According to a nationwide, doctor-centric research study, abnormal uterine bleeding affects 10 – 30% of women in India. The research suggests that females within the reproductive group (ages 15-49) account for 82.9% of the total cases reported by doctors. As such, abnormal uterine bleeding is ubiquitous because it affects the physical, mental, socio-economic, and quality of life of an individual.

Considering the fact that it affects so many women, demystifying the condition will raise awareness and increase prevention. This article seeks to expound on some causes and patterns of abnormal uterine bleeding, its symptoms, and the diagnosis and treatment of the condition.  

What Is abnormal uterine bleeding? 

Abnormal Uterine Bleeding (AUB), formerly known as Dysfunctional Uterine Bleeding, is excessive bleeding from the uterus. Excessive bleeding occurs either during your menstrual period (heavy flow) or between monthly cycles. A normal menstrual cycle lasts for about 5 to 7 days, whereas unusual uterine bleeding can last for a long duration.  

Common causes of abnormal uterine bleeding 

To determine the causes of abnormal uterine bleeding, you have to factor in the reproductive ages of those affected. The following are some of its reasons: 

1. Fibroids – Small or large non-cancerous muscle tissue that develops in and around the uterus
2. Polyps – Abnormal growths which take on round or oval shapes and develop within the uterus lining and cervix
3. Hormonal Imbalance –  When the endocrine system releases too much estrogen or too little progesterone into the bloodstream
4. Uterine Cancer – Cancer that affects the uterus
5. Cervical Cancer – Cancer that affects the cervix
6. Hypothyroidism – In severe hypothyroidism, the thyroid gland cannot produce enough thyroid hormone

Apart from the causes of abnormal uterine bleeding mentioned above, here are a few others explained: 

Endometriosis

Endometriosis entails abnormalities of the lining of the uterus. In some women, this tissue that generally grows in the uterus grows outside of it. This lining settles over the ovaries, and may even find its way to the Fallopian tubes and pelvic region.

Polycystic Ovary Syndrome (PCOS) 

PCOS is a hormonal abnormality that affects 10% of women of their reproductive age. The condition is characterised by the overproduction of testosterone. Polycystic ovaries are enlarged and comprise many small follicles that do not mature. The result may sometimes lead to menstrual irregularity and unusual uterine bleeding.  

Also, Read: Meal Plan For Polycystic Ovary Syndrome Patients

Perimenopause

Perimenopause is a term used to define your transition into menopause. In most cases, women experience conflicting bleeding patterns during perimenopause. But if you are experiencing irregular or heavy bleeding more often than not, you have chances of suffering from abnormal uterine bleeding.

Abnormal uterine bleeding: signs and symptoms 

Although the signs of excessive uterine bleeding may differ from one person to another, a few of the symptoms include:  

1. Menorrhagia – A condition wherein your bleeding is excessively heavy, or you suffer from abnormally long-period cycles
2. When your menstrual cycles are irregular for a prolonged period
3. Secondary Dysmenorrhea – Severe abdominal cramps experienced at the time of your monthly period, which may even continue after menses
4. Bleeding between cycles, after intercourse, during menopause and perimenopause

When it comes to the diagnosis of abnormal uterine bleeding, your doctor will be able to understand the symptoms correctly. Do not hesitate to talk to your gynaecologist if you notice any of these signs.

Diagnosis of abnormal uterine bleeding 

Your doctor may suggest a series of tests to diagnose you. The diagnosis of excessive uterine bleeding depends on your age, situation and history. Based upon these factors, your healthcare provider may ask you the following questions:

• A complete list of symptoms you are experiencing
• What instigates the bleeding, and how heavy is it?
• Are you pregnant?
• What is your age?

The tests involved in concluding a diagnosis are as mentioned below:

1. A pregnancy test
2. A blood count check (to ensure that you don’t have a low blood count on account of the blood loss)
3. A pelvic exam (an ultrasound of your pelvic area that could point out the cause of your bleeding)
4. An endometrial biopsy (a sample of the uterine lining will be tested for cancer or a change in cells)
5. Hysteroscopy (for a view of the inside of the uterus to look for abnormalities)
6. An exam of the cervix
7. A thyroid function test (to understand whether your ovaries are functioning)

Abnormal uterine bleeding: treatment and surgical procedures

The treatment options of unusual uterine bleeding depend on the causes of your bleeding. You must also consider age and whether you’re looking to get pregnant. This will help determine how best your doctor can help you.

Some of the standard treatment options women opt for: 

• Birth Control Pills – Your doctor may prescribe birth control pills to stop your uterus lining from getting thick. The pills can also regulate your period cycle and significantly reduce your cramps.
• Intrauterine device (IUD) – An IUD is a device used for birth control that is inserted into a woman’s uterus.  Doctors use a certain IUD known to release hormones to reduce unusual uterine bleeding considerably.
• Dilation and Curettage (D&C) – A Dilation and Curettage procedure will ensure that the thick lining of your uterus is scraped away. The process involves opening up your cervix just enough to insert a surgical tool into your uterus. The subsequent lining sample is sent to the lab to check for abnormal tissue.
• Hysterectomy – A hysterectomy involves the surgical removal of the uterus. The procedure will stop you from having your periods and getting pregnant. The surgery is usually considered as a last resort to stopping abnormal uterine bleeding.  

Prevention of excessive uterine bleeding  

Preventive measures for the dysfunctional uterine bleeding centre around several factors such as age, history and other underlying conditions. A few of the measures are: 

• Sustaining a healthy weight
• Taking your birth control pills regularly and as prescribed by your gynaecologist
• Make sure you take your regular dose of hormone replacement therapy as suggested by your doctor

Conclusion 

As it turns out, you may experience abnormal heavy bleeding due to several reasons. But still, it is wise to rule out any signs of abnormal or dysfunctional uterine bleeding. You can schedule an appointment with a gynaecologist or obstetrician if you recognise any of the above symptoms.