Uterine Bleeding: Abnormal Uterine Bleeding
What is abnormal uterine bleeding?
Abnormal uterine bleeding is when you bleed between your monthly periods, or when you bleed for too long or it is an extremely heavy flow. Normal menstrual flow typically lasts approximately five days and occurs every 21 to 35 days.
How common is abnormal uterine bleeding?
Abnormal uterine bleeding is not always reported by women experiencing symptoms. Because of this, 3% to 35% of women worldwide may have abnormal uterine bleeding. It is estimated that about 1% of women in the U.S. are impacted by abnormal uterine bleeding.
Symptoms and Causes
What are the causes of abnormal uterine bleeding?
There are many causes of abnormal bleeding, including:
- Structural abnormalities in the uterus, including:
- Uterine cancer
- Cervical cancer
- Blood thinners for anticoagulation (medications that reduce the risk of blood clots)
- Platelet dysfunction
- Early pregnancy
- Hormonal changes
Polycystic ovary syndrome (PCOS) is a condition where cysts grow in the ovaries. PCOS may lead to hormonal imbalance. This condition may cause your periods to come at different times or not at all. PCOS is caused when certain hormones are out of balance. When this happens, you may have difficulty getting pregnant. You may grow hair on your body and face. Also, the hair on your scalp may get thinner.
Women who are going into menopause or are in menopause are more apt to have changes in hormones. The changes can cause the lining of the uterus (endometrium) to get thick. This can cause bleeding, or abnormal menstrual cycles in terms of long the cycle lasts and how heavy it is (duration and quantity). For women who are in menopause, any bleeding should be thought of as not normal and should be investigated.
What are the signs and symptoms of abnormal uterine bleeding?
The signs of abnormal uterine bleeding can vary. Some signs that your bleeding may be abnormal include:
- Menorrhagia (heavy menstrual bleeding)
- Bleeding at unusual times (between periods, after sex, during menopause)
- Unusually long periods (seven days or longer)
- Inconsistent menstrual cycles
Diagnosis and Tests
How is abnormal uterine bleeding diagnosed?
Your healthcare provider will ask you several questions when working to diagnose abnormal uterine bleeding. These questions may include:
- What brings on the bleeding?
- What other symptoms are you experiencing?
- Are you pregnant?
Your healthcare provider will then do a physical exam, including:
- A pelvic exam
- An exam of the cervix
- A Pap smear
What tests will my healthcare provider order?
Your healthcare provider will order several tests when diagnosing abnormal uterine bleeding. These tests may include:
- A pregnancy test if you are not in menopause.
- Blood tests to check how your blood clots and do a complete blood count.
- A thyroid test. (Problems with thyroid function may be a sign that there is also a problem with ovary function.)
- Hormone levels.
- A hysteroscopic exam of the lining of your uterus (endometrium). This test is used to look for fibroids, polyps or signs of cancer.
- A pelvic ultrasound.
- A biopsy of the endometrium. This test is recommended if you:
- Are more than 35 years of age
- Have a family history
- Have risk factors for cancer
Management and Treatment
How is abnormal uterine bleeding treated?
Treatment of abnormal uterine bleeding will depend on the cause of the bleeding. Some treatments may include:
- Birth control pills
- Progestin (this can be given by a shot, implant or device placed in your uterus called an IUD nonsteroidal anti-inflammatory drugs [ibuprofen])
What surgical options are available for women with abnormal uterine bleeding?
There are several surgical options used to treat the causes of abnormal uterine bleeding. Your healthcare provider will advise you on the best option based on your condition.
If the cause of your abnormal uterine bleeding is a structural issues, such as a fibroid or polyp, surgery may be needed. One option for getting rid of fibroids is called uterine artery embolization. With this, the fibroids’ blood supply is cut off by putting tiny particles into the uterine arteries. This makes the fibroids shrink. Uterine fibroids can also be removed surgically, while keeping the uterus and the ability to have children. This is called a myomectomy.
Surgery to destroy the lining of the uterus, called uterine ablation, may be an option for some women. Uterine ablation is not recommended for women who may want to have more children in the future. With this, the lining of the uterus is destroyed through the use of a laser, heat, electricity, microwave energy or freezing.
Taking out the uterus (hysterectomy) may be tried as a last resort. This may be done when hormone treatment fails to control heavy bleeding.
Cancer or cancerous changes in the endometrium are often treated with hysterectomy. This is sometimes followed by radiation. If cervical cancer is the cause, the treatment depends on the stage of the cancer. Hysterectomy is often used to treat early stages. More advanced stages may need radiation or chemotherapy.