Evaluation and Treatment of Abnormal Uterine Bleeding

When should I see a doctor?

Consult your doctor when:

• You experience bleeding through the pad in 1 hour
• Bleeding for more than 7 days
• Bleeding between periods
• Severe pelvic pain and bleeding
• Postmenopausal bleeding

What is the Cause of Abnormal Uterine Bleeding?

Causes of abnormal uterine bleeding include, but are not limited to:

• Hormonal imbalance: Imbalance in the level of estrogen and progesterone leads to uneven shedding of the uterine lining.
• Uterine fibroids: Benign tumors that can cause heavy or prolonged menstrual bleeding.
• Endometrial polyps: Tiny bits of tissue that have grown too much inside the uterus and can cause spotting or irregular bleeding.
• Adenomyosis: The lining of the uterus (endometrium) grows into the muscle wall of the uterus (myometrium).
• Polycystic ovary syndrome (PCOS): A hormonal disorder that causes irregular ovulation and unpredictable bleeding.
• Endometrial hyperplasia: A thickening of the lining of the uterus, which calls for careful evaluation.
• Pregnancy-related reasons: Miscarriage, ectopic pregnancy, and complications of pregnancy can lead to abnormal bleeding. Seriousness can range from abnormal spotting to a serious medical emergency.
• Infections: Pelvic infections or inflammation affecting the reproductive organs.
• Bleeding disorders: Some disorders of blood clotting (coagulopathies) can cause very heavy periods.
• Medications: Some medications, like hormonal contraceptives (especially starting or missing doses), blood thinners (anticoagulants), aspirin, Tamoxifen, and some antidepressants or antipsychotics, can cause abnormal uterine bleeding in some patients.
• Gynecologic cancers: Abnormal bleeding may be a sign of serious conditions such as endometrial cancer, cervical cancer, and ovarian cancer, although it occurs less often.

Diagnosis of abnormal bleeding from the womb

Your gynaecologist will carry out a pelvic exam to look at your uterus, cervix and ovaries. They will ask about your menstrual cycle, the pattern of bleeding, your pregnancy history, any previous gynecological conditions, the medications you are taking, and your family’s medical history. Based on the symptoms, they recommend some tests, including a complete blood count (CBC), a pregnancy test, tests for thyroid function, a hormone test, and tests for blood clotting. Imaging tests such as pelvic ultrasound will help understand the uterus, endometrial lining, ovaries, fibroids, and ovarian cysts. A transvaginal ultrasound will provide detailed visualization of pelvic organs. Depending on the severity of the issue, doctors will recommend a diagnostic hysteroscopy, an endometrial biopsy, and MRI and CT scans (rarely required).

What is the Treatment of Abnormal Uterine Bleeding?

Treatment is usually based on the cause of the bleeding, the age, severity, desire for future pregnancy, and health status.

• Non-surgical treatments include medications and hormonal therapy. It includes birth control pills, progesterone therapy, hormonal intrauterine device (IUD). These help to regulate menstrual cycles and reduce bleeding. Non-hormonal drugs are used to reduce menstrual blood flow, relieve pain, and treat anemia. Women with iron deficiency anemia caused by heavy bleeding will be told to take iron supplements.
• Hysteroscopic polypectomy, myomectomy, and endometrial ablation are performed as minimally invasive procedures. Surgical treatment is advised in case of failure of conservative treatment or significant pathology. It includes myomectomy (fibroids removal while preserving fertility and hysterectomy (complete removal of the uterus in cases of severe symptoms or certain medical conditions).

Why does early evaluation matter?

Early diagnosis of abnormal uterine bleeding allows early identification of the underlying cause and prevents the development of anemia. Further, it allows timely treatment of serious conditions and improved fertility outcomes. More importantly, better menstrual health means improved quality of life for many women.

What are the Lifestyle Measures That May Help?

Along with medical treatment, maintaining a healthy weight and eating an iron-rich diet will improve menstrual as well as overall health. Staying physically active, exercising regularly, and attending regular gynecological check-ups will help track and monitor issues early on.

Is abnormal uterine bleeding normal?

No, abnormal uterine bleeding should never be ignored. Any bleeding other than normal menstrual bleeding is a sign of some uterine pathology. Menstrual patterns can differ. See your doctor if you have constant, heavy, irregular, or unexpected bleeding. Your gynecologist will assess the situation.

Can abnormal uterine bleeding affect fertility?

Yes, abnormal uterine bleeding causes infertility in a number of cases. But it’s not like that in all cases. Certain medical conditions, such as PCOS, fibroids, endometrial polyps, or hormonal disorders, can also affect fertility. However, when diagnosed early, many are treatable with an appropriate medical approach.

Will I need surgery to treat abnormal uterine bleeding?

Not always. Many women respond well to hormonal medications. These help reduce the bleeding and pain and deal with anemia. In severe conditions, minimally invasive procedures and surgery are recommended.