Abnormal Uterine Bleeding

Description

Abnormal uterine (from the uterus ) bleeding is defined as any uterine bleeding, which is outside the regular monthly menstrual periods of nonpregnant women. Abnormal bleeding can occur as a result of:

• Bleeding before menarche or after menopause . Uterine bleeding is not expected in girls before age 9 and in older women who have begun menopause.
• Menstrual disturbances . Uterine bleeding can be abnormal if menstrual cycles or menstrual periods are too short, too long, too frequent, too infrequent, occur at irregular intervals or are abnormally heavy (menorrhagia).
• Bleeding between periods. Uterine bleeding should not occur between normal menstrual periods, except for occasional spotting that sometimes happens in the middle of the menstrual cycle around the time of ovulation . Bleeding that occurs between normal periods is called intermenstrual bleeding .

Causes of Abnormal Uterine Bleeding

• Abnormal menstrual bleeding can be due to hormonal abnormalities (90% of all non-pregnancy bleeding is estimated as being due to hormonal causes [ 2 ] ). For example, if levels of female hormones rise too early in a young girl she may reach menarche too soon, a condition called precocious puberty . Hormone abnormalities, sometimes triggered by stress or overwork, may also be responsible for abnormal uterine bleeding in adult women, especially if menstrual irregularity is the problem.
• Adult women are at risk for uterine bleeding due to pelvic infections or pelvic inflammatory disease , benign uterine tumours called fibroids , or polyps of the uterus or cervix.
• In women who have already reached menopause , abnormal uterine bleeding may be due to side effects of hormone replacement therapy . With some women and some dosage schedules of progestogen, the endometrial lining sheds and passes from the uterus as bleeding, similar to a period. Abnormal bleeding at this stage of life can also be a symptom of uterine cancer .
• In women of any age, abnormal uterine bleeding can be a sign that blood is not clotting normally, either due to an inherited bleeding disorder or because of a medical illness that affects levels of blood platelets.

Symptoms and Signs

Abnormal uterine bleeding is a symptom in itself. However, depending on the cause of the bleeding, there may be other, associated symptoms.

Diagnosis and Treatment

The first step in diagnosing abnormal bleeding is to obtain a thorough medical history, with special attention to the patient's gynaecological status. Prior menstrual history will be established as will any history of bleeding from other parts of the body (such as nosebleeds, unusual bruising, or blood in the urine). The doctor will also ask about current symptoms and will usually perform a brief general physical examination, followed by a thorough pelvic examination .

After completing the pelvic examination, your doctor may order tests based on your history, symptoms, and physical findings. These tests may include:

• Blood tests . Thyroid function tests or tests that measure levels of hormones related to the menstrual cycle. A complete blood cell (CBC) count may also be done to determine how much blood you have lost and to check levels of platelets. If you have a history of abnormal bleeding from other areas besides your uterus, you may need special blood tests to check for an inherited bleeding disorder.
• Pregnancy test . To rule out an unsuspected pregnancy.
• Tests for STDs .
• Pap smear . To rule out cervical cancer .
• Culture of vaginal discharge , to rule out a pelvic infection
• Imaging techniques . Pelvic x-rays , pelvic ultrasound scanning , or magnetic resonance imaging scanning (MRI) may be performed to evaluate abnormal masses or swellings, including fibroids .
• Hysterosalpingography . To check for fibroids lying beneath the uterine lining (submucous fibroids).
• Hysteroscopy . To inspect the endometrium for polyps, submucous fibroids, hyperplasia (abnormal thickening of the uterine lining), or tumours (cancerous or noncancerous).
• Endometrial biopsy . In this test, the doctor takes a biopsy (a tissue sample for laboratory testing) of the uterine lining to check for uterine cancer, infection of endometrium, or tissue abnormalities that can only be seen with a microscope.

The treatment of abnormal uterine bleeding depends on the cause. For example, in patients with precocious puberty, menstrual irregularities, fibroids, or endometriosis, treatment may begin with medications that regulate the production of female hormones. For some women, this means oral contraceptives while others require medications that reduce levels of female hormones. Patients with severe pelvic infections are treated with antibiotics, usually for at least 2 weeks.

For menstrual irregularities that don't respond to medical treatment, the doctor may suggest either dilatation and curettage (D&C) or one of the newer thermal techniques (endometrial ablation or uterine balloon therapy) that burn away the uterine lining.

Surgical treatments may be necessary for some patients, such as those with fibroids.

For further, more detailed information on this topic, please refer to the reference source for this page. [ 1 ]

The information in this page is presented in summarised form and has been taken from the following source(s):
1. American Medical Association, Health Insight: Women's Health: http://www.ama-assn.org/
2. Virtual Naval Hospital, Bureau of Medicine and Surgery, Department of the Navy: http://www.vnh.org/
3. The North American Menopause Society: http://www.menopause.org/