Dysfunctional uterine bleeding.

BACKGROUND: Dysfunctional uterine bleeding (DUB) is the major cause of heavy menstrual bleeding and impacts on women's health both medically and socially. OBJECTIVE: This article reviews the management of DUB. DISCUSSION: Dysfunctional uterine bleeding is defined as heavy menstrual uterine bleeding not due to any recognisable cause and is therefore a diagnosis of exclusion. Other conditions such as uterine fibroids, endometrial polyps and systemic diseases should be excluded by appropriate investigations. In the adolescent, investigations for a coagulopathy should be performed. The pathophysiology of DUB is largely unknown but occurs in both ovulatory and anovulatory menstrual cycles. Medical treatments include nonsteroidal anti-inflammatory drugs or antiprostaglandins, tranexamic acid, the progestogen releasing intrauterine device, combined oral contraceptive pills, and other hormonal therapies. As no medical treatment is superior to another, each woman should be individually assessed as to appropriate management. Surgical treatments include endometrial ablation and hysterectomy.