Abnormal Uterine Bleeding (AUB)?
Before we consider what is abnormal, it is important to consider the range of normal menstrual patterns. Most women will have bleeding with their period that lasts for 3-8 days with an average duration between periods of 28 days and a range of 21-35 days. It is important to note that for both obstetrics and gynaecological situations ‘Day 1 of the cycle’ is considered as the first day of menstrual bleeding.
Abnormal Uterine Bleeding (AUB) may therefore be:
- Bleeding or spotting in between periods (also called intermenstrual bleeding)
- Heavy periods or periods that last longer than normal (also called menorrhagia, although this term is no longer used medically)
- Bleeding after sex (post-coital bleeding)
- Bleeding after the menopause (post-menopausal bleeding)
- Not having any periods for a minimum of 3 months (amenorrhoea)
What causes AUB?
AUB may have many different causes depending on the type of abnormal bleeding that is present. We generally divide these problems into those that may be seen (structural problems like polyps) those that cannot be seen (this group would include hormonal irregularities).
Structural problems that may lead to AUB includes:
Polyps: These are growths of the lining of the uterus. They are relatively common and most (>99%) are benign (non cancerous), but rarely they may have cellular changes of cancer or pre-cancer. Your symptoms, the size of the polyp, the number of polyps and your personal history will be considered when considering treatment options if you are diagnosed with a polyp.
Adenomyosis: Adenomyosis is a condition where the lining of the uterus has grown into the wall of the uterus. It is often considered to be similar to endometriosis, since may of the symptoms are similar and the findings under the microscope are also similar, it is only the location (inside the uterine muscle rather than outside of the uterus) that causes its change of name. Symptoms can include heavy and painful periods. A variety of medical and surgical options are used to treat this AUB problem.
Fibroids (Myomas): These are benign growths of the muscular wall of the uterus and are very common. They may cause a number of symptoms aside from bleeding issues and there is a full information available here.
Cancer: Cancer of is a rare cause of bleeding compared to the other causes of AUB, but of course is very important to diagnose, since early detection and treatment of cancers often mean cures for women. Certain types of cancer or pre-cancer may cause problems with bleeding such as vaginal, uterine or cervical cancer. If you have abnormal bleeding, then it is important that you see your GP or gynaecologist and bleeding after menopause should never be ignored, since this is a time of increased disk of cancer of the lining of the uterus in particular.
The other major group of problems that may cause AUB are those that cannot be seen with the eye or on a scan. This group includes clotting abnormalities in the blood, hormonal issues such as polycystic ovarian syndrome and some types of hormonal and other medications. Your Alana doctor may do additional tests to help determine if this is the cause for the AUB in your particular circumstance.
How is AUB diagnosed?
Your Alana Doctor will ask you about your symptoms as well as your personal and family history. If you have had previous scans or blood tests, you should bring these with you as they may be helpful. An examination will be performed by your Alana Doctor that will include a speculum examination, pap smear and internal examination to check for any abnormalities. Occasionally, these may be treated very simply at the same time as the examination, such as the removal of small polyps on the cervix. Your Alana Doctor may also for further blood tests to be performed.
A pelvic ultrasound is one of the most important investigations to help to diagnose the cause of AUB. This may be performed at the time of your examination by your Alana Doctor and will help to provide very immediate and useful information about the diagnosis.
Your Alana Doctor may recommend that you have other tests such as a hysteroscopy (a long and narrow telescope that is gently inserted through the cervix and into the uterus) and biopsy of the lining of the uterus. Your Alana Doctor will discuss this with you in more detail if it is required
What are the treatments for AUB?
The treatment of AUB will vary and depends on a number of factors, most importantly the cause, but also your age and desire to have children. Generally, the treatments may be broken down into watch-and-wait (and perhaps a review), medical treatments and surgical treatments.
Medications: Hormonal and other medications may be used to control AUB. These range from non-steroidal anti-inflammatory medications (NSAIDs) such as Ponstan, Nurofen or Ibuprofen, medications to help clotting such as Cyklokapron, or hormones such as progesterone, the oral contraceptive pill or a hormone releasing intrauterine system (IUD).
Surgery: Sometimes surgical removal of the cause of the AUB is required and this will be discussed with you by your Alana doctor. Surgical procedures are commonly performed by hysteroscopy as mentioned above, or by laparoscopy (keyhole surgery in the abdomen) depending on what the cause is. Other methods such as endometrial ablation, where the lining of the uterus is surgically and permanently removed may be recommended and your Alana doctor will discuss this with you in more detail after your specific problem has been considered.
Frequently Asked Questions
- Breakthrough bleeding: which happens as the pregnancy hormones interfere with the hormones of your normal menstrual cycle. This causes some the endometrial lining to be shed. Spotting or light bleeding may come and go for several days.
- Implantation bleeding: which happens when the fertilised egg implants in the endometrial lining of the uterus. The endometrial lining has been prepared for the nestling of the fertilised egg during the menstrual cycle and has now got a very good blood supply. The implantation may therefore be associated with some light bleeding.
- Other causes: which may include changes to your cervix by the pregnancy hormones; it softens the cervix and causes an area of cells covering the cervix to move towards the outside of the cervix. These cells are more prone to bleeding, especially when touched during intercourse. It is important to be up to date with your Pap smear screening tests as bleeding may also be caused by abnormal cells. Bleeding can also be linked to vaginal or cervical infection which would require further investigation with a vaginal swab and may need treatment. A harmless growth on the cervix called a polyp may also cause bleeding at any stage in the pregnancy. A speculum examination (as is done with the Pap smear) will reveal this polyp, and usually nothing needs to be done about it during your pregnancy.