Management of dysfunctional uterine bleeding based on endometrial thickness

Objective: To manage patients with dysfunctional uterine bleeding (DUB) according to endometrial thickness. Methods: A retrospective chart review of 49 patients who reported 8 or more days of bleeding was performed. They were then divided into three groups based on endometrial thickness (mm): less than 6, 6-11, and greater than 11. These three groups were treated with combined oral contraceptive pills (OCP), conjugated estrogen plus progesterone and megestrol respectively. Patients given megestrol also underwent endometrial biopsy before treatment. Patients recorded the degree of bleeding each day for one month after starting treatment. Results: Mean endometrial thickness in the combined OCPs, conjugated estrogen plus progesterone and megestrol groups were 4, 8 and 14 mm, respectively. Combined OCPs decreased bleeding from 46 to 8 days (P, 0.05, n = 8). Conjugated estrogen plus progesterone decreased the number of days of bleeding from a mean of 41 to 9 (P, 0.01, n = 16). Megestrol decreased bleeding from 54 to 3 days (P, 0.001, n = 25). 52% of patients given megestrol had endometrial hyperplasia. Conclusion: These results support the effectiveness of treating patients with DUB according to endometrial thickness.