Abnormal uterine bleeding is any heavy
or unusual bleeding from the uterus (through your vagina). It can occur at any
time during your monthly cycle, including during your normal menstrual period.
Symptoms of abnormal uterine bleeding
Vaginal bleeding between periods is one
symptom of abnormal uterine bleeding. Having extremely heavy bleeding during
your period can also be considered abnormal uterine bleeding. Very heavy
bleeding during a period and/or bleeding that lasts more than 7 days is called
menorrhagia. For example, women may bleed enough to soak through 1 or more
tampons or sanitary pads every hour.
What causes abnormal uterine bleeding?
A variety of things can cause abnormal
uterine bleeding. Pregnancy is a common cause. Polyps or fibroids (small and
large growths) in the uterus can also cause bleeding. Rarely, a
thyroid problem, infection of the cervix, cancer of the
uterus can cause abnormal uterine bleeding.
In most women, abnormal uterine
bleeding is caused by a hormone imbalance. When hormones are the
problem, doctors call the problem dysfunctional uterine bleeding, or DUB. Abnormal
bleeding caused by hormone imbalance is more common in teenagers or in women
who are approaching menopause.
These are just a few of the problems
that can cause abnormal uterine bleeding. These problems can occur at any age,
but the likely cause of abnormal uterine bleeding usually depends on your age.
Women in their teens, 20s, and 30s
A common cause of abnormal bleeding in
young women and teenagers is pregnancy. Many women have abnormal bleeding in
the first few months of a normal pregnancy. Some birth control pills or the
intrauterine device (IUD) can also cause abnormal bleeding.
Some young women who have abnormal
uterine bleeding do not release an egg from their ovaries (called ovulation)
during their menstrual cycle. This is common for teenagers who have just
started getting their periods. This causes a hormone imbalance where the
oestrogen in your body makes the lining of your uterus (called the endometrium)
grow until it gets too thick. When your body gets rid of this lining during
your period, the bleeding will be very heavy. A hormone imbalance may also
cause your body not to know when to shed the lining. This can cause irregular
bleeding (“spotting”) between your periods.
Women in their 40s and early 50s
In the years
before menopause and when menopause begins, women have months when
they don’t ovulate. This can cause abnormal uterine bleeding, including heavy
periods and lighter, irregular bleeding.
Thickening of the lining of the uterus
is another cause of bleeding in women in their 40s and 50s. This thickening can
be a warning of uterine cancer. If you have abnormal uterine bleeding and
you’re in this age group, you need to tell your doctor about it. It may be a
normal part of getting older, but it’s important to make sure uterine cancer
isn’t the cause.
Women after menopause
Hormone replacement therapy is a common
cause of uterine bleeding after menopause. Other causes include endometrial and
uterine cancer. These cancers are more common in older women than in younger
women. But cancer is not always the cause of abnormal uterine bleeding. Many
other problems can cause bleeding after menopause. For this reason, it’s
important to talk to your doctor if you have any bleeding after menopause.
How is abnormal uterine bleeding
The tests your doctor orders may depend
on your age. If you could be pregnant, your doctor may order a pregnancy test.
If your bleeding is heavy, in addition to other tests, your doctor may want to
check your blood count to make sure you don’t have a low blood
count from the blood loss. This could lead to iron deficiency and anaemia.
An ultrasound exam of your pelvic area shows
both the uterus and the ovaries. It may also show the cause of your bleeding.
Your doctor may want to do an
endometrial biopsy. This is a test of the uterine lining. It’s done by
putting a thin plastic tube (called a catheter) into your uterus. Your doctor
will use the catheter to remove a tiny piece of the uterine lining. He or she
will send that lining to the lab for testing. The test will show if you have
cancer or a change in the cells. A biopsy can be done in the doctor’s office
and causes only mild pain.
Another test is a hysteroscopy. A thin
tube with a tiny camera in it is put into your uterus. The camera lets your
doctor see the inside of your uterus. If anything abnormal shows up, your
doctor can get a biopsy.
Can abnormal uterine bleeding be
prevented or avoided?
If your abnormal uterine bleeding is
caused by hormonal changes, you will not be able to prevent it. But if your
hormonal changes are caused by being overweight, losing weight could help. Your
weight affects your hormone production. Maintaining a healthy weight can help
prevent abnormal uterine bleeding.
Abnormal uterine bleeding treatment
There are several treatment options for
abnormal bleeding. Your treatment will depend on the cause of your bleeding,
your age, and whether you want to get pregnant in the future. Your doctor will
help you decide which treatment is right for you. Or, if your doctor decides
that a hormone imbalance is causing your abnormal bleeding, you and your doctor
may decide to wait and see if the bleeding improves on its own. Some treatment
options include the following:
Intrauterine device (IUD). Your doctor may suggest an IUD. An IUD is a
small, plastic device that your doctor inserts into your uterus through
your vagina to prevent pregnancy. One type of IUD releases hormones,
and this type can significantly reduce abnormal bleeding. Like birth control
pills, sometimes IUDs can actually cause abnormal bleeding.
Birth control pills. Birth control pills contain hormones that can
stop the lining of your uterus from getting too thick. They also can help keep
your menstrual cycle regular and reduce cramping. Some types of birth control
pills, especially the progestin-only pill (also called the “mini-pill”) can
actually cause abnormal bleeding for some women.
A D&C, or dilatation and curettage. A D&C is a procedure in which the opening of
your cervix is stretched under general anaesthesia just enough so a
surgical tool can be put into your uterus. Your doctor uses this tool to scrape
away the lining of your uterus. The removed lining is checked in a lab for
abnormal tissue. If you’re having heavy bleeding, your doctor may perform
a D&C both to find out the problem and to treat the bleeding. The D&C
itself often makes heavy bleeding stop. Your doctor will decide if this procedure
Hysterectomy. This type of surgery removes the uterus. If
you have a hysterectomy, you won’t have any more periods and you won’t be able
to get pregnant. Hysterectomy is major surgery that requires general anesthesia
and a hospital stay. It may require a long recovery period.
Endometrial ablation is a surgical procedure that destroys the
lining of the uterus. Unlike a hysterectomy, it does not remove the uterus.
Endometrial ablation may stop all menstrual bleeding in some women. However,
some women still have light menstrual bleeding or spotting after endometrial
ablation. A few women have regular menstrual periods after the procedure. Women
who have endometrial ablation still need to use some form of birth control even
though, in most cases, pregnancy is not likely after the procedure.
Living with abnormal uterine bleeding
Abnormal uterine bleeding can impact
your life in a negative way. Not being able to predict when bleeding will begin
can cause you to be anxious all the time. Also, heavy menstrual bleeding may
limit your daily activities during your period. For some women, it even
prevents them from leaving the house.
If you have heavy menstrual bleeding,
try taking ibuprofen (Advil, Motrin) during your period (or a few days before
you expect your period, if you know). Ibuprofen is a nonsteroidal
anti-inflammatory drug (NSAID). NSAIDs can work to reduce the bleeding during your
You also should make sure that you are
getting enough iron in your diet. Your doctor may prescribe an iron supplement
to ensure that you don’t become anaemic.