Dysfunctional uterine bleeding history and symptoms

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Dysfunctional uterine bleeding Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Arooj Naz, Vishnu Vardhan Serla M.B.B.S. [2]

Overview

Assessment of anovulatory DUB should always start with a good medical history and physical examination. Laboratory assessment of hemoglobin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, T₄, thyroid stimulating hormone (TSH), pregnancy (by βhCG), and androgen profile should also happen. More extensive testing might include an ultrasound and endometrial sampling.

History

obtaining a detailed history in cases of dysfunctional uterine bleeding can aide in diagnosis of the underlying cause. Patients should be asked about:

1. Menstrual History
   • Last Menstrual Period
   • Age at menarche
   • Frequency, duration and regularity of bleeding as well as the volume
     • Frequency can be described as:
       • Normal (24 to 38 days)
       • Frequent (less than 24 days)
       • Infrequent (greater than 38 days)
     • Duration can be described as:
       • Normal (approximately 4 to 8 days)
       • Prolonged (greater than 8 days)
       • Shortened (less than 4 days)
     • Regularity can be described as:
       • Regular (with a variation of +/- 2 to 7 days)
       • Absent
       • Irregular (variation greater than 20 days)
     • Volume can be described as:
     • Normal (5 to 80 mL)
     • Heavy (greater than 80 mL)
     • Light (less than 5 mL of blood loss)
     • Patients should be asked about frequent changes of sanitary products and passage of clots
   • Presence of inter menstrual and postcoital bleeding
2. Sexual and Reproductive History
   • Previous pregnancies and route of delivery
   • Fertility desire and difficulty achieving it
   • Contraceptive use
   • History of STI's
   • Abnormal findings on previous Pap smear
3. Systematic Changes
   • Changes in weight (especially weight loss indicating an underlying malignancy)
   • Pain
   • Bowel and bladder changes
   • Symptoms of endocrine disorders
4. Drug history that must be inquired about:
   • anticoagulants
   • hormonal medications such as Tamoxifen or hormonal replacement therapy
   • hormonal contraceptives and intrauterine devices
   • dopamine agonists
5. Family History
   • Coagulopathies
   • Malignancies
6. Social History
   • Tobacco
   • Alcohol
   • Recreational drug use
   • Occupation
7. Surgical History