What is abnormal uterine bleeding (AUB)?

Abnormal uterine bleeding refers to any uterine bleeding that is not medically normal. Medically normal menstrual cycle is one in which the uterine bleeding occurs regularly anytime between every 21-35 days, lasts for a maximum of 7 days and is associated with bearable blood loss and lower back or abdominal pain. Abnormal uterine bleeding is characterized by

  • Heavy bleeding or bleeding that lasts for more days
  • Spotting or bleeding between periods
  • Excessive passage of clots.
  • Bleeding after sex
  • Absence of menstrual periods for 3-6 months
  • Bleeding after menopause

What are the causes of AUB?

Young girls : In most cases this abnormal bleeding is caused by the application of foreign bodies or external irritants in the vagina. Girls born with a bleeding disorder may bleed heavily during menstrual cycle and this may be the first time that the problem is detected. Cancer related bleeding is rare.

Adolescents : Hormones play a very important role in this age group. For normal controlled menstruation to happen, regulated interplay of hormones is required. Abnormal bleeding could be caused by hormonal disturbances or imbalance of the reproductive hormones or other hormone related problems such as thyroid problems.

Reproductive age : Hormonal imbalances are the primary reason for abnormal bleeding for women of this age group. Other causes include uterine growths such as fibroids or polyps. It could also be caused due to certain medications. Hence it is important to keep your doctor informed of the medicines you take. Post-menopausal : Post menopause, due to lack of hormonal support, the reproductive tract becomes dry and may bleed abnormally. Abnormal bleeding could be due to cancer and requires medical attention at the earliest. Before reaching a conclusion, the impact of medications should also be considered as many women in this age group tend to be on many medications.

How is abnormal uterine bleeding evaluated?

Initial evaluation includes a thorough examination and understanding of the complete history by a qualified gynecologist. To understand the effects of bleeding on hemoglobin levels, on hormonal disturbances or bleeding disorders laboratory tests may be required. To detect the presence of lumps on the uterus or to detect any pregnancy related problems an ultrasound scan is done. To detect abnormal uterine bleeding, other tests such as hysteroscopy to view the inside of the uterus or endometrial biopsy in which a sample of uterine tissue is extracted and a microscopic examination is carried out.

How is AUB treated?

Treatment options vary depending on the cause of bleeding. Hormonal medications are prescribed in cases where the abnormal bleeding is due to hormonal imbalances. In  order to preserve the uterus in premenopausal women, hysterectomy is always used as the last option in exceptional cases.