eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology
Dysfunctional Uterine Bleeding: Follow-up
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 |
| « Previous Page |
References
[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].
Bayer SR, DeCherney AH. Clinical manifestations and treatment of dysfunctional uterine bleeding. JAMA. Apr 14 1993;269(14):1823-8. [Medline].
Herbst A, Mishell D, Stenchever M. Abnormal uterine bleeding. In: Comprehensive Gynecology. 2nd ed. Mosby-Year Book; 1992:1083-1097.
Johnson CA. Making sense of dysfunctional uterine bleeding. Am Fam Physician. Jul 1991;44(1):149-57. [Medline].
Physician's Desk Reference. 50th ed. Medical Economics Books; 1996.
Pritchard JA, MacDonald PC, Gant NF. Complications of pregnancy. In: William's Obstetrics. 19th ed. McGraw-Hill Professional Publishing; 1993:819-820.
Rosenfeld JA. Treatment of menorrhagia due to dysfunctional uterine bleeding. Am Fam Physician. Jan 1996;53(1):165-72. [Medline].
Seamen C, Slovis C. Abnormal vaginal bleeding in the nonpregnant patient. Emerg Med Rep. 1996;17:219-226. [Medline].
Further Reading
Keywords
DUB, abnormal vaginal bleeding, menorrhagia, metrorrhagia, menometrorrhagia, ovulatory DUB, amenorrhea, oligomenorrhea, polycystic ovary disease, hyperandrogenism, hirsutism,obesity, enlarged ovaries, thrombocytopenia, hypothyroidism, hyperthyroidism, liver disease, hypertension, diabetes mellitus, adrenal disorders, vaginal carcinoma, cervical cancer, uterinecancer, ovarian cancer, functional ovarian cysts, cervicitis, endometritis, salpingitis, leiomyomas, vaginal infection, polyps, ectopic pregnancy, hydatidiform mole, blooddyscrasias, excessive weight gain, increased exerciseperformance
Follow-up: Dysfunctional Uterine Bleeding