Patient's question:
What is dysfunctional uterine bleeding (DUB)? What conditions can cause DUB? How does DUB manifest?Doctor's answer:
Hello: Simply put, it is functional uterine bleeding!(1) Hemostasis
Currently, sex hormones are widely used for hemostasis. Through the action of sex hormones, the endometrium either grows and repairs or completely sheds and repairs to achieve hemostasis. For those with prolonged bleeding and a larger volume, the medication duration should be extended, generally requiring about 20 days for better effects. After stopping the medication, a small amount of withdrawal bleeding may occur within a few days. The patient should be informed of this before starting treatment, and subsequent methods such as estrogen-progestogen sequential therapy or combined medication can be used to regulate the menstrual cycle.
① Progestogen Hemostasis
Progestogen hemostasis is suitable for patients who already have a certain estrogen level in their body. At this point, the addition of progestogen can cause the endometrium to undergo secretory changes and completely shed, with the hemostatic effect occurring after withdrawal bleeding.
For those with short bleeding duration and minimal blood loss, intramuscular injection of progesterone at 10–20 mg per day for 3–5 days can be used. Alternatively, synthetic progestogens such as norethisterone (Fukang tablets) at 5–10 mg, megestrol acetate (Funing tablets) at 8–12 mg, or hydroxyprogesterone acetate (An Gong Huang Li Tong) at 10–16 mg can be taken orally for 5 days, with most cases stopping bleeding. After stopping the medication, the endometrium will shed within 3–5 days, resulting in a small amount of withdrawal bleeding, which should subside within 5–7 days.
For those with prolonged bleeding and a larger volume, the dosage should be increased and the medication duration extended. After the bleeding stops or is significantly reduced, continue medication for another 20 days. Oral administration of the following medications every 4–6 hours can be used: norethisterone at 5–7.5 mg, megestrol acetate at 8 mg, or hydroxyprogesterone acetate at 8–10 mg. After 4–6 doses, bleeding should significantly decrease, and hemostasis should occur within 48–72 hours. Blood should stop.