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Many women can relate to the frustration associated with abnormal uterine bleeding. It can lead to missed days from work/school, embarrassment, disruption in sexual intimacy, anemia, and in extreme cases, loss of consciousness. So what exactly is abnormal uterine bleeding (AUB)? It’s any bleeding that occurs between your monthly menstrual cycles, or when you bleed for a long duration and/or experience a significantly heavy flow. Normally, your period should occur every 21-35 days and last 3-7 days when its present. So if you experience bleeding for let's say 10 days or your periods come every 14 days, this falls under the category of AUB. Also, your bleeding shouldn’t constantly soak through pads/tampons/clothes and cause you to become anemic, experience fatigue, or pass out. Some women have had these symptoms since they began having periods, so they never investigate or even realize that something may be wrong. However, some women develop abnormal bleeding, which alerts them to follow up with their healthcare provider. There are numerous reasons why a woman would experience AUB, but I wanted to discuss a few common reasons, as well as tests and possible treatment.
Possible Causes of AUB and Tests
This is only a list of possible causes, but you must follow up with your healthcare provider to be evaluated and determine the exact cause of your abnormal bleeding.
Fibroids - these are non-cancerous growths in the uterus that can develop and become bigger over time. Usually, they will cause very heavy periods, long periods, bleeding in between periods, and pelvic pain. A pelvic or transvaginal ultrasound can diagnose this.
Polyps - these are non-cancerous growths that can occur either on the lining of your uterus (the endometrium) or your cervix. We call them endometrial polyps or cervical polyps. An ultrasound can see if your lining looks thick and if there is a structure that appears to be a polyp. However, an endometrial biopsy is often needed to confirm. Many cervical polyps can be seen by your provider when they do a pelvic exam, such as a pap smear or culture. Usually when someone reports AUB, I will start with a pelvic exam to see if there is a polyp or lesions on the cervix.
Bleeding disorder - certain genetic conditions, such as Von Willebrand disease, can cause excessive bleeding because it affects your ability to effectively form clots. Blood work can be ordered to test for this and other bleeding disorders.
PCOS (polycystic ovarian syndrome) - this is a hormonal imbalance that can cause either excessive bleeding or missed periods. Blood work can be ordered to check your hormone levels and an ultrasound can determine if you have polycystic ovaries.
Thyroid imbalance - if your thyroid levels are not in normal range, this can cause abnormal bleeding. Blood work can check thyroid function.
Blood thinners - if you are on blood thinners, this can cause excessive bleeding because it affects your ability to form clots.
Menopause - as you begin the phase of menopause, your hormone levels can become imbalanced and cause abnormal bleeding. Usually diagnosed by symptoms and ruling out more serious causes.
Early pregnancy - some women can experience bleeding in early pregnancy, such as implantation bleeding or a miscarriage could cause excessive bleeding. A pregnancy test, beta hcg’s, and ultrasound can diagnose this.
Infection - sexually transmitted infections can cause bleeding after sex or spotting between periods. A culture can determine if this is present.
Cancer - this is the most serious reason for AUB and should always be ruled out. A pap smear can determine if there is a possibility of cervical cancer and an endometrial biopsy can diagnose endometrial (uterine) cancer.
As you can see, there are so many possible reasons for AUB. There is no way to know for sure unless you follow up with your healthcare provider and have the recommended tests.
Treatment will vary widely since there are so many possible reasons of AUB. However, some common treatments are:
Combination birth control - to regulate your periods. Can often cause shorter, lighter, and less painful periods.
Progestin only birth control - some women use an IUD or depo shot in hopes of stopping the bleeding altogether. However, there is no guarantee that this will work.
Thyroid medication - if its a thyroid issue that is causing your AUB, you will need thyroid medication or to even remove your thyroid
Myomectomy - this is a surgical procedure to remove fibroids
Polypectomy - this is a surgical procedure to remove polyps. Cervical polyps that can be seen extending out of the os can usually be removed easily in the office.
Ablation - this procedure burns the lining of your uterus and is not recommended for women who desire children in the future
Hysterectomy - surgical procedure to remove the uterus. This should only be done if no future children are desired or if cancer cannot be treated with chemo/radiation alone
Remember, always check with your individual healthcare provider. It’s best to evaluate and find out nothing is wrong then to experience abnormal bleeding for years until it finally manifests as something life threatening.
xoxo, Global Midwife