eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Dysfunctional Uterine Bleeding: Follow-up

Author: Amir Estephan, MD,, Resident Physician, Department of Emergency Medicine, Kings County Hospital Center, Brooklyn
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: Feb 1, 2010

Follow-up

Further Inpatient Care

  • Patients with severe, acute abnormal uterine bleeding and hemodynamic instability will require urgent gynecologic consultation and hospitalization.

Further Outpatient Care

  • Most patients with abnormal uterine bleeding without hemodynamic compromise should be referred to a gynecologist for definitive management on an outpatient basis.

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, may be continued for several months under the supervision of the consulting gynecologist.

Complications

  • Anemia (may become severe)
  • Adenocarcinoma of the uterus (if prolonged, unopposed estrogen stimulation)

Prognosis

  • Hormonal contraceptives reduce blood loss by 40-70% when used long term.
  • Although medical therapy is generally used first, over half of women with menorrhagia undergo hysterectomy within 5 years of referral to a gynecologist.2

Patient Education

  • Instruct patients to continue prescribed medications, although bleeding may still be occurring during the early part of the cycle. Also, patients 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 a drug regimen. Express to patients that pharmacologic intervention will not be necessary once menstrual cycles become regular.
  • Discuss ways the patient can avoid prolonged emotional stress and maintain a normal body mass index.
  • 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. Dysfunctional uterine bleeding (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.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Nedra R Dodds, MD, to the development and writing of this article.



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. Frick KD, Clark MA, Steinwachs DM, et al. Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment. Womens Health Issues. Jan-Feb 2009;19(1):70-8. [Medline].

  2. Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG. Abnormal uterine bleeding. In: Williams Gynecology. McGraw-Hill; 2008:Chap 8.

  3. Tibbles CD. Selected gynecologic disorders. In: Marx JA, Hockberger RS, Walls RM, Adams JG. Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 1. 7th ed. Mosby (Elsevier); 2009:Chap 98.

  4. Pitkin J. Dysfunctional uterine bleeding. BMJ. May 26 2007;334(7603):1110-1. [Medline].

  5. [Guideline] James AH, Kouides PA, Abdul-Kadir R, 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. Jul 2009;201(1):12.e1-8. [Medline].

  6. Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. Jun 2008;35(2):219-34, viii. [Medline].

  7. [Best Evidence] Hickey M, Higham J, Fraser IS. Progestogens versus oestrogens and progestogens for irregular uterine bleeding associated with anovulation. Cochrane Database Syst Rev. Oct 17 2007;CD001895. [Medline].

  8. Dickersin K, Munro MG, Clark M, et al. Hysterectomy compared with endometrial ablation for dysfunctional uterine bleeding: a randomized controlled trial. Obstet Gynecol. Dec 2007;110(6):1279-89. [Medline].

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Further Reading

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Keywords

dysfunctional uterine bleeding, DUB, dysfunctional uterine bleeding symptoms, dysfunctional uterine bleeding causes, abnormal uterine bleeding, abnormal vaginal bleeding, menorrhagia, metrorrhagia, menometrorrhagia, amenorrhea, oligomenorrhea, vaginal carcinoma, cervical cancer, uterine cancer, ovarian cancer, functional ovarian cysts, cervicitis, endometritis, salpingitis, vaginal infection

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Contributor Information and Disclosures

Author

Amir Estephan, MD,, Resident Physician, Department of Emergency Medicine, Kings County Hospital Center, Brooklyn
Amir Estephan, MD, is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Emergency Medicine Residents Association
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: 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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