Q: What is meant by abnormal uterine bleeding (AUB)?

A: An average menstrual cycle lasts about 28 days. If the cycle is longer than 35 days or shorter than 21 days, it is considered abnormal. The absence of menstrual periods for 3 or 6 months (amenorrhea) is also abnormal. Abnormal uterine bleeding also includes bleeding between periods, bleeding after sex, spotting anytime in the menstrual cycle, bleeding heavier or longer than normal, and bleeding after menopause.

Q: What causes abnormal uterine bleeding?

A: There are many causes of abnormal uterine bleeding. In many women, abnormal or heavy bleeding occurs because of a problem with hormones when the body makes too much or not enough of a certain hormone. This can be caused by thyroid problems or the use of some medication. Other causes include: pregnancy, miscarriage, or ectopic pregnancy, problems linked to some birth control methods, such as an intrauterine device (IUD) or birth control pills, endometrial hyperplasia (abnormal thickening of the uterine lining), infection of the uterus, fibroids, polyps, and certain types of cancers, such as cancer of the uterus, cervix, or vagina, blood clotting disorders, and chronic medical conditions such as thyroid disease and diabetes.

Q: When can abnormal uterine bleeding occur?

A: Abnormal uterine bleeding can occur at any age. Periods are often not regular the first few years after a girl begins to have periods (around 9-16 years of age). Beginning as early as 35 years of age and more commonly when a woman nears menopause (around 50 years of age), it is normal for menstrual cycles to become shorter, to skip periods, or for bleeding to become lighter. If bleeding becomes heavier, however, you should call your doctor.

Q: How does a doctor or healthcare provider diagnose abnormal uterine bleeding?

A: After obtaining your personal and family health history, you will have a physical exam. You may also have blood tests to check your blood count, hormone levels, and a pregnancy test. Procedures that may be performed in the doctor's office are: endometrial biopsy by using a catheter a small amount of tissue is taken from the uterine lining and looked at under a microscope, ultrasound to look at the pelvic organs with sound waves, sonohysterography where fluid is placed into the uterus and used to create a picture of the uterus with sound waves, and hysteroscopy where a thin telescope-like device is inserted through the vagina and cervix to view the inside of the uterus. Diagnostic procedures that are usually performed in the hospital or other facilities are: hysterosalpingography which is performed in the radiology department where dye is injected into the uterus and fallopian tubes and X-ray pictures are taken, D&C which is performed in surgery to gently remove tissue from the uterine lining and examined under the microscope, and laparoscopy which is performed in surgery by inserting a slender telescopic-like device through a small incision just below the navel to view the inside of the abdomen and pelvic organs.

Q: How is abnormal uterine bleeding treated?

A: Once the cause is found, abnormal uterine bleeding can be treated with success depending on many factors, including the cause, your age, the severity of the bleeding, and whether you want to have children. You may be prescribed hormones such as birth control pills to help your periods become more regular. Progesterone can help prevent and treat endometrial hyperplasia. Other medications that may be used are nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, to help control heavy bleeding and relieve menstrual cramps. You may be given antibiotics to treat an infection. Some women may need surgery to remove growths such as polyps or fibroids, which are causing bleeding. Endometrial ablation is also used to treat abnormal uterine bleeding by using electricity, laser, heat, or freezing to destroy the lining of the uterus and is intended to stop or reduce bleeding permanently. A woman will not be able to get pregnant after an ablation. Hysterectomy is a major surgical procedure used to treat abnormal uterine bleeding when other forms of treatments have failed or are not an option. After this procedure, a woman will no longer have periods nor will she be able to get pregnant.

Unless you're pregnant when you experience abnormal uterine bleeding, a single episode of heavy menstrual bleeding usually does not require treatment. The exception to this, however, is when excessive uterine bleeding continues for over 24 hours then you should contact your gynecologist or healthcare provider.

Source:
ACOG Patient Education. Abnormal Uterine Bleeding.
http://www.acog.org/publications/patient_education/bp095.cfm