Abnormal Uterine Bleeding: Causes, Diagnosis, and Management
Abnormal uterine bleeding (AUB) is a common gynecological concern that affects women of all ages. It refers to bleeding from the uterus that is irregular in volume, duration, or timing, and is not related to normal menstruation. While occasional changes in menstrual cycles can be normal, persistent or heavy abnormal bleeding often signals an underlying medical issue that requires evaluation.
What is Considered Abnormal Uterine Bleeding?
AUB can occur in several forms:
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Heavy menstrual bleeding (menorrhagia): Excessive blood loss during regular periods.
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Intermenstrual bleeding: Bleeding between normal periods.
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Polymenorrhea: Menstrual cycles occurring less than 21 days apart.
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Oligomenorrhea: Infrequent cycles more than 35 days apart.
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Postmenopausal bleeding: Any vaginal bleeding after menopause.
Common Causes of Abnormal Uterine Bleeding
AUB can result from a variety of structural, hormonal, and systemic factors. The FIGO PALM-COEIN classification helps organize causes into two categories:
Structural Causes (PALM)
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P – Polyps: Benign growths in the uterine lining.
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A – Adenomyosis: Endometrial tissue growing into the uterine wall.
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L – Leiomyomas (fibroids): Noncancerous tumors of the uterus.
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M – Malignancy and hyperplasia: Precancerous or cancerous growths.
Non-Structural Causes (COEIN)
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C – Coagulopathy: Blood clotting disorders.
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O – Ovulatory dysfunction: Hormonal imbalances such as PCOS, thyroid issues, or perimenopause.
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E – Endometrial: Local problems within the endometrium.
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I – Iatrogenic: Side effects of medications, contraceptives, or procedures.
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N – Not yet classified: Rare or poorly understood conditions.
Risk Factors
Several conditions increase the likelihood of AUB, including:
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Adolescence (anovulatory cycles after menarche)
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Perimenopause
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Obesity
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Polycystic ovary syndrome (PCOS)
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Thyroid disorders
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Use of anticoagulants or hormonal medications
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Family history of bleeding disorders
How is Abnormal Uterine Bleeding Diagnosed?
A thorough evaluation is necessary to identify the cause. Diagnosis may involve:
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Medical history and physical examination
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Pelvic ultrasound: To detect polyps, fibroids, or thickened endometrium
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Blood tests: To assess hormones, thyroid function, or clotting disorders
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Endometrial biopsy: To rule out hyperplasia or cancer
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Hysteroscopy: Direct visualization of the uterine cavity
Treatment Options
Treatment depends on the underlying cause, severity, age, fertility goals, and overall health.
Medical Management
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Hormonal therapy: Oral contraceptives, progestins, or intrauterine devices (IUDs) with levonorgestrel.
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Non-hormonal options: NSAIDs (reduce bleeding and pain), tranexamic acid (helps clotting).
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Iron supplementation: To manage anemia from blood loss.
Surgical Management
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Polypectomy or myomectomy: Removal of polyps or fibroids.
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Endometrial ablation: Destruction of the uterine lining to reduce bleeding.
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Hysterectomy: Removal of the uterus, considered when other treatments fail or cancer is present.
When to Seek Medical Attention
You should consult a healthcare provider if you experience:
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Soaking through pads/tampons every hour for several hours.
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Passing large blood clots frequently.
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Bleeding between periods or after sex.
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Vaginal bleeding after menopause.
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Symptoms of anemia (fatigue, dizziness, shortness of breath.
Conclusion
Abnormal uterine bleeding is not just a nuisance—it can signal significant underlying conditions ranging from hormonal imbalances to serious diseases like cancer. Early diagnosis and tailored treatment can greatly improve quality of life and prevent complications such as anemia or fertility issues. Women experiencing unusual or heavy bleeding should not ignore their symptoms but seek timely medical evaluation for proper care.
Dr.Ifrah Hassan Hilaac.
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