Abnormal uterine bleeding natural history, complications and prognosis

Dysfunctional uterine bleeding is an irregularity of the menstrual cycle that may affect the duration, frequency and blood volume. Normal cycles last around 24-38 days and average 5-80 mL of blood loss during this time. Commonly associated complications include infertility, anemia and the possibility of underlying endometrial malignancy. Generally, the prognosis is favourable, but may depend on underlying causes and treatment options. The amount of blood loss varies according to hormonal and non-hormonal medications, as well as with surgical interventions.

Dysfunctional uterine bleeding is a commonly presenting symptom and is defined as any irregularity of the menstrual cycle. This can include the duration, frequency and blood volume. It most commonly presents in women that have undergone menarche but are still perimenopausal. This is usually between the ages of 15-49. Each cycle often lasts around 24-38 days, with an average of 5-80 mL of blood loss.^[1]

The effect on a woman’s lifestyle is one of the most important complications that patients face. Generally, the associated abdominal pain and unexpected bleeding can greatly affect one’s lifestyle.

• Infertility: this complication may be the time when many women actually get diagnosed with endometriosis
• Anemia: severe anemia may lead to death and is important to manage early on
• Endometrial malignancy: it is important to rule out endometrial malignancy, as this can be one of the underlying causes of DUB. An endometrial biopsy is helpful in diagnosing the condition

The prognosis is generally favourable, but it may be altered depending on the underlying cause as well as the treatment modality.^[1]

• Blood loss may be reduced up to 50% in patients taking a combination of non-hormonal medications with NSAIDs
• Up to 50%-90% of blood loss may be reduced in patients that use injectable progesterone and GnRH agonists, such as leuprolide
• Surgical interventions such as hysterectomy have shown better results in 1 year when compared to non-surgical treatment recipients
• The recurrence rate of polyps can be significantly reduced after combining a hysteroscopic polypectomy with the insertion of a levonorgestrel intrauterine device or endometrial ablation. It’s recurrence rate is around 2%-3%. ^[2]
• Patients with leiomyoma can have varying outcomes. While many remain asymptomatic, whereas some may continue to experience symptoms depending on fertility desires and the associated hormonal exposure.^[3]
• The prognosis for endometrial malignancy is relatively poor, especially for African women in which the prognosis is worse. Mortality rates have increased 100% in the last 20 years with an overall 5 year survival rate of 80%.^[4]

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