Abnormal uterine bleeding (AUB) is the term used to refer to bleeding from your uterus (through the vagina) other than that of normal menstrual or monthly period. AUB can be ovulatory (an egg is released by your ovary) or anovulatory (egg is not released by your ovary).
Causes of Abnormal Uterine Bleeding
AUB can be due to many causes, some causes being more common than others depending on your age. It can be due to a complication of pregnancy, like intrauterine pregnancy, spontaneous abortion, ectopic pregnancy (pregnancy occurring outside the uterus), gestational trophoblastic disease, placenta previa.
AUB can also occur due to local infection or trauma. Any local pathology such as polyps or cancer of endometrium (body of uterus) or cervix can also lead to AUB. Certain systemic disorders like those of liver, kidney, endocrines and blood can cause AUB. The other causes are emotional stress, excessive exercise, and use of certain birth control measures like oral contraceptives and intrauterine devices.
AUB is called dysfunctional uterine bleeding (DUB) when no specific cause can be found, such as pelvic pathology, pregnancy, systemic disease or medication intake, and is diagnosed by excluding such causes. DUB is thought to be due to imbalance of the hormones estrogen and progesterone.
Symptoms of Abnormal Uterine Bleeding
AUB can manifest as: (a) Excessive or prolonged bleeding occurring regularly (menorrhagia); (b) Frequent but irregular bleeding that is not excessive (metrorrhagia); (c) Excessive or prolonged bleeding occurring irregularly (menometrorrhagia); (d) Regular menstrual period but lesser duration than the normal of 21 days (polymenorrhea); (e) Nil uterine bleeding for 6 months or more (amenorrhea); (f) Bleeding in between normal monthly periods (intermenstrual bleeding). The other signs and symptoms depend on the cause of the abnormal bleeding.
Diagnosis of Abnormal Uterine Bleeding
History with regard to pattern of monthly period, physical examination to rule out local causes like polyps or fibroids can aid the diagnosis. Cervical cultures, pap smears and endometrial biopsy can rule out infection and malignancy. Hysteroscopy (endoscopy of uterus) is another useful investigation. The other investigations would depend on the suspected cause based on history and physical examination.
Treatment of Abnormal Uterine Bleeding
The treatment would depend on the underlying cause for the bleeding, your age and your desire for a future pregnancy. If a cause has been found, then it should be treated appropriately. If the DUB is anovulatory in reproductive-age group women, and the bleeding is neither heavy nor prolonged, then no treatment is indicated.
If, however, the woman, particularly an adolescent, appears distressed, oral contraceptives can be given. Generally, the treatment options for a woman with DUB depend on her age. In premenopausal women (women in reproductive age group) the following can be used: (a) Oral contraceptives are effective not only for the bleeding but also provide contraception if the woman so desires; (b) Medroxyprogesterone 10 mg/day for 10 days can regulate the monthly cycles, if the woman is not particular about contraception; (c) Clomiphene 50-150 mg/day on days 5 to 9 of the monthly cycle is the right choice if the woman is desiring pregnancy. In perimenopausal women, medroxyprogesterone or oral contraceptives are indicated. In postmenopausal women cyclic hormone replacement therapy (HRT) or continuous combined HRT is the right option.
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