Abnormal Uterine Bleeding

Abnormal Uterine Bleeding: Symptoms, Causes, Diagnosis, Treatments, and Living With It

Abnormal uterine bleeding (AUB) is a common gynecological issue affecting millions of women worldwide. Despite its prevalence, many women may feel unsure about what constitutes “normal” versus “abnormal” bleeding and when to seek medical advice. This article provides a detailed overview of abnormal uterine bleeding, including its symptoms, causes, diagnostic processes, treatment options, and practical tips for living with the condition. Whether you are experiencing irregular bleeding or simply want to understand more about this condition, this guide will offer clear, comprehensive information.

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What is Abnormal Uterine Bleeding?

Abnormal uterine bleeding refers to any bleeding from the uterus that deviates from a woman’s normal menstrual pattern in terms of frequency, duration, volume, or regularity. It can occur at any age but is most common during reproductive years, perimenopause, and menopause.

Normal menstrual bleeding usually lasts between 3 to 7 days and occurs every 21 to 35 days. Any variation beyond these parameters—such as bleeding between periods, excessively heavy periods, or prolonged bleeding—may be considered abnormal.

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Symptoms of Abnormal Uterine Bleeding

Recognizing the symptoms of AUB is crucial for timely diagnosis and management. Common symptoms include:

• Heavy menstrual bleeding (Menorrhagia): Excessive bleeding during periods, soaking through one or more sanitary pads or tampons every hour for several hours.
• Irregular menstrual cycles: Periods that come more frequently than every 21 days or less often than every 35 days.
• Prolonged bleeding (Metrorrhagia): Menstrual bleeding lasting longer than 7 days.
• Bleeding between periods (Intermenstrual bleeding): Spotting or bleeding that occurs between regular menstrual cycles.
• Postmenopausal bleeding: Any bleeding occurring after menopause is abnormal and requires immediate evaluation.
• Clotting: Passing large clots during menstruation.
• Pelvic pain or discomfort: Sometimes AUB may be accompanied by pelvic cramping or pain.

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Causes of Abnormal Uterine Bleeding

AUB can result from a variety of causes, ranging from hormonal imbalances to structural abnormalities in the uterus, systemic diseases, or medications. The causes are often categorized using the PALM-COEIN classification system developed by the International Federation of Gynecology and Obstetrics (FIGO), which divides causes into structural and non-structural:

Structural Causes (PALM)

• P – Polyp: Benign growths on the lining of the uterus (endometrial polyps) can cause irregular bleeding.
• A – Adenomyosis: A condition where endometrial tissue grows into the muscular wall of the uterus, causing heavy and painful bleeding.
• L – Leiomyoma (Fibroids): Benign tumors of the uterine muscle that may cause heavy or prolonged bleeding.
• M – Malignancy and Hyperplasia: Precancerous changes or uterine cancers can lead to abnormal bleeding, especially in postmenopausal women.

Non-Structural Causes (COEIN)

• C – Coagulopathy: Blood clotting disorders like von Willebrand disease can cause heavy bleeding.
• O – Ovulatory dysfunction: Hormonal imbalances causing irregular ovulation or anovulation (absence of ovulation), common in conditions like polycystic ovary syndrome (PCOS) or thyroid disorders.
• E – Endometrial: Disorders of the uterine lining, including infections or inflammation.
• I – Iatrogenic: Bleeding caused by medications or medical devices, such as hormonal contraceptives or intrauterine devices (IUDs).
• N – Not yet classified: Other rare or unknown causes.

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Diagnosing Abnormal Uterine Bleeding

When you experience abnormal bleeding, consulting a healthcare provider is essential for accurate diagnosis. The diagnostic approach typically involves:

Medical History

• Menstrual history (cycle length, duration, flow)
• Sexual and reproductive history
• Medication and contraceptive use
• Family history of bleeding disorders or cancers
• Associated symptoms like pain or systemic signs

Physical Examination

• General examination to check for signs of systemic illness
• Pelvic examination to assess the uterus, cervix, and vagina

Laboratory Tests

• Blood tests: Complete blood count (CBC) to check for anemia, coagulation profile, thyroid function tests, hormone levels.
• Pregnancy test: To rule out pregnancy-related bleeding.

Imaging

• Ultrasound (Transvaginal or Pelvic): To visualize uterine abnormalities like fibroids, polyps, or thickened endometrium.
• Sonohysterography: Ultrasound with saline infusion to better visualize the uterine cavity.
• MRI: Occasionally used for complex cases or adenomyosis.

Endometrial Sampling

• Endometrial biopsy: Removal of a small tissue sample from the uterine lining to check for hyperplasia or cancer, especially in women over 35 or with risk factors.
• Hysteroscopy: A procedure using a thin camera inserted through the cervix to directly view the uterine lining and perform biopsies or remove polyps/fibroids.

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Treatment Options for Abnormal Uterine Bleeding

Treatment for AUB depends on the underlying cause, severity of bleeding, age, reproductive goals, and overall health. The main goals are to reduce bleeding, alleviate symptoms, and treat any underlying conditions.

Medical Treatments

1. Hormonal Therapies

• Combined oral contraceptives: Regulate menstrual cycles and reduce bleeding.
• Progestin-only therapy: Used in women who cannot take estrogen; helps stabilize the endometrium.
• Levonorgestrel-releasing intrauterine device (LNG-IUD): Highly effective in reducing heavy menstrual bleeding by thinning the uterine lining.
• Gonadotropin-releasing hormone (GnRH) agonists: Temporarily reduce estrogen production, shrinking fibroids or adenomyosis but typically used short-term due to side effects.

2. Non-Hormonal Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Reduce menstrual bleeding and pain by lowering prostaglandin levels.
• Tranexamic acid: An antifibrinolytic that helps reduce bleeding by promoting clot stability.
• Iron supplements: To treat anemia resulting from heavy bleeding.

Surgical Treatments

1. Endometrial Ablation

• Procedure to destroy the uterine lining to reduce or stop bleeding.
• Suitable for women who do not wish to preserve fertility.

2. Myomectomy

• Surgical removal of fibroids while preserving the uterus, ideal for women desiring future pregnancies.

3. Polypectomy

• Removal of uterine polyps via hysteroscopy.

4. Hysterectomy

• Complete removal of the uterus, a definitive treatment usually reserved for severe cases or cancer.

Treatment for Underlying Conditions

• Managing thyroid disorders, bleeding disorders, or infections appropriately.
• Cancer treatments such as surgery, radiation, or chemotherapy when needed.

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Living with Abnormal Uterine Bleeding

Living with abnormal uterine bleeding can significantly impact a woman’s physical, emotional, and social well-being. Here are some practical tips and considerations for managing daily life:

Managing Symptoms

• Use highly absorbent sanitary products or menstrual cups designed for heavy flow.
• Maintain iron-rich diets or take supplements to prevent or treat anemia.
• Track menstrual cycles with apps or diaries to monitor changes and help with medical consultations.
• Use pain relief methods for cramps, including heat pads and NSAIDs.

Emotional and Social Support

• Seek counseling or join support groups to discuss emotional challenges.
• Communicate openly with partners or family about the condition.
• Manage stress through mindfulness, yoga, or meditation as stress can worsen symptoms.

When to Seek Medical Help

• Sudden heavy bleeding soaking more than one pad or tampon per hour.
• Bleeding accompanied by dizziness, weakness, or fainting.
• Postmenopausal bleeding.
• Severe pelvic pain.

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Prevention and Risk Reduction

While some causes of AUB cannot be prevented, maintaining a healthy lifestyle may reduce the risk:

• Maintain a healthy weight to balance hormones.
• Manage chronic conditions like diabetes and thyroid disease.
• Avoid smoking and excessive alcohol consumption.
• Have regular gynecological check-ups.
• Use contraception as advised to regulate menstrual cycles.

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Conclusion

Abnormal uterine bleeding is a multifaceted condition that affects many women, but it is manageable with proper diagnosis and treatment. Understanding the symptoms, causes, and available treatments empowers women to seek timely care and improve their quality of life. If you experience any signs of abnormal bleeding, do not hesitate to consult your healthcare provider for personalized care.

By adopting healthy lifestyle choices and staying informed, you can take control of your reproductive health and live comfortably with or beyond abnormal uterine bleeding.

FAQs about Abnormal Uterine Bleeding

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