Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding (DUB) represents a particular type of Abnormal Uterine Bleeding (AUB), and is defined in the USA as an excessive, prolonged and irregular bleeding of the endometrium (frequency <21 days; duration >7 days; daily use of sanitary towels/tampons >1/1–2 h), that does not cause pain and does not have any organic cause, so much so that it is frequently considered to be a symptom of anovulatory bleeding. The initial assessment of an adolescent with DUB requires an accurate summary of the patient’s medical history, both familiar (in order to exclude haemorrhagic diatheses) and personal (previous surgery, trauma with ecchymosis, epistaxis or gingival bleeding, previous or current pathologies, use of drugs, accurate menstrual and sexual history), in addition to an objective medical examination (body mass index, stage of puberty, inspection of external genitalia with an eventual gynaecological examination for sexually active patients, abdominal examination). It can sometimes be useful, although not strictly necessary, to perform a pelvic ultrasound (abdominal/transrectal or transvaginal in a sexually active patient). Among the possible causes of DUB, there are blood clotting disorders, renal and hepatic impairment, diabetes, enteric, rheumatic, cardiac and neurological diseases, as well as thyroid disorders and hyperandrogenic alterations. In this chapter, we will discuss how to manage all the possible causes of DUB and, finally, summarise a complete overview of the possible treatments.