Last updated date: 14-Mar-2023
Originally Written in English
Abnormal Uterine Bleeding: Causes, Diagnosis, and Treatment
Abnormal uterine bleeding, also known as AUB, is a term used to describe any abnormal bleeding from the uterus. This can include heavy or prolonged periods, spotting between periods, or bleeding after menopause. There are many potential causes of AUB, including hormonal imbalances, structural abnormalities of the uterus, and certain medical conditions. AUB can also be a side effect of certain medications or a symptom of a more serious condition, such as cancer. It is important to consult with a healthcare provider to determine the cause and develop an appropriate treatment plan.
What is Abnormal Uterine Bleeding?
Abnormal uterine bleeding (AUB) refers to any abnormal or irregular bleeding from the uterus that is not part of a normal menstrual period. This can include heavy or prolonged bleeding, irregular or unpredictable bleeding, or bleeding between periods or after menopause. AUB can occur due to a variety of causes, including hormonal imbalances, structural abnormalities of the uterus or cervix, and certain medical conditions such as thyroid disorders or polyps. AUB can also be a side effect of certain medications or a sign of a more serious condition such as cancer. Treatment for AUB will depend on the underlying cause and can include medications, surgery, or lifestyle changes. It is important to see a healthcare provider for a proper diagnosis and treatment plan if you are experiencing AUB.
What is a Normal Menstrual Cycle?
A normal menstrual cycle typically lasts around 28 days, although it can range from 21 to 35 days. During a menstrual cycle, the lining of the uterus thickens in preparation for a potential pregnancy. If pregnancy does not occur, the lining of the uterus is shed, resulting in menstrual bleeding. The length of menstrual bleeding can vary from person to person but typically lasts around 3 to 7 days. Hormonal changes in the body, specifically fluctuations in levels of estrogen and progesterone, regulate the menstrual cycle. The first day of menstruation is considered day 1 of the menstrual cycle. The cycle is divided into two phases: the follicular phase, which begins on the first day of menstruation and lasts for about 14 days, and the luteal phase, which begins after ovulation and lasts for about 14 days. Ovulation typically occurs around day 14 of a 28-day cycle.
What is the Difference Between Menorrhagia and Menometrorrhagia?
The main difference between menorrhagia and menometrorrhagia is the timing and frequency of the abnormal bleeding. Menorrhagia specifically refers to heavy or prolonged menstrual bleeding. This is defined as bleeding that lasts longer than 7 days or bleeding that is so heavy that the person needs to change their tampon or pad every hour, or they may soak through several pads in a single day. Menometrorrhagia, on the other hand, refers to irregular and heavy bleeding that occurs during both menstruation and between periods. This means that the person may have heavy bleeding during their period, but also experience bleeding at other times of the month that is not associated with their regular menstrual cycle. Both conditions can be caused by a variety of underlying medical conditions such as hormonal imbalances, thyroid disorders, fibroids, and cancer, and can have a significant impact on a person's quality of life.
To avoid misunderstanding, the international federation of gynecology and obstetrics (FIGO) renamed the two conditions. Menorrhagia is named heavy menstrual bleeding, and menometrorrhagia is named abnormal uterine bleeding.
How Common is Abnormal Uterine Bleeding?
Abnormal uterine bleeding (AUB) is a common condition that affects women of reproductive age. The exact epidemiology of AUB can vary depending on the population studied and the definition of abnormal bleeding used. However, some general estimates of the prevalence of AUB include:
- Up to 30% of women of reproductive age experience AUB.
- AUB is the most common reason for gynecologic referral and the second most common reason for hysterectomy.
- Menstrual disorders, including AUB, are the most common reason for lost productivity among women of reproductive age.
Who Does Abnormal Uterine Bleeding Affect?
Abnormal uterine bleeding can be caused by a variety of factors, including hormonal imbalances, structural abnormalities of the uterus or cervix, and problems with the ovaries or thyroid gland. Certain medical conditions, such as infection or cancer, can also cause abnormal bleeding. In some cases, the cause may be unknown. It is important to consult a healthcare provider if you experience abnormal uterine bleeding. Abnormal uterine bleeding can affect women of any age, but it is most commonly seen in:
- Women of reproductive age, especially during pregnancy or menopause.
- Women who have a hormonal imbalance, such as those with Polycystic Ovary Syndrome (PCOS).
- Women who have structural issues in their uterus or cervix, such as fibroids or endometrial hyperplasia.
- Women who have problems with their ovaries, such as ovarian cysts or cancer.
- Women who have a thyroid disorder or blood-clotting disorder.
- Women who use hormonal contraceptives, such as birth control pills or intrauterine devices (IUDs).
- Women who have recently given birth or had an abortion.
- Women who have a history of pelvic inflammatory disease or pelvic surgery.
It is a common symptom and can be caused by several underlying conditions that can range from hormonal imbalances to structural issues. It can occur in any woman of reproductive age, especially during pregnancy or menopause. It's important to consult a healthcare provider if you experience abnormal uterine bleeding.
Causes of Abnormal Uterine Bleeding?
Some common causes of abnormal uterine bleeding (AUB) include:
- Hormonal imbalances. These can be caused by conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or menopause.
- Structural abnormalities. These include uterine fibroids, polyps, or structural abnormalities of the uterus or cervix.
- Endometriosis. This is a condition in which the lining of the uterus (endometrium) grows outside of the uterus.
- Cancer. AUB can be a symptom of cervical, endometrial, or ovarian cancer.
- Medications. Certain medications, such as blood thinners or hormonal contraceptives, can cause AUB.
- Pregnancy-related. AUB may be caused by miscarriage, ectopic pregnancy, or molar pregnancy.
- Idiopathic. In some cases, the cause of AUB is unknown.
It is important to consult a healthcare provider if you are experiencing AUB, as they can perform an examination and run tests to determine the cause and appropriate treatment.
What are the Signs and Symptoms of Abnormal Uterine Bleeding?
The signs and symptoms of Abnormal Uterine Bleeding (AUB) can vary depending on the underlying cause of the condition. However, some common signs and symptoms of AUB include:
- Heavy or prolonged menstrual bleeding. AUB is characterized by bleeding that is heavier or lasts longer than normal. This can include bleeding that lasts for more than 7 days or bleeding that requires the use of more than one pad per hour.
- Irregular menstrual cycles. AUB can also cause irregular menstrual cycles, including cycles that are shorter or longer than usual, or cycles that are more or less frequent than normal.
- Spotting or bleeding between periods. AUB can also cause spotting or bleeding between periods, which is known as intermenstrual bleeding.
- Menorrhagia. AUB can also cause excessive bleeding during periods, known as menorrhagia.
- Fatigue, lightheadedness, or weakness. Symptoms of anemia such as fatigue, lightheadedness, or weakness may be present.
- Painful periods. Some women may experience cramping or other types of pain during periods.
It is important to note that some of these symptoms may be caused by other conditions and not just AUB, so it is important to see a healthcare provider for a proper diagnosis.
How is Abnormal Uterine Bleeding Diagnosed?
To diagnose abnormal uterine bleeding (AUB), a healthcare provider may use the following tools and techniques:
- Medical history. The provider will ask about the patient's menstrual history, including the frequency, duration, and severity of bleeding, as well as any other relevant symptoms or conditions.
- Physical exam. Diagnosis of uterine bleeding typically begins with a thorough medical history and physical examination. A pelvic examination is usually performed to check for any abnormalities in the uterus or ovaries.
- Laboratory tests. The provider may order blood tests to check for hormonal imbalances or other underlying medical conditions. The doctor may also order laboratory tests, such as a complete blood count (CBC) and a pregnancy test, to rule out anemia and pregnancy as potential causes of the bleeding.
- Imaging tests. The provider may order an ultrasound or pelvic MRI to further evaluate the uterus and ovaries for any structural abnormalities or growths.
- Endometrial biopsy. This is a procedure in which a small sample of the endometrium (the lining of the uterus) is taken for examination under a microscope. If the cause of the bleeding is uncertain or if there are signs of abnormal growth, a biopsy of the uterus may be done. The biopsy can help to determine if the bleeding is caused by a precancerous or cancerous condition such as endometrial cancer.
- Dilation and curettage (D&C). A D&C is a procedure in which the cervix is dilated and a scraping of the endometrium is taken for examination under a microscope.
- Hysteroscopy. A procedure where a thin telescope-like device is inserted through the cervix to view the inside of the uterus.
These are some of the common diagnostic tools and techniques used to diagnose AUB. However, the specific tests and procedures used will depend on the individual case and the suspected cause of the bleeding.
How is Abnormal Uterine Bleeding Treated?
Treatment for abnormal uterine bleeding mostly contains various medications and surgeries in addition to the following:
- Watchful waiting. In some cases, a period of observation may be recommended before deciding on treatment.
- Home remedies. Certain herbs and supplements such as ginger, turmeric, vitamin K, and omega-3 fatty acids can be used as alternative remedies.
- Intrauterine Device (IUD). A copper or hormonal IUD can be inserted into the uterus to help regulate heavy bleeding.
- Blood transfusion. In cases of severe bleeding, a blood transfusion may be required.
Medications to Treat Abnormal Uterine Bleeding
Several medications can be used to treat abnormal uterine bleeding, including:
- Hormonal birth control. This includes birth control pills, patches, injections, and intrauterine devices (IUDs) that release hormones. These medications help regulate the menstrual cycle and reduce heavy bleeding.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen, can help reduce heavy bleeding.
- Tranexamic acid. This medication can also help reduce heavy bleeding.
- Progestins. These medications are used to help regulate the menstrual cycle and reduce heavy bleeding.
- Gonadotropin-releasing hormone (GnRH) agonists. These medications can help reduce heavy bleeding by slowing down the growth of the endometrium, the lining of the uterus.
- Danazol. This medication is a synthetic steroid that stops ovulation and reduces heavy bleeding by causing changes in the endometrium.
Surgical Procedures to Treat Abnormal Uterine Bleeding
Surgical procedures that can be used to treat abnormal uterine bleeding include:
- Endometrial ablation. This procedure involves removing the lining of the uterus (endometrium) to reduce or stop heavy bleeding. It can be performed using various techniques, such as using a laser, heated fluid, or electric current.
- Hysteroscopy. This procedure involves inserting a small camera through the cervix into the uterus to visualize the inside of the uterus and remove any polyps or fibroids that may be causing heavy bleeding.
- Myomectomy. This procedure involves removing fibroids, which are benign growths in the uterus that can cause heavy bleeding.
- Hysterectomy. This is the surgical removal of the uterus and can be total or subtotal. This is usually a last resort and is usually done when all other options failed or when the patient is suffering from severe bleeding or has a chronic condition.
- Laparoscopic surgery. This is a surgical procedure that uses a small camera and instruments to access the abdominal cavity via small incisions. Laparoscopic surgery can be used to remove fibroids, polyps, and other growths in the uterus that can cause heavy bleeding.
It is important to note that the best treatment modality will depend on the underlying cause of the abnormal bleeding and the patient's situation. Your healthcare provider will help you choose the best treatment for you.
Abnormal Uterine Bleeding Prognosis
The prognosis for abnormal uterine bleeding can vary depending on the underlying cause. In many cases, the bleeding can be easily treated and resolved with medications, such as birth control pills or hormone therapy. In other cases, such as polyps or fibroids, surgery may be necessary to remove the growths and stop the bleeding. In rare cases, such as uterine cancer, the prognosis may be more serious, but early detection and treatment can improve the chances of a positive outcome. It is important to see a healthcare provider for an accurate diagnosis and appropriate treatment plan.
How Can I Reduce my Risk of Abnormal Uterine Bleeding?
There are several ways to reduce the risk of abnormal uterine bleeding:
- Maintain a healthy weight. Being overweight or underweight can increase the risk of abnormal bleeding.
- Use hormonal birth control. Hormonal birth control can help regulate menstrual cycles and reduce heavy bleeding.
- Exercise regularly. Regular physical activity can help regulate menstrual cycles and reduce the risk of abnormal bleeding.
- Limit alcohol consumption. Excessive alcohol consumption can increase the risk of abnormal bleeding.
- Avoid smoking. Smoking can increase the risk of abnormal bleeding and other health problems.
- Avoid Blood thinning medication. Blood thinning medication can increase the risk of abnormal bleeding.
It is important to note that if you are experiencing abnormal uterine bleeding, you should consult with your healthcare provider to determine the cause and appropriate treatment.
FAQs about Abnormal Uterine Bleeding
What is the Difference Between Chronic and Acute Abnormal Uterine Bleeding?
Chronic abnormal uterine bleeding (AUB) refers to irregular or heavy menstrual periods that occur over a prolonged period, typically lasting for more than 6 months. Acute AUB, on the other hand, refers to a sudden onset of heavy or prolonged bleeding that is not part of a regular menstrual cycle. Acute AUB can be caused by various conditions such as miscarriage, ectopic pregnancy, or hormonal imbalances, whereas chronic AUB can be caused by conditions such as polyps, fibroids, or hormonal imbalances. The diagnosis and treatment for both types of AUB may differ and it is important to consult with a healthcare professional.
At What Ages is Abnormal Bleeding More Common?
Abnormal bleeding is more common during adolescence and menopause. Adolescents may experience irregular periods due to hormonal changes, while menopause is characterized by the cessation of menstruation and can cause heavy or prolonged bleeding. However, abnormal bleeding can occur at any age and can be caused by a variety of underlying conditions, such as hormonal imbalances, fibroids, polyps, or cancer. It is important to consult with a healthcare provider to determine the cause and appropriate treatment.
When Should I See my Healthcare Provider?
It is recommended that you see your healthcare provider if you experience abnormal uterine bleeding, which is defined as any bleeding that occurs outside of your expected menstrual period or is heavier or longer lasting than usual. Additionally, you should seek medical attention if you experience any other symptoms such as severe cramping, pelvic pain, or fever. It is important to see a healthcare provider to determine the cause of the abnormal bleeding and to determine an appropriate course of treatment.
In conclusion, abnormal uterine bleeding (AUB) is a term used to describe any abnormal bleeding from the uterus. The causes of AUB can be varied, including hormonal imbalances, structural abnormalities of the uterus, and certain medical conditions. AUB can also be a side effect of certain medications or a symptom of a more serious condition such as cancer. It is important to seek medical attention if you experience abnormal uterine bleeding to determine the cause and develop an appropriate treatment plan. This may include hormonal therapy, surgery, or other forms of treatment depending on the underlying cause. Regular check-ups and screenings are also important to ensure that any potential health issues are caught early and treated effectively.