Abnormal Uterine Bleeding--Definitions

Dysfunctional Uterine Bleeding (DUB)

In dysfunctional uterine bleeding, abnormal bleeding is the result of failure to ovulate. The uterus is "stuck" in the first half (pre-ovulatory) of the cycle until the endometrium can't hold together and sloughs irregularly. It takes progesterone, which is secreted by the ovary in the second half of the cycle, to hold the endometrium together, but in DUB, there can't be enough progesterone--or progesterone at all.

1. Amenorrhea, the total lack of bleeding. The most common causes are pregnancy, menopause, contraception (such as the DepoProver shot), thyroid disorders, other drugs, and the newer thinking in purposefully eliminating periods with the use of non-cyclic birth control pills.

2. Oligomenorrhea, less than 8 cycles per year or coming less frequently than every 35 days. Causes of this include PCOS and inadequate corpus luteum.

3. The corpus luteum is the remanant of the follicle from which you ovulated from. It is the site on the ovary that makes progesterone, which is why lack of ovulation results in a lack of progesterone and inabiltiy to enter the second half of the menstrual cycle. With an inadequate corpus luteum, ovulation takes place, but it's a faulty ovulation, resulting in an inadequate amount of progesterone to assure a normal rhythm. Women with an inadequate corpus luteum experience cycles in which the period is delayed or drags on well beyond the time it should last. If a pregnancy were to ensue from such a faulty follicle, miscarriage is a risk. This is the rationale for progesterone therapy in threatened miscarriage.

4. Polymenorrhea, periods coming more frequently than every 21 days, but usually it's just a less accurate description of DUB, which is usually all over the calendar. I don't use this term in my clinical practice.

Menorrhagia

While DUB, oligomenorrhea, polymenorrhea, and amenorrhea describe abnormal alterations in the rhythm of the menstrual cycle, words like menorrhagia, metrorrhagia, and menometrorrhagia describe the "icky" factor--how much bleeding is too much and just a plain mess.

Menorrhagia, very heavy bleeding during a regular period or prolonged bleeding (> 8 days)
Metrorrhagia, irregular timing of the mentrual period--probably a better term than "polymenorrhea," above. "Period" is probably not a good word here, because metrorrhagia is more than likely DUB--and not "periodic" at all.
Menometrorrhagia, a combination of heavy or prolonged bleeding on an unpredictable schedule.
Dysmenorrhea, painful bleeding, no matter what the presentation.