Abnormal Uterine Bleeding

What are the symptoms of abnormal uterine bleeding?

Abnormal uterine bleeding (AUB) refers to bleeding that is heavier, lighter, or longer than normal menstrual bleeding. The symptoms of AUB can vary depending on the underlying cause, but common symptoms include:

Heavy or Prolonged Bleeding:

• Heavy menstrual bleeding (more than 2 pads/tampons per hour)
• Prolonged bleeding lasting more than 7 days
• Menstrual bleeding that lasts for more than 10 days

Light or Irregular Bleeding:

• Light or spot-like bleeding between periods
• Spotting or light bleeding after sex
• Bleeding that is irregular in timing or duration

Other Symptoms:

• Clots or large blood clots in the menstrual flow
• Flooding or soaking through multiple pads/tampons in a short period
• Bleeding that is heavy enough to require surgery or transfusions
• Pelvic pain or cramping
• Abdominal pain or pressure
• Painful periods (dysmenorrhea)
• Irregular periods, such as changes in frequency, duration, or flow
• Postcoital bleeding (bleeding after sex)

Other Possible Symptoms:

• Heavy bleeding during pregnancy or after menopause
• Bleeding during sex (vaginal bleeding after sex)
• Bleeding between periods that is accompanied by other symptoms such as pelvic pain, cramping, or fever

If you are experiencing any of these symptoms, it’s crucial to consult a healthcare provider for a proper evaluation and diagnosis.

What are the causes of abnormal uterine bleeding?

Abnormal uterine bleeding (AUB) can be caused by a variety of factors, including:

1. Hormonal Imbalances:
   • Polycystic ovary syndrome (PCOS)
   • Thyroid disorders (hypothyroidism or hyperthyroidism)
   • Menstrual irregularities due to hormonal fluctuations
   • Contraceptive use (e.g., hormonal intrauterine devices (IUDs), hormonal birth control pills)
2. Uterine Anomalies:
   • Uterine fibroids (benign tumors)
   • Endometrial polyps (non-cancerous growths)
   • Adenomyosis (growth of endometrial tissue into the uterine muscle)
   • Cervical or uterine cancer
3. Infections:
   • Pelvic inflammatory disease (PID)
   • Endometritis (infection of the endometrium)
   • Chlamydia or other sexually transmitted infections
4. Structural Abnormalities:
   • Uterine or cervical abnormalities, such as a septate uterus or a bicornuate uterus
   • Cervical stenosis or narrowing
5. Medications:
   • Anticoagulant medications (e.g., aspirin, warfarin)
   • Hormonal medications (e.g., hormone replacement therapy, birth control pills)
   • Anti-inflammatory medications (e.g., ibuprofen, naproxen)
6. Other Medical Conditions:
   • Fibromyalgia
   • Irritable bowel syndrome (IBS)
   • Endometriosis
7. Pregnancy and Menopause:
   • Heavy bleeding during pregnancy or after menopause
8. Miscellaneous Causes:
   • Clotting disorders (e.g., von Willebrand disease)
   • Bleeding disorders (e.g., hemophilia)
   • Nutritional deficiencies (e.g., vitamin deficiency)

It’s essential to note that AUB can be caused by a combination of these factors, and in some cases, the underlying cause may not be identified. A healthcare provider can help diagnose the cause of AUB by performing a thorough physical examination, taking a medical history, and ordering diagnostic tests such as:

1. Pelvic exam
2. Transvaginal ultrasound
3. Hysteroscopy
4. Endometrial biopsy
5. Pap test
6. Blood tests (e.g., complete blood count, thyroid function tests)

Early diagnosis and treatment can help alleviate symptoms and prevent complications associated with AUB.

What are the treatments for abnormal uterine bleeding?

The treatment for abnormal uterine bleeding (AUB) depends on the underlying cause and severity of the bleeding. Here are some common treatment options:

Medical Treatments:

1. Hormonal Therapies:
   • Hormonal birth control pills (e.g., estrogen and progestin)
   • Progestin-only pills (e.g., progesterone)
   • Estrogen-replacement therapy (ERT)
   • Hormonal intrauterine devices (IUDs) (e.g., Mirena, Skyla)
2. Non-Hormonal Medications:
   • Anti-inflammatory medications (e.g., ibuprofen, naproxen)
   • Anticoagulant medications (e.g., aspirin, warfarin)
   • Tranexamic acid (a medication that helps reduce bleeding)
3. Selective Estrogen Receptor Modulators (SERMs):
   • Tamoxifen, a medication that can help reduce bleeding in some cases

Surgical Treatments:

1. Hysteroscopy:
   • A procedure to remove uterine polyps or fibroids
   • Can also be used to diagnose and treat endometrial cancer
2. Dilation and Curettage (D&C):
   • A procedure to remove excess tissue from the uterus
   • May be used to treat heavy bleeding, abnormal growths, or to diagnose uterine cancer
3. Endometrial Ablation:
   • A procedure to remove or destroy the lining of the uterus (endometrium)
   • Can help reduce heavy bleeding and alleviate symptoms
4. Uterine Fibroid Embolization (UFE):
   • A minimally invasive procedure to block blood flow to uterine fibroids
   • Can help reduce bleeding and alleviate symptoms

Other Treatments:

1. Laser Therapy:
   • A procedure that uses laser energy to remove or destroy abnormal growths
2. Radiofrequency Ablation:
   • A minimally invasive procedure that uses radiofrequency energy to destroy abnormal tissue
3. Uterine Artery Embolization:
   • A minimally invasive procedure that blocks blood flow to the uterine arteries
4. Endometrial Stimulation:
   • A procedure that uses electrical stimulation to stimulate the endometrium and reduce bleeding

Conservative Management:

1. Monitoring and Observation:
   • Closely monitoring the bleeding pattern and adjusting treatment as needed
2. Menstrual Hygiene Products:
   • Using menstrual hygiene products, such as pads or tampons, to manage bleeding
3. Dietary Changes:
   • Making dietary changes, such as increasing fiber intake or avoiding certain foods, to help manage bleeding

It’s essential to consult a healthcare provider to determine the best course of treatment for your specific case of abnormal uterine bleeding.