Abnormal Bleeding
Abnormal Bleeding
What is Abnormal Bleeding?
Abnormal bleeding (also called abnormal uterine bleeding or AUB) refers to any bleeding from the uterus that differs from a normal menstrual cycle.
A typical menstrual cycle:
- Cycle length: Occurs every 21–35 days
- Duration: Lasts about 3–7 days
- Flow: Moderate and predictable
Bleeding is considered abnormal if it involves:
- Heavy bleeding: Soaking through pads or tampons every 1–2 hours
- Prolonged bleeding: Lasting more than 7–8 days
- Irregular cycles: Bleeding at unpredictable times
- Bleeding between periods: Spotting or unexpected flow
- Bleeding after intercourse
- Bleeding after menopause
Abnormal bleeding can occur occasionally due to temporary hormonal changes, but persistent or severe symptoms should be evaluated.
Impact of Abnormal Bleeding on Anatomy and Health
Abnormal bleeding can affect both physical and emotional well-being.
- Anaemia: Heavy or prolonged bleeding can reduce iron levels, leading to fatigue, dizziness, shortness of breath, and paleness.
- Hormonal imbalance: Ongoing irregular bleeding may signal ovulation problems or endocrine disorders.
- Structural uterine changes: Conditions such as fibroids or polyps may distort the uterine cavity.
- Fertility impact: Some underlying causes may interfere with implantation or ovulation.
- Quality of life: Excessive bleeding can interfere with work, social activities, intimacy, and sleep.
In rare cases, abnormal bleeding may indicate precancerous or cancerous changes of the uterus, especially after menopause.
Risk Factors for Abnormal Bleeding
Abnormal bleeding can occur at any age, but is more common in certain groups:
- Adolescents: Due to immature hormonal regulation after menarche
- Women approaching menopause (perimenopause): Hormonal fluctuations
- Women with PCOS: Irregular ovulation
- Women with thyroid disorders
- Women using hormonal contraception or intrauterine devices (IUDs)
- Women with bleeding disorders
- Women who are overweight or obese: Increased oestrogen levels
- Women with a history of fibroids or polyps
Bleeding after menopause always requires prompt medical assessment.
Causes of Abnormal Bleeding
Causes vary depending on age and medical history. Common causes include:
Hormonal Causes
- Ovulation disorders: Irregular or absent ovulation
- Polycystic ovarian syndrome (PCOS)
- Thyroid disease
- Perimenopause hormonal changes
Structural Causes
- Fibroids: Non-cancerous growths in the uterus
- Endometrial polyps
- Adenomyosis: Uterine lining growing into the muscle wall
- Endometrial hyperplasia: Thickened uterine lining
Pregnancy-Related Causes
- Early pregnancy bleeding
- Miscarriage
- Ectopic pregnancy
Infections
- Pelvic inflammatory disease
- Cervicitis or endometritis
Medical Conditions
- Bleeding disorders
- Liver disease
- Diabetes
Medication-Related Causes
- Hormonal contraceptives
- Anticoagulants (blood thinners)
- Hormone replacement therapy
Malignancy (Less Common but Important)
- Endometrial cancer
- Cervical cancer
Symptoms of Abnormal Bleeding
Symptoms may include:
- Bleeding between periods
- Very heavy menstrual flow
- Periods lasting longer than usual
- Clots larger than a 50-cent coin
- Bleeding after sex
- Postmenopausal bleeding
- Pelvic pain or pressure
- Symptoms of anaemia: Fatigue, weakness, dizziness
Preventing Abnormal Bleeding
Not all causes are preventable, but certain steps may reduce risk:
- Maintain a healthy weight: Helps regulate hormones
- Manage chronic conditions: Such as thyroid disease or diabetes
- Attend regular cervical screening tests
- Avoid smoking
- Follow prescribed contraception guidance
- Seek early review for irregular cycles
Early assessment often prevents complications.
Types of Abnormal Bleeding
Abnormal bleeding is classified based on pattern:
- Heavy menstrual bleeding (menorrhagia)
- Irregular menstrual bleeding (metrorrhagia)
- Frequent periods (polymenorrhoea)
- Infrequent periods (oligomenorrhoea)
- Intermenstrual bleeding
- Postcoital bleeding
- Postmenopausal bleeding
Doctors may also classify causes using the PALM-COEIN system, which separates structural and non-structural causes.
Diagnosis of Abnormal Bleeding
Diagnosis begins with a thorough consultation and examination.
Medical History
- Cycle details: Timing, duration, flow
- Pregnancy possibility
- Medication use
- Family history
- Associated symptoms
Physical Examination
- Pelvic examination
- Cervical screening if due
Blood Tests
- Pregnancy test
- Hormone levels
- Thyroid function
- Iron levels
- Clotting studies (if indicated)
Imaging
- Pelvic ultrasound: First-line imaging test
- Saline sonohysterography: Detailed uterine cavity view
- MRI (selected cases)
Additional Tests
- Endometrial biopsy: To check for hyperplasia or cancer
- Hysteroscopy: Direct camera examination of the uterus
The choice of investigations depends on age, symptoms, and risk factors.
Treatment for Abnormal Bleeding
Medical Treatment
- Hormonal therapy:
- Combined oral contraceptive pill
- Progesterone tablets
- Hormonal IUD
- Injectable hormones
- Non-hormonal options:
- Anti-inflammatory medications
- Tranexamic acid to reduce heavy bleeding
- Iron supplements for anaemia
- Antibiotics: If infection is present
Surgical Treatment
If medication is ineffective or structural causes are identified:
- Hysteroscopic removal of polyps or fibroids
- Myomectomy: Removal of fibroids while preserving the uterus
- Endometrial ablation: Reduces heavy bleeding (for women who have completed childbearing)
- Hysterectomy: Removal of the uterus (definitive treatment)
The most appropriate option depends on your individual circumstances.
What if Abnormal Bleeding is Untreated?
Ignoring abnormal bleeding can lead to:
- Severe anaemia
- Chronic fatigue and reduced quality of life
- Progression of untreated conditions (such as fibroids)
- Missed diagnosis of serious conditions
- Fertility complications
Postmenopausal bleeding should never be ignored, as early detection of uterine cancer significantly improves outcomes.
