Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Dysfunctional Uterine Bleeding


Related Terms

  • Abnormal Vaginal Bleeding
  • Amenorrhea
  • DUB
  • Dysfunctional Uterine Hemorrhage
  • Excessive Menstruation
  • Intermenstrual Bleeding or Spotting
  • Menometrorrhagia
  • Menorrhagia
  • Metrorrhagia
  • Oligomenorrhea
  • Polymenorrhea
  • Retained Menstruation
  • Suppression of Menstruation

Differential Diagnosis

Specialists

  • Emergency Medicine Physician
  • Endocrinologist
  • Gynecologist

Comorbid Conditions

Factors Influencing Duration

Length of disability is influenced by the severity of symptoms, method of treatment, and individual's response to treatment.

Medical Codes

ICD-9-CM:
626.8 - Uterine Bleeding, Dysfunctional

Overview

Dysfunctional uterine bleeding is a nonspecific term for abnormal uterine bleeding. Dysfunctional uterine bleeding should only be diagnosed after ruling out pregnancy or structural causes, such as fibroid tumors or polyps, endometrial cancer, and other endometrial lesions.

During a menstrual cycle, the female hormones estrogen and progesterone are normally produced in balance with each other through the interaction of the hypothalamus, pituitary gland, and the ovaries. Up to 90% of cases of dysfunctional uterine bleeding result from menstrual cycles in which ovulation does not occur (anovulation) (Dodds). The remainder of cases arise from problems associated with ovulation, such as a dysfunction of the corpus luteum or prolonged progesterone secretion.

With dysfunctional uterine bleeding, bleeding patterns become unpredictable in the duration, amount, or interval of menstruation. Normally, the menstrual cycle occurs every 21 to 35 days, with blood loss (menstruation) lasting 2 to 7 days (Dodds). The average amount of blood loss is between 35 and 150 ml, which is equivalent to up to 8 soaked pads containing 5 to 15 ml of fluid per day, with no more than 2 heavy days per cycle (Dodds).

Menorrhagia occurs when the menstrual period is regular but prolonged (>7 days) or involves excessive blood flow, typically more than 80 ml per day. Metrorrhagia describes uterine bleeding that occurs more frequently than normal and at irregular intervals. Menometrorrhagia involves uterine bleeding that is prolonged, excessive, and more frequent than normal. Polymenorrhea` describes a shortened menstrual cycle of less than 21 days. Oligomenorrhea is a menstrual cycle of 35 days to 6 months. Intermenstrual bleeding (spotting) describes menstrual flow that occurs between normal menstrual periods. Amenorrhea can be primary or secondary: primary amenorrhea is the absence of the first menstrual period (menarche) by 16 years of age; secondary amenorrhea is the lack of menstrual flow for 3 months or longer in a woman with previously normal menses.

Incidence and Prevalence: The incidence of dysfunctional uterine bleeding is 10% of women in their reproductive years (Lobo).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Dysfunctional uterine bleeding occurs most commonly at the beginning and end of the reproductive years: 20% of cases occur in adolescent girls, and women between the ages of 40 and 50 account for more than 50% of cases (Behera).

Risk factors include obesity, polycystic ovary syndrome, endometriosis, and prolonged estrogen or progesterone use. Stress, crash diets, irregular sleep patterns, overwork, vigorous exercise, and drug or alcohol abuse can also disrupt normal hormone balance and cause dysfunctional uterine bleeding.

Source: Medical Disability Advisor



Diagnosis

History: Women complain of bleeding occurring outside the normal menstrual pattern or of the absence of menses. Bleeding may occur between menstrual periods, periods may be excessively long and / or heavy, and pain may or may not be reported with the bleeding.

Pertinent history includes duration of bleeding, amount of flow, presence of clots, pain, relationship to last menstrual period, history of recent illnesses, and all medications taken in the previous several months.

Physical exam: A thorough pelvic exam and a general physical exam are done. Reproductive organs will be examined for problems such as areas of bleeding, ectopic pregnancy, or tumors.

Tests: Diagnostic tests may include cervical smear (Pap smear); complete blood count (CBC); erythrocyte sedimentation rate; blood glucose; and coagulation, thyroid function, and pregnancy tests. A pelvic ultrasound, hysterosalpingography, CT, or MRI may be done to locate or rule out tumors. A biopsy, curettage, or aspiration of the uterine lining may be required for further tissue examination.

Source: Medical Disability Advisor



Treatment

Treatment depends on the exact cause of the bleeding and on the woman's age, condition of the uterine lining, and plans regarding pregnancy. Individuals are separated into two groups: those with acute bleeding episodes and those with chronic, repetitive, bleeding problems. An acute bleeding episode is best controlled with high-dose estrogen. Treatment of chronic, repetitive, bleeding problems may consist of hormonal therapy with estrogen and progestin or cyclical progestin alone (Chen). Oral contraceptives may help regulate the menstrual cycle. Progesterone or progestin may be prescribed on a cyclic basis to induce normal menses in anovulatory patients. An intrauterine device (IUD) that releases a progestin has provided a satisfactory treatment for some individuals. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be required and are helpful in reducing the amount of heavy blood flow (Chen) by lowering prostaglandin levels. Iron may be needed if the woman is anemic.

Lifestyle changes to correct underlying hormone imbalances due to excessive stress, irregular sleep patterns, overwork, and drug or alcohol abuse may be warranted.

The individual who presents with dysfunctional uterine bleeding and a history of menstrual cycle irregularity warrants an endometrial biopsy, regardless of age. Surgery may be needed if hormone therapy fails. Surgical options include dilation and curettage (D&C), laser or electrocauterization, endometrial ablation, or hysterectomy. In order to rebuild the woman's hemoglobin level, medication may be necessary to stop the bleeding for up to 3 months prior to surgery.

Source: Medical Disability Advisor



Prognosis

With appropriate treatment, hormonal balance can usually be achieved. Individuals using a transvaginal contraceptive ring for management of dysfunctional uterine bleeding may experience 89% to 95% improvement in breakthrough bleeding or spotting (Sulak). If pregnancy is desired, infertility may need to be addressed with fertility drugs. If pregnancy is not desired and more conservative measures are ineffective, endometrial ablation may reduce excessive uterine bleeding in up to 88% of individuals (Kdous). Endometrial ablation may be effective in the short term, but by 48 months after ablation, 29% of individuals may require another procedure (Dickersin). Hysterectomy is effective in resolving the problem that leads to seek care in 94.4% of individuals (Dickersin).

Source: Medical Disability Advisor



Complications

Prolonged and heavy uterine bleeding can cause iron deficiency anemia in 30% of individuals (Behera). Continued hormonal imbalance may block ovulation, resulting in infertility. In 1% to 2% of individuals with a chronic imbalance of estrogen and progesterone, there is an increased risk of endometrial cancer (Behera).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions, such as reduced workload or time off, may be needed if surgery is required or anemia is pronounced. Frequent breaks may be needed for the individual to visit the restroom during bouts of heavy bleeding.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • How old is individual?
  • Does individual have any risk factors such as obesity, polycystic ovary syndrome, endometriosis, and prolonged estrogen or progesterone use?
  • Does individual have stress, use crash diets, have irregular sleep patterns, work too much, engage in vigorous exercise, and / or use drugs or alcohol?
  • Has bleeding outside the normal menstrual cycle occurred? What is the duration of bleeding, amount of flow, and relationship to last menstrual period? Does individual feel pain or pass numerous blood clots?
  • Has individual had any recent illnesses?
  • What medications were taken in the previous several months?
  • Was a pelvic exam done? Have a Pap smear; CBC; erythrocyte sedimentation rate; blood glucose; and coagulation, thyroid function, and pregnancy tests been performed? Has individual had a pelvic ultrasound, hysterosalpingography, or MRI? Was it necessary to do a uterine biopsy?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual being treated with hormone therapy?
  • Is individual on iron supplements, if needed?
  • Has individual addressed correctable lifestyle issues such as excessive stress, irregular sleep patterns, overwork, and drug or alcohol abuse?
  • Was surgery necessary? D&C? Endometrial ablation? Hysterectomy?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Have any complications developed, such as anemia or infertility?

Source: Medical Disability Advisor



References

Cited

Behera, Millie A., and Thomas Michael Price. "Dysfunctional Uterine Bleeding." eMedicine. Eds. Anthony Charles Sciscione, et al. 11 Jun. 2009. Medscape. 10 Jul. 2009 <http://emedicine.medscape.com/article/257007-overview>.

Chen, E. C., P. G. Danis, and E. Tweed. "Clinical Inquiries. Menstrual Disturbances in Perimenopausal Women: What’s Best?" Journal of Family Practice 58 6 (2009): E3. National Center for Biotechnology Information. National Library of Medicine. 19 Oct. 2009 <PMID: 19508841>.

Dickersin, K., et al. "Hysterectomy Compared With Endometrial Ablation for Dysfunctional Uterine Bleeding: A Randomized Controlled Trial." Obstetrics and Gynecology 110 6 (2007): 1279-1289. National Center for Biotechnology Information. National Library of Medicine. 19 Oct. 2009 <PMID: 18055721>.

Dodds, Nedra, and Richard H. Sinert. "Dysfunctional Uterine Bleeding." eMedicine. Eds. Steven A. Conrad, et al. 9 Jun. 2009. Medscape. 10 Jul. 2009 <http://emedicine.medscape.com/article/795587-overview>.

Kdous, M., et al. "Thermal Balloon Endometrial Ablation for Dysfunctional Uterine Bleeding: Technical Aspects and Results. A Prospective Cohort Study of 152 Cases [Translation of article in French]." Tunis Medicine 86 5 (2008): 473-478. National Center for Biotechnology Information. National Library of Medicine. 19 Oct. 2009 <PMID: 19469303>.

Lobo, Rogerio A. "Chapter 37 – Abnormal Uterine Bleeding: Ovulatory and Anovaulatory Dysfunctional Uterine Bleeding, Management of Acute and Chronic Excessive Bleeding." Comprehensive Gynecology. Eds. V. L. Katz, et al. 5th ed. Mosby Elsevier, 2007. MD Consult. Elsevier, Inc. 10 Jul. 2009 <http://www.mdconsult.com/das/book/0/view/1524/248.html>.

Sulak, P. J., et al. "Frequency and Management of Breakthrough Bleeding with Continuous Use of the Transvaginal Contraceptive Ring: A Randomized Controlled Trial." Obstetrics and Gynecology 112 3 (2008): 563-571. National Center for Biotechnology Information. National Library of Medicine. 19 Oct. 2009 <PMID: 18757653>.

Source: Medical Disability Advisor






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