17:219-226. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Nedra R Dodds, MD, Medical Director, Opulence Aesthetic Medicine
Nedra R Dodds, MD is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Cosmetic Surgery, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Steven A Conrad, MD, PhD, Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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