What Is Abnormal Uterine Bleeding? Symptoms, Causes & Treatment

Written by Medicover Team and Medically Reviewed by Dr Vineela Medapati , Gynecologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Abnormal uterine bleeding (AUB) is a common gynaecological issue affecting women of all ages. It is characterized by bleeding that differs from a woman's normal menstrual cycle. This can include heavy bleeding, prolonged periods, spotting between periods, or bleeding after menopause. Understanding the causes of AUB is crucial for accurate diagnosis and effective treatment.

What are the Symptoms of Abnormal Uterine Bleeding

The symptoms of AUB can vary widely, often depending on the underlying cause. Some common symptoms include:

Bleeding or spotting between periods
Menstrual bleeding that lasts longer than usual
Menstrual cycles that are shorter than 21 days or longer than 35 days
Heavy menstrual bleeding requiring frequent change of sanitary products
Bleeding after sexual intercourse
Postmenopausal bleeding

What are the Causes of Abnormal Uterine Bleeding?

The causes of abnormal uterine bleeding are diverse and can be categorized into structural and non-structural causes, as per the PALM-COEIN classification:

Structural Causes of Abnormal Uterine Bleeding

Polyps: Benign growths on the lining of the uterus or cervix can cause heavy or irregular bleeding.
Adenomyosis: The inner lining of the uterus breaks through the muscle wall of the uterus, leading to heavy periods and painful menstruation.
Leiomyomas (Fibroids): Noncancerous growths of the uterus that often appear during childbearing years can cause heavy menstrual bleeding and prolonged periods.
Malignancy and Hyperplasia: Precancerous changes or cancer of the uterus or cervix can result in abnormal bleeding.

Non-Structural Causes of Abnormal Uterine Bleeding

Coagulopathy: Disorders affecting blood clotting can lead to heavy menstrual bleeding.
Ovulatory Dysfunction: Irregular or absent ovulation can cause irregular menstrual cycles and bleeding.
Endometrial Causes: Issues with the lining of the uterus that are not related to structural abnormalities can cause abnormal bleeding.
Iatrogenic Causes: Certain medications, especially those affecting hormone levels, can cause AUB.
Not Yet Classified: Situations where the cause of bleeding does not fit into the above categories.

Hormonal Factors of Abnormal Uterine Bleeding

Hormones play a significant role in regulating the menstrual cycle. Imbalances in hormones such as estrogen and progesterone can lead to abnormal uterine bleeding. Conditions such as polycystic ovary syndrome (PCOS) and thyroid disorders can also disrupt hormonal balance, leading to AUB.

When to See a Doctor for Abnormal Uterine Bleeding During Menopause?

Abnormal uterine bleeding can disrupt your daily routine, causing severe fatigue or social withdrawal. Persistent heavy flow may lead to chronic anemia or indicate underlying health issues that require professional diagnosis and hospital-based management to restore your quality of life.

You should see a doctor if you have:

Bleeding that lasts longer than seven days per cycle.
The need to change pads or tampons every hour for several hours.
Spotting or bleeding between periods or after menopause.

Get medical help immediately if:

You experience severe pelvic pain or high fever with bleeding.
Dizziness, fainting, or extreme paleness occurs.
You are passing blood clots larger than the size of a quarter.

These could be signs of a serious complication like Anemia, which needs urgent care.

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What is the Abnormal Uterine Bleeding During Pregnancy?

Abnormal uterine bleeding can sometimes be associated with pregnancy. It can indicate various conditions, such as:

Ectopic Pregnancy: A pregnancy that occurs outside the uterus, often in a fallopian tube, can cause bleeding and is a medical emergency.
Miscarriage: Bleeding during early pregnancy can be a sign of miscarriage.
Placental Abruption: The detachment of the placenta from the uterus before delivery can cause bleeding and is a severe condition.

What are the Diagnosis of Abnormal Uterine Bleeding?

Diagnosing the cause of abnormal uterine bleeding involves a comprehensive approach, including:

Medical History and Physical Examination: Understanding the patient's medical history and conducting a physical exam to identify any potential causes.
Laboratory Tests: Blood tests to check for anaemia, thyroid issues, and clotting disorders.
Imaging Tests: Ultrasound, MRI, or hysteroscopy to visualize the uterus and detect any structural abnormalities.

What are the Treatment Options for Abnormal Uterine Bleeding

Treatment for abnormal uterine bleeding depends on the underlying cause, the severity of the bleeding, and the patient's overall health and preferences. Options include:

Medications for Abnormal Uterine Bleeding

Hormonal Therapy: Birth control pills, hormonal IUDs, and other hormone therapies can regulate menstrual cycles and reduce bleeding.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These can reduce menstrual blood loss and relieve pain.
Tranexamic Acid: A medication that helps reduce bleeding.

Surgical Options for Abnormal Uterine Bleeding

Dilation and Curettage (D&C): A procedure to remove tissue from the inside of the uterus.
Endometrial Ablation: A procedure to destroy the lining of the uterus to reduce or stop bleeding.
Myomectomy: Surgical removal of fibroids.
Hysterectomy: Removal of the uterus, which is considered for severe cases where other treatments have failed.

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What are the Reasons for Abnormal Uterine Bleeding During Menopause?

Bleeding after menopause is considered abnormal and requires medical evaluation. Common causes include:

Hormone Replacement Therapy (HRT) Can cause bleeding similar to a menstrual period.
Endometrial Atrophy: Thinning of the lining of the uterus due to lower hormone levels.
Endometrial Hyperplasia or Cancer: Thickening of the uterine lining can lead to cancer, particularly in postmenopausal women.

Abnormal uterine bleeding is a multifaceted condition with a wide array of causes. Understanding these causes is essential for accurate diagnosis and effective treatment.

If you experience any symptoms of abnormal uterine bleeding, consult a healthcare professional for evaluation and management. Early intervention can help address underlying health issues and improve quality of life.