Abnormal Uterine Bleeding, Everything You Need To Know

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Abnormal Uterine Bleeding is when there is an abnormality in duration of cycle, amount of flow and cycle length. Normal Menstrual cycle lasts between 4 to 6 days, duration of cycle is between 21 to 35 days,
Blood loss is 30-35cc.

Abnormality is when cycle length is less than 21 days or more than 35 days. More than 80cc of blood loss and bleeding for more than 7days.

Common terminologies to be understood:

  • Dysmenorrhea is painful menses
  • Polymenorrhea is cycle length less than 21 days
  • Menorrhagia is more than 80cc of blood loss or more than 7days of bleeding.
  • Amenorrhea is absent menses.

Causes:

According to age

  1. Puberty menorrhagia, history of early menarche, precocious puberty
  2. Adolescent it’s the normal age to get periods between 12 to 14 years but there can be heavy bleeding due to
    • Anovulatory cycles
    • Coagulation defects
  3. Reproductive age group. Abnormal bleeding due to
  4. Fibroids
  5. Adenomyosis
  6. Polyps
  7. Dysfunctional uterine bleeding(Anovulatory cycles)
  8. Perimenopausal age group(Not yet reached menopause)
    • Dysfunctional uterine bleeding (Hormonal imbalance)
    • Endometrial hyperplasia
    • Adenomyosis
    • Polyp
    • Fibroids
    • Carcinoma of Endometrium
  9. Postmenopausal Age group(After menses stop)
    • Endometrial Hyperplasia
    • Polyp
    • Carcinoma of endometrium
  10. Iatrogenic Causes
    • Copper T
    • Oral or injectable steroids
    • Psychiatric medications

What is Dysfunctional Uterine Bleeding?

When there is Heavy bleeding with No organic pathology involved like fibroids, polyps or No iatrogenic cause like Copper T or Medications or No Other medical conditions like Thyroid or pituitary disorders is called Dysfunctional uterine bleeding. The main cause of bleeding here is Hormonal Imbalance.
Hormonal imbalance can be divided into two variants

90% of the cases have an ovulatory cycles where there is unopposed estrogen secretion and No progesterone which causes heavy bleeding

10% of the cases have ovulatory cycles where there is irregular supply of progesterone with No estrogen hence heavy bleeding.

Polycystic Ovarian Disease mainly has features of amenorrhea for 3to4 months and an ovulatory cycles
Features include Obesity, Acne, Hirsuitism and Irregular cycles

Patients require Lifestyle modification like exercise, weight loss.

Acne and hirsuitism can be treated cosmetically.

Thyroid profile is also important in PCOD patients as thyroid imbalance in mostly associated with PCOD.

Hormonal imbalance can be corrected after hormonal evaluation and starting on cyclical low dose estrogen progesterone combination medication and also insulin sensitizers which helps to get regular periods with less bleeding and helps in controlling weight gain.

Approach to a patient with Abnormal Uterine Bleeding:

History of the patient is very important which includes number of days of bleeding, number of pads soaked, passage of clots.

External appearance like pallor, General examination which includes Height and weight to calculate BMI for PCOD Hirsuitism (Excessive Hair growth on face and body),Acne

Investigations includes

  1. Blood investigations – CBC, Thyroid profile Hormonal profile(FSH,LH,Prolactin)
  2. Ultrasonography to know cause of bleeding like fibroids,Polyp.
  3. Hysteroscopy DNC is visualization of the uterine cavity with a scope.can be used both as a diagnostic and therapeutic tool for fibroids polyp
  4. Endometrial biopsy for hyperplasia and carcinoma.

Treatment should be according to the patients Age and Requirment.

Hematinics should be given to improve the haemoglobin levels

  1. Puberty menorrhagia should be controlled after ruling out any coagulatinf abnormality.with Hormonal treatment.
  2. Reproductive age group to rule out any iatrogenic cause. Hormonal therapy with cyclical Estrogen progesterone combination. Bleeding in anovulatory cycles can be controlled with continuous or cyclical progesterones.

In young women in reproductive age but completed family where no organic cause Progesterone intrauterine device which releases low dose progesterone can also be used to control bleeding.

Fibroids, Adenomyosis, Polypcan be treated by Laparoscopic or Hysteroscopic removal .

Elderly age group and Postmenopausal age group after evaluation through endometrial biopsy an option of Hysterectomy can be given done through open surgery of Laparoscopy.

The treatment of patient should necessarily be on what is her age, her need for that time and on what she wants. it should be customised according to her needs and she should be given options to chose from rather than forcing her to some form of treatment.

– Dr. Sangeeta Shetty
Consultant – Gynecologist, Currae hospital, Thane (View Profile)

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