About Abnormal Uterine Bleeding

Overview

Abnormal uterine bleeding (AUB) refers to bleeding from the uterus that is not normal in terms of frequency, duration, volume, or regularity. It occurs when a person is not pregnant and can be acute (sudden) or chronic (long-lasting). AUB is a common issue, affecting up to 30% of women of reproductive age. It can cause significant distress, impact daily activities, and even lead to anemia. AUB can occur at any age but is more common around the times of a woman’s start of menstrual periods or menopause (when a woman stops producing hormones and periods stop permanently). It is important to evaluate and address AUB to ensure overall health and well-being.

Causes and Risk Factors

Abnormal uterine bleeding (AUB) can have various causes, including:

• Structural causes:
• Polyp: A growth on the inner lining of the uterus.
• Adenomyosis: The presence of endometrial tissue within the muscular wall of the uterus.
• Leiomyoma: Also known as uterine fibroids, these are noncancerous growths in the uterus.
• Malignancy: Refers to cancerous growths in the uterus.
• Non-structural causes:
• Coagulopathy: A disorder that affects blood clotting.
• Ovulatory Dysfunction: Irregular or absent ovulation, which can disrupt the menstrual cycle.
• Endometrial Causes: Disorders or abnormalities in the endometrium (inner lining of the uterus).
• Iatrogenic Causes: Related to medical procedures or treatments.

Non-modifiable risk factors for abnormal uterine bleeding cannot be changed or controlled. These include:

• Age: Adolescents and women in the perimenopause age groups have a higher risk of AUB.
• Conditions associated with decreased ability to clot: Liver disease, kidney disease, clotting factor deficiencies.
• Conditions associated with hormone imbalances: Examples include thyroid disease, Polycystic ovary syndrome (PCOS).
• Non-cancerous growths in the uterus: Polyps, fibroids, adenomyosis, endometriosis.
• Cancerous growths: Uterine cancer, cervical cancer, ovarian cancer, vaginal cancer.
• Previous surgery or injuries to the uterus.

Modifiable risk factors for abnormal uterine bleeding can be influenced or changed. These include:

• Sexually-transmitted infections (STIs), including pelvic inflammatory disease.
• Weight: Overweight or obesity increases the risk of AUB.
• Medications: Blood thinners (including aspirin), hormone replacement therapy.
• Intrauterine devices (IUDs).

It's important to note that while most cases of AUB are not linked to cancerous tissue, it may still be possible. Overall, understanding the causes and risk factors for AUB is crucial for proper diagnosis and management of this condition.

Symptoms

Abnormal uterine bleeding can include bleeding that happens after menopause, between periods (spotting), or after sex. If you menstruate, abnormal uterine bleeding may also involve noticeable changes to your period, such as heavier flow, longer duration, or irregularity.

As abnormal uterine bleeding becomes more severe, other symptoms may include:

• Pelvic pain and cramping
• Abdominal bloating
• Feeling full soon after eating
• Changes to bladder and bowel habits
• Blood in your urine
• Pain with intercourse
• Weight loss
• A mass or lump in your lower abdomen (if bleeding is due a mass).

It's important to note that these symptoms can be caused by other health conditions. However, if you're experiencing abnormal uterine bleeding or any of these symptoms, it's a good idea to reach out to a healthcare professional for an assessment and to rule out any potential causes.

Diagnosis

To diagnose abnormal uterine bleeding, doctors commonly perform the following examinations, tests, and procedures:

• Patient history: Doctors will ask questions about individual and family medical histories to gather important information about the patient's health.
• Physical exam: A full physical exam is performed to assess the patient's overall health and identify any visible abnormalities. A pelvic exam may be performed.
• Blood tests: Blood tests may be conducted to check for hormonal imbalances, anemia, or other underlying conditions that could be causing AUB.
• Transvaginal ultrasound: This imaging test uses sound waves to create images of the reproductive organs. It helps doctors check for changes in the endometrium (lining of the uterus), growths in the uterine cavity, and abnormal masses in the ovaries or fallopian tubes.
• Hysteroscopy: This procedure involves inserting a thin, lighted tube called a hysteroscope through the vagina and cervix into the uterus. It allows doctors to directly visualize the inside of the uterus and detect any malformations, polyps, fibroids, or malignant lesions.
• Diagnostic curettage: Also known as dilation and curettage (D&C), this procedure involves dilating the cervix and scraping tissue from the lining of the uterus. The tissue sample is then examined under a microscope to determine if there are any abnormal cells or conditions causing AUB.

Additional examinations, tests, and procedures may be performed based on initial findings or individual factors. These can include:

• Culture tests: Doctors may take samples from the cervix or vagina to check for infections that could be contributing to AUB.
• Biopsies: If abnormal growths or masses are detected during examinations, doctors may perform biopsies to obtain tissue samples for further analysis.
• Colposcopy: This procedure involves using a special magnifying instrument called a colposcope to examine the cervix for abnormalities more closely.
• Pregnancy test: A pregnancy test may be conducted to rule out pregnancy as a cause of AUB.

The diagnostic process may vary depending on individual factors. If a doctor cannot determine the cause of AUB, they may refer a patient to a gynecologist for further evaluation and management.

Treatment Options

The goals of treatment for abnormal uterine bleeding are to:

• Stop bleeding and correct anemia
• Regulate the menstrual cycle
• Prevent endometrial cancer
• Improve quality of life

To achieve these goals, various treatment options are available. These include:

Medications:

• Progestins: These are synthetic hormones that can be taken orally or through an intrauterine device (IUD). They work by causing the endometrium (lining of the uterus) to become thinner, which reduces bleeding.
• Estrogens and progesterone combination: This combination therapy helps regulate the menstrual cycle and reduce heavy bleeding.
• Prostaglandin inhibitors: These medications help reduce uterine contractions, which can alleviate pain and reduce bleeding.
• GnRH agonists: These medications work by suppressing the production of estrogen, which can help regulate the menstrual cycle and reduce bleeding.

Procedures:

• Endometrial ablation: This is a non-invasive procedure that involves removing or destroying the lining of the uterus. It can be done using various techniques, such as laser, heat, or freezing. Endometrial ablation helps reduce or eliminate menstrual bleeding.
• Removal of any masses: If AUB is due to fibroids, polyps or a malignancy, surgical removal may be necessary.

Self-care and health behavior changes:

• Lifestyle modifications: Making certain changes in lifestyle can help manage AUB. These may include maintaining a healthy weight, exercising regularly, managing stress levels, and getting enough sleep.

It's important to note that the choice of treatment depends on the underlying cause of AUB, individual preferences, and other factors. Therefore, treatment should be individualized based on a person's specific needs and circumstances.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.

Progression or Complications

Abnormal uterine bleeding can have different patterns and symptoms over time. Here is a breakdown of the natural progression of AUB, common complications, and the impact of treatment:

Natural progression of abnormal uterine bleeding:

• AUB can be acute or chronic, meaning it can occur suddenly or persist over time.
• It is defined as bleeding from the uterus that is abnormal in terms of regularity, volume, frequency, or duration, and occurs outside of pregnancy.
• The prevalence of AUB is up to 30% among women of reproductive age.
• AUB can be caused by diseases, reproductive changes, intrauterine devices (IUD), steroid use, and contraceptives.
• It can also be caused by a functional disorder called dysfunctional uterine bleeding (DUB).
• AUB has different categories including endometrial polyps, adenomyosis, endometrial hyperplasia, ovulation disorders, and abnormal coagulation function.
• The menstrual cycle may become disrupted with variations in period length and amount of bleeding.
• Some individuals may experience irregular vaginal bleeding or prolonged bleeding that is difficult to stop.
• Abdominal pain or discomfort is not always present with abnormal uterine bleeding.

Common complications of abnormal uterine bleeding:

• Anemia may occur in individuals who feel fatigued, weak, or tired due to a lack of healthy red blood cells carrying oxygen throughout the body.
• Heavy or excessive bleeding could indicate conditions to be treated, such as fibroids or endometrial conditions. Much less commonly, AUB could indicate endometrial or uterine cancer.

Impact of treatment for abnormal uterine bleeding:

• Treatment options for AUB depend on the underlying cause and individual circumstances. It's important to consult with a healthcare provider to determine the best course of action.
• Hormonal treatments have shown effectiveness in reducing the amount of bleeding in some studies. These treatments aim to regulate hormonal imbalances or address structural issues that may be causing AUB.

It's important to remember that each individual's experience with AUB may vary. Consulting with a healthcare provider is crucial for accurate diagnosis and appropriate treatment options.