Abnormal Uterine Bleeding (AUB): Causes, Symptoms, Diagnosis & Treatment

Introduction: Understanding Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) refers to any bleeding from the uterus that differs from a normal menstrual pattern. This may include heavy periods, irregular cycles, prolonged bleeding, or spotting between periods. While AUB can significantly impact a woman's quality of life, causing discomfort and anxiety, it's important to remember that most cases are manageable or treatable with proper medical care. In this article, we'll explore the causes, symptoms, diagnostic process, and treatment options for abnormal uterine bleeding, empowering you with the knowledge to take charge of your menstrual health.

What Is Abnormal Uterine Bleeding (AUB)?

Abnormal uterine bleeding refers to any variation in menstrual bleeding that falls outside the normal pattern in terms of timing, duration, frequency, or volume. This includes bleeding or spotting between periods, excessively heavy or prolonged menstrual flow, and cycles that are unusually short or long.

AUB may result from hormonal imbalances, structural abnormalities in the uterus, certain medications, or other health conditions. The unpredictable nature of abnormal uterine bleeding can disrupt daily life and, if left unchecked, potentially lead to complications like anaemia or fertility issues. Distinguishing AUB from normal variation in menstrual cycles is important to ensure appropriate evaluation and management.

What Is the Difference Between Menorrhagia and Menometrorrhagia?

While both are types of abnormal uterine bleeding, menorrhagia specifically describes excessively heavy or prolonged menstrual bleeding at regular intervals. In contrast, menometrorrhagia refers to heavy, irregular menstrual bleeding that occurs both during and between periods, often unpredictably.

How Common Is Abnormal Uterine Bleeding?

Abnormal uterine bleeding is a very common gynaecological issue. It is estimated to affect approximately 30% of women at some point during their reproductive years. AUB is particularly prevalent among adolescents and perimenopausal women due to the hormonal fluctuations experienced during these life stages. However, abnormal bleeding patterns can occur at any age and should always be evaluated by a doctor.

What Are The Symptoms of Abnormal Uterine Bleeding?

The abnormal uterine bleeding symptoms can vary from woman to woman but may include:

• Bleeding between periods: Spotting or unexpected bleeding outside your regular cycle may be a sign of abnormal uterine bleeding.
• Irregular menstrual cycles: Cycles shorter than 21 days or longer than 35 days, or frequent changes in timing from month to month, can indicate hormonal imbalance or ovulatory issues.
• Heavy menstrual flow: Soaking through a pad or tampon every hour for several hours is considered abnormally heavy and may lead to blood loss complications.
• Passing large blood clots: Expelling unusually large clots during menstruation often accompanies heavy bleeding and warrants medical evaluation.
• Prolonged periods: Bleeding that lasts more than seven days is another hallmark of AUB.
• Postmenopausal bleeding: Any bleeding after menopause is abnormal and should be assessed promptly.
• Fatigue and anaemia symptoms: Excessive bleeding may cause fatigue, dizziness, or shortness of breath due to low iron levels.
• Pelvic pain or cramping: Pain may occur with bleeding and could indicate underlying conditions.
• Hormonal symptoms: Vaginal dryness, mood swings, hot flashes, or excessive hair growth may also be present in some cases.

If you experience persistent or severe symptoms, it's important to promptly consult your doctor to rule out serious causes and prevent potential complications.

Common Causes of Abnormal Uterine Bleeding

There are several potential abnormal uterine bleeding causes, including:

1. Hormonal imbalances:
Hormonal regulation plays a critical role in the menstrual cycle. Disruptions in oestrogen and progesterone levels can cause irregular or heavy bleeding.

• Anovulatory cycles: When ovulation does not occur, the body may produce oestrogen without progesterone, leading to irregular or prolonged bleeding.
• Polycystic ovary syndrome (PCOS): This hormonal disorder can cause infrequent, prolonged, or absent periods due to imbalanced hormone levels.
• Thyroid disorders: Both hypothyroidism and hyperthyroidism can interfere with menstrual regularity.
• Perimenopause: As women approach menopause, fluctuating hormone levels often result in unpredictable bleeding patterns.

2. Structural abnormalities:
Issues within the uterus or reproductive tract can directly impact menstrual flow and cause abnormal bleeding.

• Uterine fibroids: These noncancerous growths in the uterine wall can cause heavy, prolonged, or irregular menstrual bleeding.
• Uterine polyps: Benign growths on the uterine lining may cause spotting between periods or heavy menstrual flow.
• Adenomyosis: This condition occurs when endometrial tissue grows into the uterine muscle, often leading to painful and heavy bleeding.
• Endometriosis: Endometrial tissue growing outside the uterus may cause painful periods, pelvic pain, and sometimes irregular bleeding, though it more commonly causes pain than heavy bleeding.

3. Pregnancy-related issues:
Abnormal bleeding can also occur in early pregnancy and may indicate complications:

• Miscarriage: Bleeding during early pregnancy may be a sign of pregnancy loss.
• Ectopic pregnancy: A dangerous condition where a fertilised egg implants outside the uterus, often causing bleeding and pelvic pain.

4. Other medical conditions:
Systemic health issues can also contribute to AUB:

• Bleeding disorders: Conditions like von Willebrand disease can make blood clotting difficult, leading to heavy menstrual bleeding.
• Liver or kidney disease: These can affect hormone metabolism and platelet function.
• Certain cancers: Uterine, cervical, or ovarian cancers may cause postmenopausal or abnormal bleeding.

5. Medications and devices:
Certain medications or contraceptives can also trigger AUB.

• Hormonal contraceptives or hormone replacement therapy (HRT) may cause irregular bleeding, especially when started or changed.
• Blood thinners can increase bleeding risk.
• Intrauterine devices (IUDs), particularly copper IUDs, may cause heavier periods or spotting.

Being aware of this range of potential abnormal uterine bleeding causes can help guide timely diagnosis and appropriate treatment.

When Is Bleeding Considered Abnormal?

Bleeding is considered abnormal if it meets any of these criteria:

• Occurs between regular periods (intermenstrual bleeding)
• Excessively heavy flow (soaking through protection hourly for several hours, passing large clots)
• Lasts longer than 7 days
• Cycles shorter than 21 days or longer than 35 days
• Unpredictable or erratic cycle length
• Any vaginal bleeding after menopause

If you notice any of these patterns, it's recommended to promptly seek medical evaluation to identify the underlying cause and appropriate treatment.

How Is Abnormal Uterine Bleeding Diagnosed?

Diagnosing AUB involves a thorough medical history, physical exam, and laboratory testing to uncover potential causes:

• Comprehensive medical and menstrual history (cycle length, duration, flow, associated symptoms)
• Physical and pelvic exam to assess the vagina, cervix, and uterus
• Pregnancy test to rule out pregnancy-related bleeding
• Blood tests to check for anaemia, hormone levels (FSH, LH, thyroid, androgen, prolactin, and progesterone), and clotting disorders
• Pap smear to screen for cervical pathology
• Cultures to test for infection when indicated

Based on these initial findings, your doctor may recommend further evaluation with imaging studies or an endometrial biopsy to provide a complete picture.

Diagnostic Tests for AUB

Specific tests can help pinpoint the cause of abnormal uterine bleeding:

• Pelvic ultrasound: Uses sound waves to visualise the uterus, endometrial lining, and ovaries, checking for uterine fibroids, polyps, or other structural abnormalities.
• Saline infusion sonohysterogram: Employs saline solution and ultrasound to enhance visualisation of the uterine cavity.
• Endometrial biopsy: Obtains a small sample of the uterine lining to check for cancer, precancerous changes, or hormonal imbalances.
• Hysteroscopy: Allows direct visualisation of the uterine cavity using a thin, lighted camera. May be used to identify and sometimes treat polyps or fibroids.
• Complete blood count (CBC): Checks for anaemia resulting from heavy blood loss.
• Blood clotting and liver/kidney function tests: Can identify bleeding disorders or systemic disease contributing to AUB.
• Pap smear and HPV test: Screens for cervical cancer or precancerous changes.

The choice of diagnostic tests depends on factors like age, specific symptoms, and individual risk factors.

Who Does Abnormal Uterine Bleeding Affect?

Abnormal uterine bleeding can affect women across various life stages and health backgrounds:

• Adolescent girls, especially in the first two years after their first period, due to anovulatory cycles
• Women approaching menopause, as hormonal fluctuations become more pronounced
• Those with polycystic ovary syndrome, thyroid disorders, or bleeding disorders
• Women who have uterine fibroids, polyps, or adenomyosis
• Anyone taking certain medications, such as anticoagulants or hormonal therapies, or using an IUD
• Women who are pregnant or experiencing pregnancy-related complications
• Postmenopausal women (any bleeding after menopause is always abnormal).

What Are The Complications of Abnormal Uterine Bleeding?

Chronic or heavy abnormal uterine bleeding can lead to iron-deficiency anaemia, causing symptoms like fatigue, weakness, and shortness of breath. In severe, untreated cases, significant blood loss may require medical intervention. Additionally, AUB may signal underlying conditions such as endometrial hyperplasia or cancer. For some women, abnormal uterine bleeding can impact fertility, either by indicating ovulatory dysfunction or causing structural changes in the uterus.

How Can We Reduce Our Risk Of Menometrorrhagia?

Maintaining a healthy weight, managing stress levels, and addressing underlying medical conditions (such as thyroid or bleeding disorders) can help reduce the risk of menometrorrhagia. Regular gynaecologic check-ups, prompt treatment of hormonal imbalances, and early intervention for abnormalities like uterine fibroids are also important preventive measures. Women should report any unusual bleeding patterns to their doctor without delay for proper evaluation.

Treatment Options for AUB

Abnormal uterine bleeding treatment depends on the specific cause, severity of symptoms, and individual patient preferences.

The options include:

• Hormonal therapy: Combined hormonal contraceptives (pills, patches, or rings) or progestin-only options can help regulate cycles and reduce bleeding. The hormonal IUD is another effective option for many women.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can decrease blood loss and relieve cramps. Tranexamic acid is sometimes prescribed to promote blood clotting and reduce heavy flow.
• Surgical procedures: Endometrial ablation destroys the uterine lining, while uterine artery embolisation blocks blood supply to fibroids to shrink them. Hysterectomy (surgical removal of the uterus) may be considered for severe cases not responsive to other treatments.

Your doctor will work with you to develop a personalised abnormal uterine bleeding treatment plan that addresses your specific needs and health goals.

How AUB Affects Fertility and Menstrual Health

For some women, abnormal uterine bleeding can impact fertility and overall menstrual health. Irregular or absent ovulation (anovulation) associated with AUB may make it more difficult to conceive. Structural issues like uterine fibroids or polyps can also potentially interfere with implantation and pregnancy. Heavy or prolonged bleeding can lead to anaemia, fatigue, and reduced quality of life. Seeking prompt evaluation and treatment for abnormal uterine bleeding symptoms is important to address any underlying issues and preserve reproductive health.

What Can I Expect If I Have Abnormal Uterine Bleeding?

If you are diagnosed with abnormal uterine bleeding, you can expect:

• A comprehensive evaluation to identify the underlying cause
• An individualised treatment plan tailored to your specific needs
• Regular follow-up appointments to monitor your response to treatment
• Guidance on lifestyle modifications that may help manage symptoms
• Support and resources to help you cope with the emotional impact of AUB.

When to See a Doctor

It's important to consult your doctor if you experience:

• Bleeding or spotting between periods
• Extremely heavy bleeding (changing pad/tampon hourly)
• Menstrual cycles shorter than 21 days or longer than 35 days
• Bleeding lasting more than 7 days
• Bleeding after menopause
• Anemia symptoms like fatigue, shortness of breath, or pale skin

Your doctor can perform a thorough evaluation to determine the cause of your abnormal uterine bleeding and recommend appropriate treatment options.

Conclusion: Don't Ignore Unusual Bleeding Patterns

Abnormal uterine bleeding is a common concern, but it shouldn't be ignored. While many cases are benign, unusual bleeding patterns can occasionally signal underlying health issues that require medical attention. Familiarising yourself with the symptoms, causes, and diagnostic tests for AUB empowers you to take charge of your menstrual health. If you experience any signs of abnormal uterine bleeding, don't hesitate to consult your doctor for proper evaluation and care.

If you're experiencing abnormal bleeding patterns or have concerns about your menstrual cycle, Metropolis Healthcare is here to help. With a network of state-of-the-art diagnostic laboratories across India, Metropolis offers comprehensive testing services to aid in the diagnosis and management of abnormal uterine bleeding. Our team of skilled phlebotomists provides convenient at-home sample collection, ensuring your comfort and privacy.

FAQs

What qualifies as abnormal uterine bleeding?

Abnormal uterine bleeding refers to any bleeding that differs from your normal menstrual pattern in terms of regularity, duration, or amount. This includes heavy periods, bleeding between periods, prolonged bleeding, or postmenopausal bleeding.

What causes irregular menstrual bleeding?

Irregular menstrual bleeding can be caused by various factors, including hormonal imbalances, structural abnormalities (such as fibroids or polyps), certain medications, bleeding disorders, or underlying medical conditions like PCOS or thyroid disorders.

What is abnormal uterine bleeding called?

Abnormal uterine bleeding is often referred to as AUB. The term 'dysfunctional uterine bleeding' (DUB) specifically describes abnormal bleeding caused by hormonal imbalances, without any identifiable structural or organic cause.

Can abnormal bleeding be a sign of cancer?

While most cases of abnormal uterine bleeding are benign, in rare instances, it can be a symptom of cervical, uterine, or ovarian cancer, especially in postmenopausal women. Any abnormal bleeding should be evaluated by a doctor to rule out malignancy.

What is the abnormal uterine bleeding criteria?

Abnormal uterine bleeding is diagnosed when menstrual cycles are shorter than 21 days or longer than 35 days, bleeding lasts more than seven days, bleeding is excessively heavy, or there is bleeding between periods or after menopause.

Does abnormal bleeding affect fertility?

Abnormal uterine bleeding can impact fertility, particularly if the underlying cause is related to ovulatory dysfunction or structural abnormalities that interfere with conception or implantation. Treating the root cause can often improve fertility outcomes.

When should I be concerned about bleeding between periods?

Any bleeding between periods should be evaluated by a doctor. While occasional spotting may be normal, consistent or heavy bleeding between periods can indicate an underlying issue that requires medical attention.