No man will ever fully appreciate how lucky he is to be male, because no man will ever menstruate. Menstruation is so basically unfair that a woman’s vote should count twice as much as a man’s (which, incidentally, might be a very good thing for the planet.)
But back to the subject of this story. A normal menstrual cycle is difficult enough, but it can have additional complications, such as abnormal uterine bleeding.
What is menstruation?
Before we talk about abnormal bleeding of the uterus, let’s first establish some context by discussing menstruation, menstrual periods, and normal uterine bleeding.
Every 28 days or so, the hypothalamus (a small endocrine gland located in the center of the brain) tells the nearby pituitary gland to send a message to the ovaries. Receipt of this message causes the ovaries to release an egg that has reached maturity. This event, called ovulation, usually occurs about midway through the menstrual cycle.
If the egg is fertilized and is successfully implanted in the wall of the uterus, the menstrual cycle will cease for the next nine months, while the fertilized egg (a.k.a. embryo) is transformed into a human infant.
If no embryo is implanted, the egg and the lining of the uterus, (a.k.a. the endometrium) are flushed out of the system. The flushing agent is blood.
What is abnormal uterine bleeding (AUB)?
Abnormal uterine bleeding can be described as:
- Spotting, or bleeding between periods.
- Unusually heavy menstrual bleeding.
- Prolonged menstrual flow.
- Vaginal bleeding after or during sex.
- Bleeding after menopause.
- Pre-menopausal cessation of bleeding for more than 3 months, also known amenorrhea.
What are the common causes of abnormal uterine bleeding?
A woman’s reproductive apparatus is a marvelously complex and delicate mechanism. This means that women’s health is quite vulnerable in this regard. Lots of things can go wrong. Like the following lengthy list:
- Problems inherent in a woman’s blood, like hemophilia, or other clotting difficulties, can manifest as abnormal uterine bleeding.
- Noncancerous growths, such as fibroids and polyps, can appear in the uterus and cause abnormal bleeding.
- The uterine lining, known as the endometrium, is made of very specialized cells. It is, after all, the first home of a baby. Sometimes those cells start to grow into the muscular wall of the uterus itself. This condition is known as adenomyosis. When the cells of the endometrium start to grow away from the uterus, the condition is known as endometriosis. Either condition can result in abnormal bleeding.
- AUB can be an early symptom of either uterine cancer or cervical cancer.
- Some modes of birth control, like an IUD, can cause abnormally heavy periods.
- Infections, either cervical or uterine, can result in abnormal blood loss from the uterus.
- Difficulties related to pregnancy, like a miscarriage or an ectopic pregnancy (where the fetus starts to grow outside the uterus), can cause abnormal bleeding. Even an otherwise normal pregnancy can involve abnormal bleeding.
- Thickening of the endometrium, a condition known as hyperplasia, is often related to abnormal uterine bleeding. This condition is not cancerous but can be a precursor.
- Thyroid problems can cause ovulatory dysfunction which can lead to abnormal uterine bleeding.
- Polycystic ovary syndrome (PCOS) is an incompletely understood condition that is often related to abnormal bleeding of the uterus.
- Medical conditions only indirectly related to a woman’s reproductive system, like diseases of the liver, heart, or kidney, can sometimes lead to AUB.
- Shortly before the onset of actual menopause, a woman is provided with a preview of what’s to come. This phase of women’s health histories is known as perimenopause. During perimenopause, both the timing and intensity of a woman’s period become erratic. The hormonal changes that trigger perimenopause cause the endometrium to thicken more than usual, often resulting in heavier and prolonged menstrual flow.
How is Abnormal Bleeding of the Uterus (AUB) diagnosed?
The symptoms of AUB are quite simple: bleeding too much, bleeding too long, bleeding erratically, or not bleeding at all.
But there is a multitude of causes for irregular bleeding, and each cause requires a different treatment protocol. So, the overarching task that abnormal uterine bleeding presents to the diagnostician is the identification of the cause.
The tools that enable the OB/GYN practitioner to meet this challenge include:
- Blood tests, to identify anemia, thyroid problems, or inherent blood clotting difficulties.
- Pap test. Cells from the cervix are collected and examined for infection, inflammation, or precursor changes in cells.
- Endometrial biopsy. Cells are taken from the uterus lining and analyzed for abnormalities that could indicate endometrial cancer.
- Ultrasound. Using sound waves and a computer, this test displays vessels, organs, and tissues.
- MRI. Sometimes the deeper vision and higher definition that MRI provides are necessary for accurate identification of an abnormal bleeding cause.
- Computed tomography. This imaging procedure shows internal organs and structures in cross-section.
- Hysteroscopy. In this mode of examination, a light and camera at the end of a slender wand are introduced through the cervix. This enables the diagnostician to view the inside of the uterine cavity.
- Sonohysterography. The uterus is filled with fluid and then examined by ultrasound.
Treatment of dysfunctional uterine bleeding
It’s only logical. A myriad of possible causes entails a corresponding myriad of possible treatments for AUB, also known as dysfunctional uterine bleeding.
For milder cases, nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, may help control heavy bleeding and relieve cramping.
For cases with a hormone imbalance, the remedy may be:
- An oral contraceptive, i.e., birth control pills, or similar hormone therapy, using estrogen and progesterone to help restore hormone levels.
- Gonadotropin-releasing hormones. These drugs can halt the menstrual cycle and reduce the size of fibroids.
- Sometimes, instead of being a cause of abnormal uterine bleeding, an intrauterine device (IUD) is the cure.
- Antibiotics are appropriate when the cause is an infection, whether cervical or uterine.
- When abnormal bleeding is the result of a bleeding disorder, medications that help the blood clot more normally are in order.
When medications don’t work, a similarly wide array of surgical interventions is available.
- Endometrial ablation eradicates the lining of the uterus. This surgical procedure makes a future pregnancy both unlikely and highly dangerous.
- If abnormal uterine bleeding is caused by uterine fibroids, a procedure known as uterine artery embolization can starve the fibroids by cutting off their blood supply.
- A procedure known as myomectomy surgically removes fibroids and polyps.
- A hysterectomy is the surgical removal of the uterus. It ends menstruation and, of course, makes future pregnancy impossible.
- Focused ultrasound surgery treats bleeding caused by fibroids by shrinking them. Instead of cutting off the blood supply, this procedure uses ultrasound waves to destroy the fibroid tissue. There are no incisions required for this procedure.
About Dr. Thaïs Aliabadi
As one of the nation’s leading obstetricians, Dr. Thaïs Aliabadi offers the very best in gynecology and obstetrics care. Together with her warm professional team, Dr. Aliabadi supports women through all phases of life. She fosters a special one-on-one relationship between patient and doctor.
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