Abnormal Uterine Bleeding
Abnormal Uterine Bleeding
Abnormal Uterine Bleeding
Causes of Abnormal Uterine Bleeding
Many different things can cause abnormal uterine bleeding. Pregnancy, polyps or fibroids (small and large growths) in the uterus, infection of the cervix or cancer of the uterus as well as thyroid problems can cause abnormal bleeding. In most women, abnormal uterine bleeding is caused by a hormone imbalance. During a normal menstrual cycle, levels of different female hormones made by your body go up and down. Estrogen and progesterone are two very important hormones.
Ovulation
Ovulation is the part of the normal menstrual cycle when an egg is released from the ovaries. The most common cause of dysfunctional uterine bleeding is when your ovaries do not release an egg. When this occurs, the hormone levels in your body are not the same, causing your period to be later or earlier and heavier than normal. Abnormal bleeding caused by hormone imbalance is more common in teenagers or in women who are approaching menopause.
Common Causes
These are just a few of the problems that can cause abnormal uterine bleeding. These problems can occur at any age, but the likely cause of abnormal uterine bleeding usually depends on your age:
A woman in her teens, 20s and 30s A common cause of abnormal bleeding in young women and teenagers is pregnancy. Some birth control pills or the intrauterine device can also cause abnormal bleeding. Some young women who have abnormal uterine bleeding do not release an egg from their ovaries (called ovulation) during their period, causing a hormone imbalance where the estrogen in your body makes the lining of your uterus too thick. This is common for teenagers who have just started getting their periods. During a menstrual cycle, the bleeding will be very heavy. Hormone imbalances may also cause your body to not know when to shed the lining. This can cause irregular bleeding ("spotting") between periods.
A woman in her 40s and early 50s In the years before menopause and when menopause begins, women have months when they don't ovulate causing abnormal uterine bleeding. Thickening of the lining of the uterus is another cause of abnormal bleeding. In some cases, this thickening is a warning of uterine cancer. If you have abnormal uterine bleeding and you're in this age group, talk to your doctor to rule out uterine cancer.
Women after menopause Hormone replacement therapy is a common cause of uterine bleeding after menopause. Other causes include endometrial and uterine cancer. These cancers are more common in older women but are not always the cause of abnormal uterine bleeding. Talk to your doctor if you have any bleeding after menopause.
Dysfunctional Uterine Bleeding Symptoms
A woman with dysfunctional uterine bleeding bleeding as a result of a hormonal imbalance may notice the following changes in her menstrual cycle:
Bleeding or spotting from the vagina occurs between periods
Menstrual periods may be less than 28 days or more than 35 days apart
Irregularity of menstrual period cycles
Bleeding is heavier including: passing large clots, needing to change protection overnight and soaking through a pad or tampon every hour for 2-3 hours in a row
Bleeding lasts for more days than normal or for more than 7 days
Other symptoms caused by changes in hormone levels are:
Excessive growth of body hair in a male pattern
Hot flashes
Mood swings
Tenderness and dryness of the vagina
A woman may feel tiredness or fatigue if she is losing too much blood over time and becomes anemic
Tests & Diagnosis
Your OB/GYN doctor will do a pelvic examination and may recommend lab tests, including:
Complete Blood Count (CBC)
Blood clotting profile
Hormone tests
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH)
Male hormone (androgen) levels
Prolactin
Progesterone
Serum or urine HCG (to rule out pregnancy)
Thyroid function tests
Culture to look for infection
Common Procedures
In addition to the pelvic exam and lab tests, the provider may recommend the following procedures to diagnose the issue including:
Endometrial biopsy to look for infection, precancer or cancer, or to help decide on an appropriate hormone treatment.
Hysteroscopy is an office procedure in which the doctor inserts a flexible tube with a light and a tiny camera on the end into the uterus through the vagina.
Transvaginal ultrasound may be done to look for abnormalities in the uterus or pelvis.
Treatment
Non-Surgical Options
Teenagers are often not treated unless symptoms are very severe, such as heavy blood loss causing anemia. In other women, the goal of treatment is to control the menstrual cycle.Some treatment options include:
Oral birth control pills or progesterone only pills
An intrauterine device (IUD) that releases the hormone progestin
Surgical Options
If a woman is seeking to get pregnant, they may be given medication to stimulate ovulation.For those whose symptoms are severe and do not respond to other therapies, OB/GYN physicians may offer alternative treatments, including surgery.Surgical treatment options include:
Endometrial ablation or resection - destroying (cauterizing) or removing the lining of the uterus will often stop or reduce the amount of menstrual bleeding
Hysterectomy - performed less often than in the past
D and C - for diagnosis and to remove polyps
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