To understand what abnormal uterine bleeding is, let us first see what we mean by a medically normal menstrual cycle. Menses is considered normal when uterine bleeding occurs regularly between every 21- 35 days and is not excessive, associated with tolerable lower abdominal and lower back pain, and usually lasts up to 7 days.
Bleeding in any of the following situations is abnormal
• Bleeding heavier or for more days
• Bleeding or spotting between periods
• Bleeding after sex
• Bleeding after menopause
• Excessive passage of clots.
• Lack of menses for 3-6 months
AUB can affect young girls, adolescents, pre and post-menopausal women. The causes differ from one age group to another.
Young girls : In young girls, AUB is often caused by application external irritants or foreign bodies in the vagina. Those with a bleeding disorder from birth have a tendency to bleed heavily from menses and this may be the first time that the bleeding problem is identified. Cancer related bleeding is rare in this age group.
Adolescents : In adolescents the most common cause is hormonal. A regulated interplay of hormones is required for menstruation to occur in a controlled manner. Hormonal disturbances may cause imbalance in the menstrual process and result in abnormal bleeding. In addition to imbalances of the reproductive hormones, other hormonal problems such as thyroid problems can cause abnormal bleeding.
Reproductive age : In reproductive age women hormonal causes again predominate. Other causes in this age group include growths within the uterus such as polyps or fibroids. Certain medications can also cause abnormal bleeding. Keep a note of all medicines that you take and take them with you when you visit the doctor. Pregnancy related complications need to be considered in all women in this age group. Women with endometriosis (the growth of uterine tissue outside the uterine cavity) often have heavy and painful periods.
Post-menopausal : In post-menopausal women, after the hormonal support is lost, the reproductive tract becomes dry and may bleed in an abnormal manner. Cancer is an important cause of bleeding in this age group and all postmenopausal women with abnormal bleeding should seek medical attention at the earliest. Again, as older women tend to be on many medications, it is important to check the list of medicines before a final conclusion is drawn regarding the cause of abnormal bleeding.
Initial evaluation includes complete history and a thorough examination by a qualified gynecologist. Laboratory testing may be required to look for the effect of the bleeding on the hemoglobin levels, bleeding disorders, hormonal disturbances etc. An ultrasound scan may reveal the presence of lumps in the uterus responsible for the bleeding problem or pregnancy related problems. Other tests that are employed often in cases with abnormal uterine bleeding include hysteroscopy to look inside the uterus and endometrial biopsy where a sample of uterine tissue is sent for microscopic examination.
The treatment of AUB will depend on the cause of it. Most cases with hormonal causes for the abnormal bleeding can be treated with the usage of hormonal medicines. If bleeding disorders are found, they will require evaluation and management by a hematologist. If medical therapy fails the patient may have to undergo surgical treatment. Rarely, removal of the uterus may be required if the bleeding is uncontrolled with medicines and taking a toll on the general health. We take every effort to preserve the uterus in premenopausal women and resort to hysterectomy only in exceptional cases.