Abnormal Uterine Bleeding
Abnormal Uterine Bleeding (AUB) is any bleeding from the uterus that is different from your typical period or menses. This can mean changes in the frequency, regularity, duration, or amount of your bleeding.
Abnormal Uterine Bleeding?
What’s considered a “normal” period, or menses, varies from person to person, but it generally falls within these ranges:
Occurs every 24 to 38 days.
Lasts 8 days or less.
The length of your cycles is consistent.
The amount of blood loss doesn’t interfere with daily life.
- Bleeding or spotting between periods.
- Bleeding after sexual intercourse.
- Very heavy bleeding during your period (e.g., soaking through a pad or tampon every hour for several hours).
- Periods that last longer than 8 days.
- Irregular periods where the cycle length changes unpredictably.
- Any bleeding after menopause.
What Causes AUB?
AUB can be caused by a wide range of factors, which can be grouped into two main categories: structural problems with the uterus and other causes, like hormonal imbalances.
Structural Causes
For individuals at average risk, regular screening should begin at age 45. You may be at a higher risk and need to start screening earlier or be tested more frequently if you have:
Non-cancerous growths in the muscle of the uterine wall.
Small, non-cancerous growths on the lining of the uterus or cervix.
A condition where the uterine lining grows into the muscular wall of the uterus.
The thickening of the uterine lining, which can sometimes contain abnormal cells. This is a less common cause but important to rule out.
Non-Structural Causes
This is one of the most common causes. Conditions like Polycystic Ovary Syndrome (PCOS), thyroid problems, or stress can disrupt the hormonal cycle that controls menstruation.
Conditions that prevent blood from clotting properly, like Von Willebrand disease.
Certain medications, such as blood thinners or some hormonal contraceptives, can affect your bleeding pattern.
Both hormonal and copper IUDs can cause changes in bleeding, especially in the first few months.
Infections of the cervix or uterus can cause bleeding.
When to Call Us
Please contact our office if you are experiencing any of the symptoms of AUB. It's especially important to call us right away if you have:
- Extremely heavy bleeding that soaks through more than one pad or tampon per hour for two hours or more.
- Symptoms of anemia, such as dizziness, lightheadedness, shortness of breath, or extreme fatigue.
- Any bleeding after menopause.
Diagnosis & Treatment
To find the cause of your bleeding, your provider will start by discussing your medical history and symptoms.
- A detailed discussion of your bleeding patterns.
- A pelvic exam.
- Possible tests may include:
- Blood tests to check for anemia, thyroid issues, or bleeding disorders.
- Pelvic ultrasound to get a clear picture of your uterus and ovaries.
- Endometrial biopsy, where a small sample of the uterine lining is taken for testing.
- Hysteroscopy, a procedure where a thin, lighted camera is used to look inside your uterus.
Treatment for AUB is tailored to the specific cause, your age, the severity of your symptoms, and your desire for future pregnancy. Options may include:
- Medications:
- Hormonal birth control (pills, patch, ring, shot)
- Hormone-releasing IUDs (e.g., Mirena, Liletta)
- Other medications to help control bleeding
- Procedures:
- Endometrial Ablation: A procedure that removes the lining of the uterus to reduce or stop bleeding. This is only for women who are finished with childbearing.
- Myomectomy or Polypectomy: Surgical removal of fibroids or polyps.
- Hysterectomy: Surgical removal of the uterus. This is a permanent solution and is typically considered when other treatments have not been successful.
Whether or not you need a DEXA scan now, it’s never too early or too late to protect your bones!
- Get Enough Calcium and Vitamin D: Aim for 1,200 mg of calcium and 800-1,000 IU of vitamin D daily (for women over 50). Dairy products, leafy greens, and fortified foods are great sources.
- Do Weight-Bearing Exercises: Activities like walking, jogging, dancing, and weightlifting help strengthen bones.
- Avoid Smoking and Limit Alcohol: Both can weaken your bones.
Please schedule a time to talk with your provider about your personal risk factors and decide if a DEXA scan is the right next step for you.