Abnormal Uterine Bleeding: Types, causes, diagnosis, and management
Abnormal uterine bleeding (AUB) refers to bleeding that differs in volume, frequency, or duration from normal cycles. It includes patterns like menorrhagia, polymenorrhea, metrorrhagia, oligomenorrhea, and hypomenorrhea. Causes vary from hormonal imbalances to infections. Diagnosis involves clinical evaluation and tests, with treatment based on the underlying cause and severity
Overview of menstruation Menstruation begins during puberty and lasts till menopause, the physiological cessation of menses. During this time, the monthly cycle results in bleeding due to the breakdown of the innermost layer of the uterus, the endometrium. The menstrual cycle can last for 21–35 days, with menstrual flow for 4–5 days with a blood loss of around 20–80 mL
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Definition and patterns of abnormal uterine bleeding Any uterine bleeding that exceeds the normal volume, regularity, duration, or frequency is referred to as abnormal uterine bleeding (AUB). There may be various patterns of AUB like menorrhagia, polymenorrhea, metrorrhagia, oligomenorrhea, and hypomenorrhea. These can have multifactorial etiology.
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Menorrhagia Menorrhagia refers to cyclical bleeding at normal intervals that either shows excessive amount of blood, more than 80 mL, or that lasts for more than seven days, or both. It can occur due to a fibroid in the uterus, intra-uterine contraceptive device, tumours of the ovary, or conditions like adenomyosis and endometriosis.
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Polymenorrhea Polymenorrhea, also called epimenorrhea, is a pattern of abnormal uterine bleeding where the cycle becomes less than twenty-one days and remains at that frequency. If it is also associated with prolonged bleeding, it is called epimenorrhagia. It is often seen in adolescence or just before the female achieves menopause. It can also be seen following delivery or miscarriage.
Metrorrhagia Metrorrhagia refers to irregular, acyclic bleeding from the uterus where the amount of bleeding is variable. It can also be in the form of contact bleeding (also called post-coital bleeding, that occurs after intercourse). It can occur due to carcinoma cervix, polyps in the cervix, cervical endometriosis, and chlamydial infections.
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Oligomenorrhea When menstrual bleeding occurs more than thirty-five days apart and stays at that frequency, it is referred to as oligomenorrhea. Girls who have just attained menarche and women who are about to achieve menopause may experience oligomenorrhea. Other causes include obesity, stress, polycystic ovarian syndrome, and increased level of thyroid.
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Hypomenorrhea Scanty menstrual bleeding that lasts for two days or less is termed hypomenorrhea. It can be caused due to tuberculosis of the endometrium, use of oral contraceptive pills, abnormality of the thyroid function, or during the pre-menopausal period. Systemic causes like malnutrition can also be a reason for hypomenorrhea.
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Diagnosis of abnormal uterine bleeding The diagnosis for such conditions and patterns, along with the underlying cause, may be found after a detailed history, clinical examination, and investigations like ultrasonography, PAP smear for cervical cancer, testing for genital tuberculosis, thyroid function tests, and androgen levels to confirm polycystic ovarian syndrome.
Supportive care and general management Some general measures can be taken to deal with abnormal uterine bleeding. Resting during the bleeding phase is often recommended, and adolescents must especially be handled with sympathy and given assurance. Anaemia that can develop because of the bleeding must be corrected with iron supplements and blood transfusion if necessary.
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Treatment based on cause If the underlying cause of abnormal uterine bleeding is identified, it must be treated on a priority basis. Any systemic or endocrine abnormality that may be causing this condition should be investigated and treated. Medical management with antifibrinolytics and hormones can be considered, and surgery may be needed in some cases.
Rajeshwaari Kalla is a freelance health and wellness writer
