Dysfunctional Uterine Bleeding Follow-up
- Author: Amir Estephan, MD; Chief Editor: Pamela L Dyne, MD more...
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.
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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.
Pitkin J. Dysfunctional uterine bleeding. BMJ. May 26 2007;334(7603):1110-1. [Medline].
[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].
Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. Jun 2008;35(2):219-34, viii. [Medline].
[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].
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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