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Abnormal Uterine Bleeding

By Dr S.N. Basu in Obstetrics And Gynaecology

Nov 13 , 2020 | 2 min read

What is a normal menstrual cycle?

The average age when a girl starts menstruating is between the age of 11 to 14 years of age. A normal menstrual cycle varies from 24 to 38 days approximately. Any change from the above parameters, at any age, is called abnormal uterine bleeding and needs to be investigated.

What is abnormal uterine bleeding?

Any bleeding which occurs outside these parameters and is different from the normal cycle for a woman is considered abnormal e.g.

Irregular, heavy, or intermenstrual bleeding in young girls
Heavy bleeding during periods
Bleeding after menopause
Bleeding in between periods
Bleeding after sexual intercourse
Cycles shorter than 24 days and longer than 38 days approximately
Irregular menstruation cycles

What can be the causes of abnormal uterine bleeding?

There can be several causes for the abnormal bleeding.

Pregnancy-related

It can be the first sign of a miscarriage
It may be due to an ectopic pregnancy in which the pregnancy starts to grow in the fallopian tube and has not reached the uterus. This can be dangerous and needs to be diagnosed early so that it can be managed without surgery other causes

Other causes

In young girls, while the hormonal axis is maturing there may be abnormal patterns of bleeding
Disturbances in ovulation and can lead to infertility
Can be due to fibroids and polyps in the uterus
Can be due to sexually transmitted disease
Can be due to cancer of the uterus or the cervix
Adenomyosis and endometriosis can also cause abnormality in the cycles
Problems with the birth control methods used
Bleeding disorders may also lead to abnormal bleeding
Associated conditions like thyroid disorders and diabetes and high blood pressure may also contribute to abnormal bleeding
Using unsupervised medication for emergency contraception and other hormone tablets can lead to disruption of your normal cycles.

What should you do after abnormal uterine bleeding?

If you have any of the symptoms described above you should consult a gynaecologist and get a thorough check-up.

What will happen at the doctor’s visit?

Your gynaecologist will take a detailed history of your symptoms, your past cycles, your past medical history, and other details regarding your health.

After this, you will be advised to undergo certain tests.

What tests will be needed for abnormal uterine bleeding?

You will require the following tests:

Clinical Examination
Blood tests
Ultrasound scan
Pap Smear
May require a CT scan or MRI ( your doctor will guide you appropriately)
Hysteroscopy – In this, a narrow scope with a light is inserted into the uterine cavity to diagnose the cause of the bleeding and it may be possible to treat it at the same time.
An endometrial Biopsy will be taken. Sometimes it may be taken in the Outpatient also.

What is the treatment for Abnormal Uterine bleeding?

The treatment will depend upon the cause of abnormal bleeding.

If the bleeding is caused by a pregnancy the management will depend upon the condition of the pregnancy and its site.
You may require antibiotics if there is any infection.
Hormonal tablets to regularise the cycles
Medicines to stop your bleeding – haemostatics.
Hormone-laden intrauterine contraceptive devices.
Tablets to correct the thyroid dysfunction
Dilation and curettage
Ablation of the uterine lining
Cervical cauterisation if needed
Myomectomy
Uterine artery embolization
Removal of the uterus by laparoscopy or conventional method