Abnormal Uterine Bleeding: Definition, Causes and Treatment

Abnormal uterine bleeding is one of the most common reasons women see their doctors.

Bleeding anywhere in the body is always a concern and can be a great cause of alarm.I will review the definition, causes and what is appropriate to do with abnormal uterine bleeding.

What Is Normal?

Abnormal means there is a ‘normal’. Generally, no bleeding is considered normal except for the exception of normal menses. Normal menstruation is characterized by its duration, amount, frequency of
occurrence,color and odor. When uterine bleeding goes out of these normal limits, it is called abnormal.

Furthermore, there should be no uterine bleeding after menopause.

It is important to be familiar with normal menstruation before looking at what is abnormal.

What Is Abnormal?

Abnormal uterine bleeding is simply bleeding from the uterus that is not within its normal amount , frequency, setting of occurrence or rarely its color and odor.Though it is often used to described abnormal bleeding during menstruation years, it also refers to any uterine bleeding after menopause.

It can occur in any of the following ways

  1. Bleeding between periods, called metrorrhagia. Amongst others, abnormal bleeding may occur in specific contexts such as Break through bleeding associated with birth control pills, Mid cycle bleeding associated with ovulation and Spotting before period which is mild bleeding just before the expected periods.
  2. Irregular periods.
    This occurs due to problems in the length of the cycle. The shorter the cycle length, the more frequent the cycles become and the longer the length, the fewer cycles a woman gets. Frequent periods are due to short cycle lengths while oligomenorrhea or long menstrual cycle is due to long cycle lengths.
  3. Bleeding after hysterectomy occurs after the surgical procedure of hysterectomy while bleeding after sex occurs after sexual intercourse.
  4. Bleeding in abnormal amounts. Frequently, it is heavier or last longer than normal. This is called menorrhagia or heavy menstruation. Rarely, it could be scanty bleeding.
  5. When bleeding between periods occur with heavy or prolonged menstrual bleeding, it is called meno-metrorrhagia.
  6. Spotting anytime in the menstrual cycle
  7. Blood clots during menstruation
  8. Bleeding after menopause

Causes

Abnormal bleeding can have many causes. Some are serious while others are simple to treat. About 33% of woman suffer from menorrhagia and only 20% of them seek medical care. Your doctor may start by
checking for problems most common in your age group. Some of them are not serious and are easy to treat.

For bleeding that occurs after a hysterectomy surgery, please visit bleeding after hysterectomy.

  • Dysfunctional uterine bleedingThis is the most common cause of abnormal bleeding especially among adolescent girls and perimenopausal women. It is due to hormonal imbalances, especially when a cycle occurs without ovulation (Anovulatory cycles) and there are usually no detectable diseases with the genital tract. It is a diagnosis made only after all other causes have been excluded.
  • PregnancyIn
    women of childbearing age (around 18-40 years), the most common cause of abnormal uterine bleeding is pregnancy and its complications such as ectopic pregnancies molar pregnancies miscarriages late complications such as placenta previa.
  • Birth control methodsBirth control pills or intrauterine devises can lead to abnormal uterine bleeding.
  • Diseases of the genital tractThese includeInfection of the uterus or cervix Fibroids Uterine polyps Cancers such as cancer of the uterus, cervix, or vagina. Similar conditions such as hyperplasia of the endometrium( excessive growth). Chronic medical conditions (for instance, thyroid problems and diabetes.Coagulation disorders can result in abnormal bleeding.
  • TraumaTrauma to the uterus may result in uterine bleeding. Sexual abuse may result from vaginal bleeding also.

You can read specifically about the causes of irregular periods, either of frequent or fewer periods.


Diagnosis

Medical evaluation is required to evaluated uterine or vaginal bleeding that is nor normal.

The following tests may be requested depending on what is the probable cause(s)

  • Ultrasound or echography of the pelvic organs
  • Endometrial biopsy—Using a small or thin catheter (tube), tissue is taken from the lining of the uterus. It is looked at under a microscope.
  • Hysteroscopy:A thin device is inserted through the vagina and the opening of the
    cervix. It lets the doctor view the inside of the uterus.
  • Hysterosalpingography:Dye is injected into the uterus and fallopian tubes. Then an X-ray is taken.
  • Dilation and curettage (D&C):The opening of the cervix is enlarged. Tissue is gently scraped or suctioned from the lining of the uterus. It is examined under a microscope. About 15% of women undergo this procedure for abnormal bleeding evaluation.
  • Laparoscopy:A thin device like a telescope is inserted through a small cut just below or through the navel. The doctor can then view the inside of the abdomen.

Treatment

Treatment definitely depends on the cause of the bleeding and other factors such as your age and whether you want to have children or not.

Generally, the three options often used are

  • Medications (hormones)
  • Surgery
  • ‘Watch and Wait”

Hormones

The female hormones can be given as drugs to treat abnormal bleeding. It could be given as pills, injections or vaginal cream. Other medications like antibiotics and pain killers may be added depending on the cause.

Surgery

Some women may need to have surgery to remove growths (such as polyps or fibroids) that cause bleeding. This often can be done with hysteroscopy. Endometrial ablation using methods such as heat and laser may be used to destroy the endometrium and control bleeding in some cases.

When all methods above fail, the uterus is removed (hysterectomy) to control the bleeding. About 200,000 hysterectomies are done per year to treat menorrhagia.

Watchful waiting

Your doctor will advice you on this depending on cause at hand.

Abnormal uterine bleeding is therefore common and will require medical evaluation to determine the precise cause for appropriate treatment to be given.


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