Dysfunctional uterine bleeding is an irregular menstrual flow that interferes with women’s social, physical, and psychological quality of life (Pitkin, 2007). The bleeding is a departure from the norm in the menstrual cycle. LaCour, Long, and Perlman (2010) observe that structural gynaecological abnormalities, systemic disorders, pregnancy, inflammation, complications in pregnancy or use of certain drugs do not cause dysfunctional uterine bleeding.
National Clinical Guidelines
The National Institute for Health and Care Excellence (NICE) has set out the clinical guidelines for dysfunctional uterine bleeding. The guidelines compel the physicians to note vital signs such as body-mass-index and signs of endocrine abnormality. The clinicians should take into account the history of the patients and variability in menstrual cycles during diagnosis (NICE, 2007). Then, laboratory tests such as full blood count should be carried out to rule out other diagnoses.
Signs and Symptoms
The major symptoms of dysfunctional uterine bleeding include heavy bleeding during the menstrual cycle, spotting, and irregular time changes between periods. The affected patients tend to bleed beyond the usual seven days. Sometimes, menstruation occurs in less than twenty-one days from the previous cycle (Pitkin, 2007). Other symptoms of dysfunctional uterine bleeding consist of heavy bleeding that passes large clots, excessive growth of the body hair, and dryness or tenderness of the vagina. The patients should consult medical professionals if they experience the aforementioned symptoms.
Pregnancy is a major risk factor for dysfunctional uterine bleeding. This is especially in women aged below thirty years. Many women under thirty years experience abnormal menstrual flow in the initial months of conception. Pitkin (2007) argues that intrauterine devices cause hormonal imbalance that leads to irregular bleeding. Similarly, uterine cancer is a risk factor for dysfunctional uterine bleeding in women over forty years of age.
The differential diagnosis of dysfunctional uterine bleeding includes ultrasound, blood tests, and endometrial biopsy. Physicians recommend an ultrasound to diagnose abnormal vaginal bleeding. Essentially, ultrasound views the reproductive organs. The examination reveals whether fibroids, polyps, and any other abnormal growths are in the patient’s reproductive system (Casablanca, 2008). In addition, ultrasound is important in ruling out elements of internal bleeding. On the other hand, blood count measures the hormone levels, as well as a complete blood count. Pitkin (2007) asserts that the assessment of hormone level offers crucial information regarding the cause of bleeding. Similarly, a complete blood count gives the percentage of the red blood cells in the blood. Casablanca (2008) argues that endometrial biopsy tests uterine tissue, especially in cases of unusual thickening of the uterine lining.
The health care providers should recommend a transvaginal ultrasound, biopsy, and hysteroscopy to patients presenting signs of dysfunctional uterine bleeding. Biopsy examines the presence of infection and cancers. Casablanca (2008) contends that a biopsy assists health care providers to make decisions that relieve the physical and emotional burdens of the patients. Similarly, hysteroscopy is a significant procedure in managing dysfunctional uterine bleeding. Likewise, transvaginal ultrasound examines the problems that may be in the pelvis or the uterus.
Hormone therapy relieves the signs and symptoms of dysfunctional uterine bleeding. The therapy decreases the heavy menstrual flow and suppresses the abnormal thickening of the uterine lining. The prognosis is excellent after the young patients with dysfunctional uterine bleeding attain regular menstrual cycles (LaCour, Long, and Perlman, 2010). Similarly, the prognosis is superb in peri-menopausal patients, especially after the medical treatment.
The management of dysfunctional uterine bleeding involves the administration of drugs. Women with the condition should be referred to secondary care only when the primary care fails. The insertion of the Levonorgestrel-releasing intrauterine system improves the menstrual flow and quality of life (Middleton et al, 2010). Similarly, healthcare providers administer oral contraceptives that repress endometrial development. For instance, mefenamic acid inhibits prostaglandin synthesis and reduces blood loss through excessive bleeding. Michelle (2011) argues that contraceptives decrease the flow of blood during menstruation and re-establish regular bleeding patterns. Likewise, the administration of oestrogen induces normal endometrial growth.
Role of Advanced Registered Nurse Practitioners
The Advanced Registered Nurse Practitioners (ARNPs) assist the patients to manage the physical, as well as psychological issues associated with dysfunctional uterine bleeding. Michelle (2011) argues that the nurse practitioner should educate patients on the significance of seeking social and emotional support from counselling and support groups. Thus, the nurse practitioner needs to know the available local support and counselling groups that can offer help to patients with dysfunctional uterine bleeding.
In-depth patient education provides important information that patients need to know regarding dysfunctional uterine bleeding. The notable ways of educating patients include the use of medical publications. The distribution of the educational materials covering comprehensively critical issues on dysfunctional uterine bleeding will facilitate the dissemination of information to the target group of patients. The materials should give the health care providers and patients the current findings and management strategies for dysfunctional uterine bleeding.
Persistent bleeding requires gynaecologic follow-up to ensure the patients live quality lives. The healthcare providers should examine the patients regularly. The examination endeavours to evaluate whether the bleeding patterns of the patients have improved to satisfactory levels. In addition, the follow-up determines whether the patients are progressing well with medications. In effect, the patients should be followed to regulate the menstrual flow even in cases where they use hormonal therapy.
Casablanca, Y. (2008). Management of dysfunctional uterine bleeding. Obstetrics and Gynaecology Clinics of North America, 35 (2), 219-234.
LaCour, D., Long, D., & Perlman, S. (2010). Dysfunctional uterine bleeding in adolescent females associated with endocrine causes and medical conditions. Journal of Paediatrics Adolescence Gynaecology, 23 (2), 62-70.
Michelle, T. (2011). Treatment options for Dysfunctional uterine bleeding. Nurse Practitioner, 36 (8), 14-20.
Middleton, L., et al (2010). Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine. British Medical Journal, 341, c3929.
National Institute for Health and Care Excellence (2007). Heavy menstrual bleeding. Web.
Pitkin, J. (2007). Dysfunctional uterine bleeding. British Medical Journal, 334 (7603), 1110-1111.