Understanding Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) is a common gynaecological issue affecting women of all ages. It is characterized by bleeding that differs from a woman's normal menstrual cycle. This can include heavy bleeding, prolonged periods, spotting between periods, or bleeding after menopause. Understanding the causes of AUB is crucial for accurate diagnosis and effective treatment.

What is Abnormal Uterine Bleeding?

Abnormal uterine bleeding refers to any bleeding from the uterus that is irregular in volume, duration, or timing. It encompasses a wide range of symptoms, including:

Heavy menstrual bleeding (Menorrhagia): Excessive menstrual blood loss that interferes with a woman's physical, emotional, social, and material quality of life.
Intermenstrual bleeding: Bleeding that occurs between regular menstrual periods.
Postmenopausal bleeding: Any bleeding that occurs after a woman has gone through menopause.

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Symptoms of Abnormal Uterine Bleeding

The symptoms of AUB can vary widely, often depending on the underlying cause. Some common symptoms include:

Bleeding or spotting between periods
Menstrual bleeding that lasts longer than usual
Menstrual cycles that are shorter than 21 days or longer than 35 days
Heavy menstrual bleeding requiring frequent change of sanitary products
Bleeding after sexual intercourse
Postmenopausal bleeding

Causes of Abnormal Uterine Bleeding

The causes of abnormal uterine bleeding are diverse and can be categorized into structural and non-structural causes, as per the PALM-COEIN classification:

Structural Causes

Polyps: Benign growths on the lining of the uterus or cervix can cause heavy or irregular bleeding.
Adenomyosis: The inner lining of the uterus breaks through the muscle wall of the uterus, leading to heavy periods and painful menstruation.
Leiomyomas (Fibroids): Noncancerous growths of the uterus that often appear during childbearing years can cause heavy menstrual bleeding and prolonged periods.
Malignancy and Hyperplasia: Precancerous changes or cancer of the uterus or cervix can result in abnormal bleeding.

Non-Structural Causes

Coagulopathy: Disorders affecting blood clotting can lead to heavy menstrual bleeding.
Ovulatory Dysfunction: Irregular or absent ovulation can cause irregular menstrual cycles and bleeding.
Endometrial Causes: Issues with the lining of the uterus that are not related to structural abnormalities can cause abnormal bleeding.
Iatrogenic Causes: Certain medications, especially those affecting hormone levels, can cause AUB.
Not Yet Classified: Situations where the cause of bleeding does not fit into the above categories.

Hormonal Factors

Hormones play a significant role in regulating the menstrual cycle. Imbalances in hormones such as estrogen and progesterone can lead to abnormal uterine bleeding. Conditions such as polycystic ovary syndrome (PCOS) and thyroid disorders can also disrupt hormonal balance, leading to AUB.

Abnormal Uterine Bleeding and Pregnancy

Abnormal uterine bleeding can sometimes be associated with pregnancy. It can indicate various conditions, such as:

Ectopic Pregnancy: A pregnancy that occurs outside the uterus, often in a fallopian tube, can cause bleeding and is a medical emergency.
Miscarriage: Bleeding during early pregnancy can be a sign of miscarriage.
Placental Abruption: The detachment of the placenta from the uterus before delivery can cause bleeding and is a severe condition.

Diagnosis of Abnormal Uterine Bleeding

Diagnosing the cause of abnormal uterine bleeding involves a comprehensive approach, including:

Medical History and Physical Examination: Understanding the patient's medical history and conducting a physical exam to identify any potential causes.
Laboratory Tests: Blood tests to check for anaemia, thyroid issues, and clotting disorders.
Imaging Tests: Ultrasound, MRI, or hysteroscopy to visualize the uterus and detect any structural abnormalities.

Treatment Options for Abnormal Uterine Bleeding

Treatment for abnormal uterine bleeding depends on the underlying cause, the severity of the bleeding, and the patient's overall health and preferences. Options include:

Medications

Hormonal Therapy: Birth control pills, hormonal IUDs, and other hormone therapies can regulate menstrual cycles and reduce bleeding.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These can reduce menstrual blood loss and relieve pain.
Tranexamic Acid: A medication that helps reduce bleeding.

Surgical Options

Dilation and Curettage (D&C): A procedure to remove tissue from the inside of the uterus.
Endometrial Ablation: A procedure to destroy the lining of the uterus to reduce or stop bleeding.
Myomectomy: Surgical removal of fibroids.
Hysterectomy: Removal of the uterus, which is considered for severe cases where other treatments have failed.

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Abnormal Uterine Bleeding in Menopause

Bleeding after menopause is considered abnormal and requires medical evaluation. Common causes include:

Hormone Replacement Therapy (HRT) Can cause bleeding similar to a menstrual period.
Endometrial Atrophy: Thinning of the lining of the uterus due to lower hormone levels.
Endometrial Hyperplasia or Cancer: Thickening of the uterine lining can lead to cancer, particularly in postmenopausal women.

Abnormal uterine bleeding is a multifaceted condition with a wide array of causes. Understanding these causes is essential for accurate diagnosis and effective treatment. If you experience any symptoms of abnormal uterine bleeding, consult a healthcare professional for evaluation and management. Early intervention can help address underlying health issues and improve quality of life.

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