Dysfunctional uterine bleeding: diagnosis and treatment.

Dysfunctional uterine bleeding is not a specific diagnosis. It encompasses a spectrum of endocrinologic dysfunction which must be considered in reference to the presence or absence of ovulation. Specific causes must not be forgotten, particularly in those women who do not respond as expected to hormonal therapy. A variety of empiric therapies are used which have no benefit, such as thyroid hormone in the absence of proven hypothyroidism, corticosteroid in the absence of proven adrenal hypofunction, and megavitamin therapies in the absence of nutritional disorders. Curettage is valuable for diagnosis, not for therapy. Medical therapy offers a successful alternative to hysterectomy in many women, but the choice must be made on an individual basis. Medical and surgical management should not be viewed as competitive treatment regimens.