Abnormal uterine bleeding (AUB) is a common issue, affecting about one-third of women at some point in their lives. While some irregular bleeding is normal during life stages such as menarche (the onset of menstruation) and perimenopause (the transition to menopause), unexpected or irregular bleeding should not be overlooked as it can signal more serious health conditions.
Occasional variations in menstrual cycles or bleeding patterns can be normal for some women, particularly during adolescence, perimenopause, or in association with hormonal changes, says Rene Schickerling, women’s health category manager for Pharma Dynamics.
However, persistent or recurrent abnormal uterine bleeding warrants evaluation by a healthcare provider to determine the underlying cause and appropriate management, she adds.
Potential causes of abnormal uterine bleeding
There are multiple reasons that could lead to AUB, including:
- Stress and lifestyle changes: Stress and rapid weight changes can affect hormonal balance.
- Medications: Certain medications, including some oral contraceptives and intrauterine devices (IUDs), can cause irregular bleeding.
- Health conditions: Conditions such as fibroids, polyps, endometriosis, diabetes, kidney disease, polycystic ovary syndrome (PCOS), thyroid disease, and sexually transmitted diseases (STDs) can lead to abnormal bleeding.
- Cancer: Certain types of cancer, including endometrial cancer, can present with abnormal bleeding.
“Additionally, factors such as age, overall health, and individual menstrual history may influence what is considered abnormal for a particular woman. Therefore, any changes or concerns regarding menstrual bleeding that is outside of the norm should be discussed with a doctor.”
Rene Schickerling
Manifestations of AUB
Schickerling says AUB can manifest in various ways, including:
- Heavy menstrual bleeding (menorrhagia): This involves menstrual periods that are unusually heavy, with prolonged bleeding lasting more than seven days or requiring frequent changing of sanitary products.
- Bleeding between periods (metrorrhagia): Unexpected bleeding or spotting that occurs between menstrual periods.
- Irregular menstrual cycles: Menstrual cycles that are significantly shorter or longer than usual, or menstrual periods that occur at irregular intervals.
- Intermenstrual spotting: Light bleeding or spotting that occurs intermittently between menstrual periods.
- Bleeding after menopause: Any vaginal bleeding that occurs after a woman has gone through menopause, defined as the absence of menstrual periods for 12 consecutive months in women over the age of 45-55.
- Bleeding after sexual intercourse (postcoital bleeding): Vaginal bleeding that occurs immediately or shortly after sexual activity.
Treatment options for AUB
The treatment for abnormal uterine bleeding depends on its underlying cause. Schickerling notes that in cases of ovulatory dysfunction, AUB can often be managed with a low-dose combined oral contraceptive (COC) containing ethinylestradiol (estrogen) and levonorgestrel (progestin).
“If not effective, minimally invasive procedures such as endometrial ablation could be considered. Hysterectomy may also be an option, yet this depends on individual factors such as hormone levels, severity of symptoms, underlying health conditions, reproductive plans, age, and personal preferences,” says Schickerling.
Lifestyle and management
Maintaining a healthy lifestyle can also help manage AUB. Regular exercise, a balanced diet, and effective stress management are crucial in regulating menstrual cycles and reducing abnormal bleeding.
“Abnormal uterine bleeding can significantly impact multiple aspects of a woman’s life, affecting physical health, emotional well-being, social interactions, and daily activities,” advises Schickerling. “Seeking timely medical evaluation and appropriate treatment can help alleviate symptoms, improve quality of life, and address any underlying health concerns.”
While abnormal uterine bleeding is a common issue, it is important for women to be vigilant about their menstrual health. Consulting with healthcare providers for persistent or unusual symptoms ensures proper diagnosis and treatment, ultimately safeguarding overall well-being.
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