Abnormal Uterine Bleeding

By: Dr. Suneet Kaur Malhotra – Consultant, Obstetrics & Gynaecology

Learn more about Dr. Suneet Kaur Malhotra

What is AUB?

Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time. Bleeding may be heavier or lighter than usual and occur often or randomly. Any deviation from your usual pattern of menses/periods comes under abnormal uterine bleeding.

Abnormal Uterine Bleeding can occur as:

• Spotting or bleeding between your periods.
• After sexual intercourse.
• For longer days or heavier than normal menstrual cycle.
• After menopause.
• More common in teenagers or in premenopausal women.

What are the causes of AUB?

In many women, AUB is caused by hormonal imbalance. It can also occur due to the following causes:

• Thickening of the uterine wall or lining.
• Uterine fibroids.
• Uterine polyps.
• Cancers of ovaries, uterus, cervix, or vagina.
• Bleeding disorders or problems with blood clotting.
• Polycystic ovary syndrome.
• Severe weight loss.
• Hormonal birth control, such as birth control pills or intrauterine devices (IUD).
• Excessive weight gain or loss (more than 4.5 kilograms).
• Infection of the uterus or cervix.

Diagnosis for the cause of Abnormal Uterine Bleeding

It is very essential to understand the cause of abnormal bleeding. The following diagnostic methods can be done:

• Thorough pelvic examination by ultrasound.
• Pap smear - Screening test for cervical cancer.
• Hormone tests in blood, like thyroid and prolactin levels.
• Pregnancy test.
• Hysteroscopy - Examination of the inside of the uterus and its lining with a camera.
• Endometrial biopsy - To rule out any cancer or pre-cancerous conditions like hyperplasia.

Treatment

The treatment modalities include medications or surgical methods:

Medicines

Non-hormonal and hormonal medications depending on the diagnosis.

Surgical

• Hysteroscopy: A procedure through which atypical structures in the uterus, like fibroids and polyps, are removed.
• Uterine artery embolization: Stops blood flow to fibroids, causing them to shrink.
• Myomectomy: Removes fibroids while keeping the uterus intact and preserving one’s ability to get pregnant.
• Endometrial ablation: Destroys the uterus lining through the use of laser, heat, electricity, microwave energy, or freezing.
• Hysterectomy: Removal of the uterus. Used when medication does not provide relief or to treat cancer or pre-cancerous changes in the endometrium. Advanced stages of cancer may need radiation or chemotherapy.

Prevention

It is difficult to prevent many causes of abnormal uterine bleeding, but the risk of certain conditions can be reduced:

• Maintaining a healthy weight plays a potential role in keeping hormones balanced.
• Avoiding diets that contain a high amount of animal fat can reduce the risk of some cancers.
• Ensuring safer sexual practices can reduce the risk of certain sexually transmitted infections (STIs) that can cause abnormal uterine bleeding.

Conclusion

Abnormal Uterine Bleeding should never be ignored. Timely and proper diagnosis is a must to prevent its complications, such as cancer, and for further management.