Abnormal Uterine Bleeding

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What is abnormal uterine bleeding?

Abnormal uterine bleeding is a very common symptom that brings a woman to her doctor. It can happen at any age group. It is important to report these symptoms immediately as some times the cause of this bleeding can be very serious. Normally the bleeding happens every 28 days and a period of seven days before or after is considered a variation of normal.

What are the types?

There are various types of abnormal uterine bleeding. The terminologies used to describe the different types are explained below.

Dysmenorrhoea (Painful Cramps)

Dysmenorrhoea is severe and frequent cramping during menstruation. Pain occurs in the lower abdomen but can also spread to the lower back and thighs.

Menorrhagia (Heavy bleeding)

Menorrhagia is the medical term for significantly heavier bleeding. This can be caused by a number of factors. You should consult a doctor if any of the following occurs

  • Soaking through at least one pad or tampon ever 1-2 hours for several hours
  • Heavy periods that regularly last more than 10 days

Intermenstrual bleeding

Intermenstrual bleeding is bleeding from the uterus in-between periods. This should be evaluated immediately as it may be due to cancer or pre-cancer.

Post coital bleeding

Post coital bleeding (PCB) is non-menstrual bleeding that occurs immediately after sexual intercourse.

Post menopausal bleeding

Post menopausal bleeding (PMB) is vaginal bleeding that occurs after 12 months without a period. It does not apply to young women unless it follows premature ovarian failure or premature menopause.

What causes it?

There are various causes that lead to any of the abnormal uterine bleeding. Some of the causes are listed below

  • Hormonal imbalance
  • Some of the contraceptive methods like combined oral contraceptive pills
  • Vaginal infections
  • Cervical polyps
  • Cervical cancer
  • Uterine cancer
  • Vaginitis
  • Fibroids
  • Polycystic ovaries
  • Systemic disorders e.g. thyroid
Diagnosis:

Usually a series of investigations are performed in order to find the aetiology behind the disorder. These investigations may include:

  • Blood Tests
  • Vaginal swabs
  • Pap smear
  • Pelvic ultrasound
  • Dilatation and curettage – taking a small sample of the lining of the uterus to check for any abnormalities
  • Hysteroscopy – a small thin telescope to visualise the inside of the uterus
  • Laparoscopy – a small thin telescope to visualise the pelvic cavity
Treatment

The treatment of abnormal uterine bleeding depends on the type of abnormality, your age, cause of bleeding and whether you have completed your family or not. Treatments can be medications or surgery.

Medications:

Some of the medications used are

  • Oral contraceptive pills – these will help the periods and decrease the amount of bleeding
  • Non steroidal anti-inflammatory drugs – This will help with the pain and amount of bleeding
  • Tranexamic acid - This is a non hormonal medication that helps to reduce the amount of bleeding
  • Mirena IUCD – this is a contraceptive device that helps in reducing the volume of menstrual flow.
Surgery:

Sometimes, surgery is the only option for treatment like fibroids inside the uterine cavity. This will require removal of the same either hysteroscopically or removal through laparoscopy or open procedure. Other surgical procedures include endometrial ablation, which uses various sources of energy to destroy the lining of the uterus. Most of the times, it stops the bleeding altogether or reduces to a small amount.

When all other options have been explored, hysterectomy is a final option. As it is major surgery, this needs to be discussed with your doctor.