Abnormal Uterine Bleeding ( Disease & Conditions, Treatments & Procedures , Symptoms )

Abnormal Uterine Bleeding (AUB) refers to any irregularity in the menstrual cycle, including changes in the frequency, duration, or volume of blood flow. AUB can be caused by various factors, such as hormonal imbalances, structural abnormalities, or medical conditions. Symptoms may include heavy or prolonged periods, bleeding between periods, or irregular menstrual cycles. Diagnosis typically involves a thorough medical history, physical examination, and additional tests, such as blood tests or imaging. Treatment options depend on the underlying cause and may include medication, hormonal therapy, or surgery. It is important to consult a healthcare professional if you suspect AUB, as proper diagnosis and treatment can help alleviate symptoms and address any underlying health issues.

This article covers the following topics :

What is abnormal uterine bleeding (menometrorrhagia)?

Abnormal uterine bleeding, also known as menometrorrhagia, is a condition characterized by irregular and excessive menstrual bleeding. This includes both the heavy bleeding experienced during menstrual periods (menorrhagia) and bleeding that occurs between periods (metrorrhagia). Menometrorrhagia can significantly impact a woman’s quality of life, causing physical discomfort, emotional distress, and potential complications if left untreated.

Various factors can contribute to the development of menometrorrhagia, including:

1-Hormonal imbalances: Imbalances in estrogen and progesterone levels can disrupt the normal menstrual cycle, leading to irregular and excessive bleeding. Such imbalances may be caused by illnesses such as polycystic ovarian syndrome (PCOS) and thyroid abnormalities.

2-Structural abnormalities: Abnormalities within the uterus, such as fibroids, polyps, or adhesions, can interfere with the normal shedding of the uterine lining and result in heavy or irregular bleeding.

3-Medical conditions: Certain medical conditions, like endometriosis, adenomyosis, or pelvic inflammatory disease (PID), can cause inflammation and abnormal bleeding patterns.

4-Blood clotting disorders: Women with clotting disorders like Von Willebrand disease may experience excessive bleeding during menstruation.

5-Medications and contraceptives: Some medications, particularly hormonal contraceptives like intrauterine devices (IUDs) or birth control pills, can cause irregular bleeding patterns as a side effect.

6-Pregnancy complications: Ectopic pregnancy or miscarriage can present with abnormal bleeding, making it crucial to rule out pregnancy when evaluating menometrorrhagia.

7-Cancer: In rare cases, uterine, cervical, or ovarian cancers can cause abnormal bleeding, highlighting the importance of timely diagnosis and treatment.

Diagnosing menometrorrhagia typically involves a comprehensive medical history, a physical examination, and additional tests such as blood tests, imaging studies, and endometrial biopsies. Treatment options depend on the underlying cause and the severity of the bleeding. They may include:

1-Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and bleeding, while hormonal medications, such as birth control pills or progestin-releasing IUDs, can regulate the menstrual cycle and decrease bleeding.

2-Hormonal therapy: In cases of hormonal imbalances, hormone replacement therapy or medications to correct specific hormone deficiencies may be prescribed.

3-Surgical interventions: Surgical procedures like dilation and curettage (D&C), endometrial ablation, myomectomy, or hysterectomy may be recommended, depending on the cause and severity of the bleeding.

4-Treatment of underlying conditions: Addressing medical conditions like PCOS, endometriosis, or thyroid disorders can help alleviate menometrorrhagia symptoms.

5-It is essential to consult with a healthcare professional if you experience abnormal uterine bleeding. Proper diagnosis and treatment can help reduce symptoms, improve quality of life, and address any underlying health issues.

Is there a difference between menorrhagia and menometrorrhagia?

Yes, there is a difference between menorrhagia and menometrorrhagia, although both terms refer to types of abnormal uterine bleeding:

1-Menorrhagia: This term describes excessive or prolonged menstrual bleeding that occurs at regular intervals during the menstrual cycle. Women with menorrhagia experience heavy bleeding during their periods, which may last longer than the typical duration of menstrual bleeding (5-7 days). This condition can lead to anemia and have a significant impact on a woman’s quality of life.

2-Menometrorrhagia: This term refers to a combination of menorrhagia and metrorrhagia. It is characterized by both heavy menstrual bleeding (menorrhagia) and irregular bleeding between periods (metrorrhagia). Menometrorrhagia represents a more complex form of abnormal uterine bleeding, as it involves both excessive blood loss and unpredictable bleeding patterns.

While both conditions involve abnormal uterine bleeding, the primary difference lies in the timing and regularity of the bleeding. Menorrhagia refers specifically to heavy or prolonged bleeding during regular menstrual cycles, while menometrorrhagia involves both heavy menstrual bleeding and irregular bleeding between periods.

Who is affected by abnormal uterine bleeding (menometrorrhagia)?

Menometrorrhagia, a form of abnormal uterine bleeding, can affect women of any age, from adolescents to postmenopausal individuals. However, the prevalence and underlying causes may vary according to age and reproductive status.

Adolescents: In the early years following the onset of menstruation, adolescents may experience irregular or heavy bleeding due to an immature hypothalamic-pituitary-ovarian (HPO) axis, which regulates the menstrual cycle. Hormonal imbalances and anovulatory cycles are common in this age group.

Reproductive-aged women: Women of reproductive age may experience menometrorrhagia due to a variety of factors, such as hormonal imbalances, structural abnormalities (e.g., fibroids or polyps), medical conditions (e.g., endometriosis, pelvic inflammatory disease), or contraceptive use. Stress, obesity, and certain medications can also contribute to abnormal bleeding in this population

Perimenopausal women: As women approach menopause, hormonal fluctuations can lead to irregular and unpredictable bleeding patterns, including menometrorrhagia. Perimenopausal women may also develop structural abnormalities like fibroids or polyps that can cause abnormal bleeding.

Postmenopausal women: After menopause, any uterine bleeding should be considered abnormal and warrants medical evaluation. In postmenopausal women, menometrorrhagia may be caused by structural abnormalities, hormone replacement therapy, or, in rare cases, malignancies such as uterine or cervical cancer.

It is important for women experiencing menometrorrhagia or any form of abnormal uterine bleeding to consult a healthcare professional for proper diagnosis and treatment. Identifying and addressing the underlying cause can help improve quality of life and prevent potential complications.

Is abnormal uterine bleeding common?

Yes, abnormal uterine bleeding (AUB) is a common gynecological concern, affecting a significant number of women at various stages of their lives. It is estimated that approximately 10-30% of women of reproductive age may experience some form of AUB. The prevalence may vary according to age, reproductive status, and underlying health conditions.

AUB can manifest in various ways, including heavy or prolonged menstrual bleeding (menorrhagia), bleeding between periods (metrorrhagia), irregular menstrual cycles, or a combination of these symptoms (menometrorrhagia). The causes of AUB can range from hormonal imbalances and structural abnormalities to medical conditions, medications, and contraceptive use.

Since abnormal uterine bleeding can impact a woman’s quality of life and lead to complications if left untreated, it is essential to consult a healthcare professional for proper evaluation, diagnosis, and treatment.

What are the signs and symptoms of abnormal uterine bleeding (menometrorrhagia) bleeding?

Menometrorrhagia, a type of abnormal uterine bleeding, is characterized by a combination of heavy menstrual bleeding (menorrhagia) and irregular bleeding between periods (metrorrhagia). The signs and symptoms may include:

1-Heavy menstrual bleeding: Women with menometrorrhagia may experience an excessive blood loss during their periods, soaking through pads or tampons within a short time frame (e.g., within an hour or two) and often requiring frequent changes.

2-Prolonged menstrual bleeding: Menstrual bleeding may last longer than the typical duration of 5-7 days, sometimes extending up to 10 days or more.

3-Irregular menstrual cycle: The interval between periods may be unpredictable and vary significantly, with cycles sometimes shorter or longer than the normal range of 21-35 days.

4-Bleeding between periods: Women with menometrorrhagia may experience spotting or bleeding between their regular menstrual periods.

5-Blood clots: The presence of large blood clots in the menstrual blood may be a sign of menometrorrhagia.

6-Anemia-related symptoms: Due to excessive blood loss, women with menometrorrhagia may develop anemia, which can cause fatigue, weakness, dizziness, shortness of breath, and pallor.

7-Pain or cramping: Some women may experience pelvic pain, discomfort, or cramping associated with heavy or irregular bleeding.

If you experience any of these signs or symptoms, it is essential to consult a healthcare professional for proper evaluation, diagnosis, and treatment. Identifying and addressing the underlying cause of menometrorrhagia can help improve quality of life and prevent potential complications.

What are the causes of abnormal uterine bleeding?

Abnormal uterine bleeding (AUB) can result from a variety of causes, which can be broadly classified into hormonal, structural, and other factors. Some common causes of AUB include:

1-Hormonal imbalances: Imbalances in estrogen and progesterone levels can disrupt the normal menstrual cycle and lead to AUB. Conditions like polycystic ovary syndrome (PCOS) or thyroid disorders may cause such imbalances.

2-Structural abnormalities: Abnormalities within the uterus, such as fibroids (benign growths in the uterine wall), polyps (abnormal growths in the uterine lining), or adhesions (scar tissue), can interfere with the normal shedding of the uterine lining, resulting in AUB.

3-Anovulation: Anovulatory cycles, where the ovaries do not release an egg, can lead to hormonal imbalances and irregular bleeding. This is common during puberty and perimenopause.

4-Endometrial hyperplasia: Thickening of the uterine lining due to excessive estrogen and insufficient progesterone can cause AUB. If left untreated, endometrial hyperplasia can progress to endometrial cancer in some cases.

5-Endometriosis: The presence of endometrial tissue outside the uterus can cause inflammation, pain, and irregular bleeding.

6-Adenomyosis: The growth of endometrial tissue into the uterine muscle can result in heavy, painful menstrual bleeding.

7-Pelvic inflammatory disease (PID): Infection and inflammation of the female reproductive organs can lead to irregular bleeding.

8-Blood clotting disorders: Conditions like Von Willebrand disease or platelet dysfunction can cause excessive bleeding during menstruation.

9-Medications and contraceptives: Some medications, including anticoagulants and hormonal contraceptives like intrauterine devices (IUDs) or birth control pills, can cause irregular bleeding patterns as a side effect.

10-Pregnancy complications: Ectopic pregnancy or miscarriage can present with abnormal bleeding, making it crucial to rule out pregnancy when evaluating AUB.

11-Cancer: In rare cases, uterine, cervical, or ovarian cancers can cause abnormal bleeding, highlighting the importance of timely diagnosis and treatment.

It is essential to consult a healthcare professional if you experience AUB, as proper diagnosis and treatment can help alleviate symptoms and address any underlying health issues.

What are the diagnostic methods for abnormal uterine bleeding?

Diagnosing abnormal uterine bleeding (AUB) typically involves a combination of methods to determine the underlying cause. The diagnostic process may include:

1-Medical history: A thorough medical history helps the healthcare professional understand the nature of the bleeding, associated symptoms, personal and family medical history, medications, and contraceptive use.

2-Physical examination: A general physical examination, including a pelvic examination, can help identify any abnormalities or signs of infection, inflammation, or other issues.

3-Blood tests: Blood tests can be used to check for anemia, clotting disorders, hormonal imbalances (e.g., thyroid hormones, prolactin, and reproductive hormones), and pregnancy.

4-Imaging studies:

4-1 Ultrasound: A pelvic ultrasound can provide detailed images of the uterus, ovaries, and other pelvic structures, helping identify structural abnormalities like fibroids, polyps, or ovarian cysts.

4-2 Hysterosonography: Also known as saline infusion sonography, this procedure involves injecting sterile saline into the uterus while performing an ultrasound to obtain clearer images of the uterine cavity.

4-3 MRI: Magnetic resonance imaging can provide more detailed images of the uterus and surrounding structures in cases where ultrasound results are inconclusive or more information is needed.

5-Endometrial biopsy: A small sample of the uterine lining (endometrium) is obtained and analyzed to detect any abnormalities, such as endometrial hyperplasia or cancer.

6-Hysteroscopy: A thin, lighted instrument called a hysteroscope is inserted into the uterus through the cervix to visually examine the uterine cavity for abnormalities, like polyps or fibroids.

7-Dilation and curettage (D&C): In some cases, the cervix is dilated, and a curette (a small, spoon-shaped instrument) is used to remove tissue samples from the uterine lining for further examination. This procedure can also be therapeutic, as it may help remove polyps or other abnormal tissues.

The choice of diagnostic methods will depend on the patient’s medical history, physical examination findings, and the healthcare professional’s clinical judgment. Identifying and addressing the underlying cause of AUB is crucial to provide appropriate treatment and improve the patient’s quality of life.

How is abnormal uterine bleeding treated?

Treatment for abnormal uterine bleeding (AUB) depends on the underlying cause, the severity of the symptoms, and the patient’s age, general health, and reproductive goals. Some common treatment options include:

1-Medications:

1-1 Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications can help reduce pain and bleeding associated with AUB.

1-2 Hormonal therapy: Birth control pills, progesterone-only pills, or hormonal patches can help regulate the menstrual cycle and reduce bleeding. In some cases, gonadotropin-releasing hormone (GnRH) agonists or antagonists may be prescribed to temporarily suppress hormone production and alleviate symptoms.

1-3 Tranexamic acid: This medication helps reduce blood loss by promoting clotting during menstruation and is often used for short-term management of heavy menstrual bleeding.

2-Intrauterine device (IUD): A progestin-releasing IUD, such as the levonorgestrel-releasing intrauterine system (LNG-IUS), can help reduce menstrual bleeding and may also serve as a contraceptive method.

3-Treatment of underlying conditions: Addressing the root cause of AUB, such as treating endometriosis, polycystic ovary syndrome (PCOS), or thyroid disorders, can help alleviate symptoms.

4-Surgical interventions:

4-1 Endometrial ablation: This procedure destroys the uterine lining using heat, cold, or other methods to reduce heavy menstrual bleeding. It is typically used for women who do not wish to have children in the future.

4-2 Hysteroscopy and removal of polyps or fibroids: A hysteroscope is used to visually examine the uterus and remove polyps, small fibroids, or other abnormal tissues.

4-3 Myomectomy: This surgery removes fibroids from the uterus while preserving the uterus, making it a suitable option for women who want to maintain fertility.

4-4 Hysterectomy: In severe cases or when other treatments have failed, a hysterectomy (removal of the uterus) may be considered. This procedure results in permanent infertility and is typically reserved for cases where other treatments have not been successful or the patient’s health is at risk.

The choice of treatment will depend on the individual patient’s circumstances and the healthcare professional’s recommendations. It is essential to consult with a healthcare provider to determine the most appropriate treatment plan for managing AUB.

When is surgery performed in abnormal uterine bleeding?

Surgery may be considered for abnormal uterine bleeding (AUB) when conservative treatments have not provided adequate relief or when certain specific conditions are present. Some situations where surgery may be performed include:

1-Severe or persistent bleeding: If heavy bleeding persists despite medication or other non-surgical treatments, surgery may be necessary to manage the symptoms and prevent complications such as anemia.

2- Structural abnormalities: The presence of fibroids, polyps, or adhesions within the uterus may require surgical intervention to alleviate symptoms and restore normal uterine function.

3-Endometrial hyperplasia: If non-surgical treatments fail to resolve endometrial hyperplasia (thickening of the uterine lining), surgery may be needed to prevent progression to endometrial cancer.

4–Adenomyosis: In severe cases of adenomyosis (endometrial tissue growing into the uterine muscle), surgery may be recommended to alleviate pain and heavy bleeding.

5-Endometriosis: Surgical intervention may be considered for endometriosis-related AUB if conservative treatments are ineffective or if the condition is causing significant pain, inflammation, or fertility issues.

6-Failed conservative treatments: If medications, hormonal therapy, or other non-surgical treatments have not provided adequate relief or if the patient cannot tolerate these treatments due to side effects, surgery may be considered.

7-Cancer: In cases where AUB is caused by uterine, cervical, or ovarian cancer, surgery may be necessary to remove the tumor and possibly other affected organs, depending on the stage and severity of the cancer.

Common surgical procedures for AUB include endometrial ablation, hysteroscopy with removal of polyps or fibroids, myomectomy, and hysterectomy. The choice of surgery will depend on the underlying cause, the patient’s age, general health, and reproductive goals. It is essential to discuss the available surgical options and potential risks with a healthcare provider to determine the most appropriate course of action.

Is abnormal uterine bleeding risky for surgery?

Abnormal uterine bleeding (AUB) in itself is not necessarily a risk factor for surgery. However, certain factors related to AUB or the patient’s overall health may increase the risks associated with surgical procedures. These factors include:

1-Anemia: Heavy or prolonged bleeding can lead to anemia, a condition characterized by a lack of red blood cells or hemoglobin. Anemia can cause fatigue, weakness, dizziness, and shortness of breath. If severe, anemia may increase the risk of complications during surgery and may require treatment before surgery.

2-Blood clotting disorders: Women with blood clotting disorders may have an increased risk of excessive bleeding during surgery, which could lead to complications.

3-Co-existing medical conditions: The presence of other medical conditions, such as obesity, diabetes, heart disease, or lung disease, can increase the risk of complications during surgery.

4-Infection: If there is an active infection, such as pelvic inflammatory disease (PID), it is essential to treat the infection before surgery to reduce the risk of complications.

5-Patient’s general health: A patient’s overall health status and ability to tolerate anesthesia and surgery may impact the risk of complications. The surgical team will typically evaluate the patient’s health before surgery and optimize any medical conditions to minimize risks.

It is important to discuss the risks and benefits of surgery with your healthcare provider to determine the most appropriate treatment plan for your specific situation. They will take into account your individual circumstances, including the cause of the AUB, your overall health, and any potential risk factors, to minimize the risks associated with surgery.

What are the surgical methods for abnormal uterine bleeding?

Several surgical methods can be used to treat abnormal uterine bleeding (AUB), depending on the underlying cause, severity of symptoms, and the patient’s age, general health, and reproductive goals. Some common surgical methods include:

1-Endometrial ablation: This procedure destroys the uterine lining using heat, cold, or other methods to reduce heavy menstrual bleeding. It is typically used for women who do not wish to have children in the future, as it may impair fertility.

2-Hysteroscopy: A thin, lighted instrument called a hysteroscope is inserted into the uterus through the cervix to visually examine the uterine cavity for abnormalities like polyps or fibroids. Hysteroscopy can be both diagnostic and therapeutic, as the surgeon can remove polyps, small fibroids, or other abnormal tissues during the procedure.

3-Myomectomy: This surgery removes fibroids from the uterus while preserving the uterus, making it a suitable option for women who want to maintain fertility. Myomectomy can be performed through various methods, such as hysteroscopic myomectomy, laparoscopic myomectomy, or an open abdominal myomectomy.

4-Uterine artery embolization (UAE): This minimally invasive procedure involves injecting small particles into the uterine arteries to block blood flow to the fibroids, causing them to shrink and potentially reducing heavy bleeding. UAE is generally used for the treatment of symptomatic fibroids and is not recommended for women who wish to become pregnant in the future.

5-Dilation and curettage (D&C): The cervix is dilated, and a curette (a small, spoon-shaped instrument) is used to remove tissue samples from the uterine lining for further examination. This procedure can also be therapeutic, as it may help remove polyps or other abnormal tissues that cause heavy bleeding.

6-Hysterectomy: In severe cases or when other treatments have failed, a hysterectomy (removal of the uterus) may be considered. This procedure results in permanent infertility and is typically reserved for cases where other treatments have not been successful or the patient’s health is at risk. Hysterectomy can be performed through different approaches, such as abdominal, vaginal, laparoscopic, or robotic-assisted surgery.

The choice of surgical method will depend on the individual patient’s circumstances and the healthcare professional’s recommendations. It is essential to consult with a healthcare provider to determine the most appropriate surgical treatment plan for managing AUB.

How can I prevent abnormal uterine bleeding?

While not all cases of abnormal uterine bleeding (AUB) can be prevented, there are steps you can take to reduce your risk and maintain your overall reproductive health. Some preventive measures include:

1-Maintain a healthy lifestyle: A balanced diet, regular exercise, and maintaining a healthy weight can help regulate your menstrual cycle and reduce the risk of AUB related to hormonal imbalances.

2-Manage stress: High stress levels can disrupt hormone balance and contribute to menstrual irregularities. Implement stress-reduction techniques such as meditation, yoga, or deep breathing exercises to promote overall well-being.

3-Avoid smoking and excessive alcohol consumption: Smoking and excessive alcohol intake can negatively affect hormone levels and increase the risk of AUB.

4-Monitor medications: If you are taking medications that can affect your menstrual cycle or cause bleeding, such as anticoagulants or hormonal contraceptives, talk to your healthcare provider about potential side effects and alternatives if necessary

5-Regular check-ups: Schedule regular check-ups with your healthcare provider to monitor your reproductive health and address any issues early on.

6-Treat underlying conditions: If you have a medical condition that can cause AUB, such as polycystic ovary syndrome (PCOS), thyroid disorders, or blood clotting disorders, work with your healthcare provider to manage the condition and minimize its impact on your menstrual cycle.

7-Use contraception responsibly: If you are using hormonal contraceptives, follow the instructions and guidelines provided by your healthcare provider to minimize the risk of AUB.

While these measures can help promote general reproductive health and reduce the risk of AUB, it is essential to consult a healthcare professional if you experience abnormal bleeding or other symptoms. Early diagnosis and treatment can help address any underlying issues and improve your quality of life.