Dysfunctional uterine bleeding risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S

Overview

Diseases presenting with dysfunctional uterine bleeding have a multitude of risk factors. Some that are commonly found in multiple conditions include those where estrogen exposure is uncontrolled and excessive. Some examples include early onset of menarche and late onset of menopause, obesity, anovulatory conditions such as PCOS, estrogen exclusive hormonal contraceptives and tamoxifen therapy for breast cancer. It is to be notes that smoking has actually resulted in a reduced risk of some disease, due to its anti-estrogenic causes. The efficacy of smoking in preventing DUB is questionable considering the multitude of other diseases such a behavioural activity results in. Although some conditions affected women of all ages, adenomyosis and malignancy were found to affect older woman.

Risk Factors

Dysfunctional uterine bleeding may be due to many various diseases and although many have similar risk factors, it may be helpful to understand them individually based on the underlying cause.

Risk factors of underlying conditions causing DUB

Condition causing DUB	Risk Factors
Polyps	Increased blood pressure Obesity Use of Tamoxifen for breast cancer therapy
Adenomyosis	Age: More common in the fourth and fifth decade of life Early menarche Late menopause Short menstrual cycles Obesity Use of oral contraceptives Multiparity and Pregnancy Previous ectopic pregnancy Tamoxifen use Prior uterine surgeries (cesarean section, myomectomy, dilation and curettage) Smoking has been shown to reduce the risk in some cases due to its estrogenic effects
Leiomyoma	Race (more prevalent in those of African descent) Early menarche Obesity Use of oral contraceptives; the use of progestin-only contraceptives were shown to reduce the risk of leiomyoma Multiparity has also been shown to reduce the risk
Malignancy and hyperplasia	Race (incidence is twice in African women compared to Caucasian women) Age: More common in the elderly Early menarche Late menopause Obesity Radiation exposure Infertility Long term use of estrogen contraceptives Smoking has been shown to reduce the risk in some cases due to its estrogenic effects
Coagulopathies	Most often familial causes (eg, Von Willebrand disease) Some conditions may be due to acquired coagulation defects (eg, use of anticoagulant medication, DIC)
Polycystic Ovarian Syndrome	Hyperinsulinemia secondary to insulin resistance; associated with type 2 diabetes mellitus Obesity Family history of PCOS among first-degree relatives Premature adrenarche Fetal androgen exposure Low birth weight
Endometrial disorders (Endometriosis)	Presence of cervical stenosis and other congenital outflow obstructions (leads to the retrograde efflux of the menstrual fluid into the fallopian tubes and peritoneal cavity) Caffeine or alcohol use First-degree family relative with endometriosis Nulliparity Menarche at less than 11 years of age Short menstrual cycle length Tall stature