Definition

Abnormal uterine bleeding, previously known as menometrorrhagia, is when you experience heavy bleeding from the uterus that is discharged through the vagina. This occurs outside your monthly menstrual period. The bleeding can be prolonged or more severe than usual.

A menstrual period typically lasts about 5-7 days. The normal menstrual cycle duration ranges between 21 and 35 days.

Menometrorrhagia, or abnormal uterine bleeding, differs from menorrhagia, which is heavy bleeding during menstruation. Abnormal uterine bleeding occurs when there is excessive, prolonged, and irregular bleeding that is not associated with your menstrual cycle. In contrast, menorrhagia, or heavy menstrual bleeding, is characterized by excessive bleeding and prolonged duration during menstruation.

The prevalence of abnormal uterine bleeding is around 10–35% among women, and this number may be higher due to underdiagnosis. Generally, abnormal uterine bleeding occurs at ages when a woman has recently begun menstruating or is approaching menopause. This bleeding does not occur during pregnancy, as the causes of bleeding during pregnancy are different.

Causes

One of the most common causes of abnormal uterine bleeding is a hormonal imbalance, particularly in women who are approaching menopause or are just beginning to get periods. During these ages, the uterine wall may grow thick.

During ovulation, when the ovaries release an egg, certain hormones signal the body to form and shed the uterine wall called the endometrium. Abnormal uterine bleeding occurs when the ovaries do not release an egg, which is caused by fluctuating hormone levels.

Other factors that can cause abnormal uterine bleeding include:

• Uterine structure. Thickening, fibroids, and polyps in the uterine lining
• Cancer. Cancer of the uterus, ovaries, cervix, or vagina
• Blood clotting disorders
• Polycystic ovary syndrome (PCOS)
• Excess body weight
• Infections in the uterus or cervix

If you want to know more about PCOS, you can read it here: Polycystic Ovarian Syndrome - Understanding, Cause, Symptoms, And Treatment.

Risk Factor

• Age. It occurs in women who have recently started menstruating and those approaching menopause.
• Hormonal imbalance: can be caused by conditions such as Polycystic Ovary Syndrome (PCOS), thyroid disease, and lack of ovulation or egg fertilization.
  • Birth control pills or hormonal medications that affect hormones can also increase the risk of hormonal imbalances. Other drugs, such as warfarin and hormone therapy medications, can also impact hormonal balance.
  • Excess body weight: Can affect hormone balance, leading to abnormal uterine bleeding.
  • Psychological factors, such as stress, can also impact hormone balance.
• Uterine structure. Abnormal uterine structures such as polyps, fibroids, and adenomyosis (fibroids).
• Cancer. Conditions such as vaginal cancer, uterine cancer, cervical cancer, and endometrial hyperplasia can increase the risk of abnormal uterine bleeding.
• Infections, such as trichomoniasis, chlamydia, gonorrhea, endometritis, and vaginitis.
• Other health conditions:
  • Kidney failure and liver failure
  • Pelvic inflammatory disease (PID)
  • Leukemia or platelet disorders

Symptoms

Symptoms of abnormal uterine bleeding can vary. Some signs of abnormal bleeding include:

• Heavy menstrual bleeding (previously referred to as menorrhagia)
• Bleeding at unusual times (between periods or after sexual intercourse)
• Prolonged periods (more than 7 days)
• Irregular menstrual cycles
• Menstrual cycles shorter than 28 days or longer than 35 days
• Mood changes
• Fatigue
• Anemia

Diagnosis

Doctors will ask a series of questions to help diagnose abnormal uterine bleeding, such as the characteristics of the bleeding, any symptoms experienced, and whether you are pregnant.

Physical Examination

In addition, the doctor may recommend several examinations, including:

• Pelvic examination
• Cervical examination. This examination is performed by directly viewing the cervix with an instrument, typically for patients who have had sexual intercourse

Diagnostic Tests

• Pap smear. This is recommended for patients who have had sexual intercourse to assess for cervical cancer. Cervical cancer can also present with bleeding symptoms
• Pregnancy test. A miscarriage can cause heavy bleeding. A pregnancy test can provide a positive result after 35 days following a miscarriage. Light bleeding is also a common sign of early pregnancy
• Blood test. It helps check for blood clotting and perform a complete blood count
• Thyroid function test. It helps assess thyroid function. Thyroid problems can indicate issues with ovarian function that can cause bleeding
• Hormone tests. Hormonal imbalance can cause abnormal bleeding or signal underlying conditions causing the bleeding
• Ultrasonography (USG). A pelvic ultrasound provides imaging that helps diagnose which organs are causing the bleeding
• Biopsy. A sample from the uterus is taken to check for indications of cancerous cells.

Management

Treatment for abnormal uterine bleeding depends on the cause of the bleeding. Treatment and surgical options depend on the severity of the bleeding and the underlying cause.

Medications

Medications used to treat abnormal uterine bleeding include:

• Hormonal contraceptives: to regulate hormonal imbalances
• Birth control pills: containing progestin and estrogen
• Progestin: Administered via injection, implant, or intrauterine device (IUD)
• Non-steroidal anti-inflammatory drugs (NSAIDs): Such as ibuprofen
• Gonadotropin agonist drugs: To stop or reduce bleeding by inhibiting ovulation
• Gonadotropin antagonist drugs: To treat heavy bleeding associated with fibroids

Surgery

Discuss with your doctor the procedures available for treating abnormal uterine bleeding. Types of surgery include:

• Hysteroscopy: to remove atypical structures in the uterus, such as fibroids and polyps
• Uterine artery embolization: to cut off the blood supply to fibroids, causing them to shrink
• Myomectomy: to remove fibroids while preserving the uterus so you can still conceive and have children
• Endometrial ablation: to destroy the uterine lining using laser, heat, electricity, microwave waves, or freezing. You should not undergo this surgery if you plan to conceive and have more children.
• Hysterectomy: surgery to remove the uterus. Hysterectomy is typically performed as part of cancer treatment or for cancer-related conditions that cause changes in the endometrium. Advanced-stage cancer may also require radiation therapy or chemotherapy.

Complications

Possible complications include:

• Infertility
• Severe anemia caused by excessive bleeding
• Increased risk of uterine (endometrial) cancer

Prevention

You cannot prevent the causes of abnormal uterine bleeding, but you can reduce the risk factors that may cause abnormal bleeding. For example, maintaining a healthy lifestyle, such as managing your weight, plays an important role in maintaining hormonal balance.

When to See a Doctor?

Contact your doctor if you experience symptoms of abnormal uterine bleeding so you can determine the cause. Some warning signs include:

• Large blood clot
• Changing pads every less than 2 hours (due to excessive blood flow)
• Bleeding between periods or for a prolonged time
• Symptoms of anemia, such as fatigue, weakness, and shortness of breath

If the abnormal bleeding disrupts your daily activities, consult your doctor immediately.

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