Abnormal uterine bleeding
Between 10% to 30% of women will suffer from Abnormal Uterine Bleeding (AUB) during their reproductive age and these figures are slightly higher in women around menopause.
AUB ranges from cyclical bleeding which is increased in length and/or flow to bleeding just about every day, or after intercourse. Any bleeding that is heavy (increased number of pads), irregular or unrelated to your normal period is considered as abnormal.
AUB is the broad term where a cause is still sought, but when no cause is found it is termed dysfunctional bleeding.
During a normal period the following should take place, bleeding for three to eight days, and not more than 80ml of blood per cycle, no clots (as menstrual blood should not clot), and the number of days between periods should not be less than 21, or more than 36 days with an average around 28 days.
The definitions have changed slightly over the last few years, but you can get increased flow and duration of every period, bleeding not regular with the period, bleeding after sex, long or short cycles and lastly decreased, or increased flow during what can still be considered as a normal period. The above may, or may not be associated with pain.
To get to a diagnosis it is important to clearly understand the bleeding problem and any factors that may be causing AUB, like thyroid disease, liver and kidney failure, blood disorders, certain medication especially blood thinners, hormonal problems and possible cancer. Secondly, it is important for the doctor to do a physical examination looking for any features that may point to a diagnosis.
Investigations should always include a pregnancy test, but the other tests should be to confirm a suspected diagnosis is confirmed. A pap smear and a biopsy from the uterus may be needed depending on the age of the person either in the office or in theatre. Radiological investigations like CT-scans and ultrasounds are usually done.
Causes may be as follows:
Dysfunctional bleeding, ovulatory or anovulatory this may be physiological (during puberty and around menopause).
Organic lesions that may include pregnancy associated causes, uterine causes like fibroids, polyps, cancer, infections, and trauma. And non-uterine causes that may be ovarian, tubal, or from vaginal, or cervical lesions.
Systemic abnormalities may include hormone administration including contraception, bleeding disorders, liver and kidney disease, and a range of hormonal disorders, especially Poly Cystic Ovarian Disease(PCOS), thyroid disease and even obesity and severe weight loss or eating disorders.
Cancer risk is highest around and after menopause and such bleeding should never be ignored.
Treatment may be medical or surgical:
Medical treatment may be as simple as non-steroidal anti-inflammatories, to hormones like birth control tablets, or injections failing which a drug that will interfere with the hypothalamic-pituitary-ovarian-axis. As mentioned in a previous topic the Mirena can also be used.
Surgical treatment can start from a curettage (womb scrape), or endometrial destructive procedures like endometrial ablation to hysterectomy where the uterus is removed all depending on the cause.
Systemic causes will require treatment of the underlying problem, like treat the thyroid disease, control the diabetes, avoiding and treating infections.
Bleeding disorder may prove to be a little more challengingto manage, but the services of a heamatologist may be useful.
Bleeding that is perceived to be different from the normal period should be investigated and treated. Warning signs include clots, inter-menstrual bleeding, post sex bleeding and other hormonal changes like increase hair growth, obesity and weight loss. The aim of the tests is to find a cause, but more so to diagnose cancer as most female cancers have very little symptoms before it has spread.
Bleeding may just be due to stress, trauma or exogenous hormones, but time to diagnosis is essential.