Abnormal Uterine Bleeding (AUB)
In general, normal menstrual cycles happen once in 21-40 days and periods can last for 3-8 days. If there is any variation form normal menstrual cycle, then it is known as abnormal uterine bleeding (AUB).
- In young girls: bleeding before maturity (menarche – first periods) can happen and this could be due to trauma to private parts, foreign body in vagina (such as small stone, toy, etc), bubble bath can cause local irritation and bleeding, remember in young girls bleeding can also happen if there has been sexual abuse.
- In adolescents: most of young women can have AUB for couple of months or years after maturity. This is mainly due to hormonal issues and generally they resolve without any treatment.
- In young women AUB can be due to pregnancy, vaginal/ cervical infections, fibroid uterus (non-cancerous tumor of the womb), adenomyosis (inner lining of the womb is found in the muscle layer), endometrial polyp (small non-cancerpus fleshy growth in the womb) and in PCOS (polycystic ovaries, where in eggs are not released from the ovary).
- Sometimes AUB can be symptom of bleeding disorders (where blood doesn’t clot normally)
- AUB can also be seen in certain types of cancer, such as cancer of the womb and the neck of the womb (cervix).
If you have any abnormal bleeding per-vagina such as
- Bleeding or spotting in-between your normal periods
- Bleeding after sexual intercourse
- If your menstrual cycle are shorter than 21dyas or longer than 40 days
- Heavy bleeding during periods (lasting more than 8 days or passing huge blood clots or need to wake up in the night to change the pad)
- Bleeding after menopause.
After you doctor notes down your symptoms, your tummy will be felt and if required and if your are sexually active internal examination will be done. Based on the findings you may be advise for any of the following tests.
- Ultrasound examination: to check any abnormalities within your womb
- MRI / CT scan: may be required sometimes, MRI is preferable in young patients.
- Sometimes you may be advise to have biopsy of the inner lining of the womb (endometrium), this can be done in OPD / out-patient clinic and doesn’t require admission nor anesthesia.
- Hysteroscopy: You may also require hysteroscopy; this is a procedure wherein a thin telescope will be passed into your womb to look for any abnormalities.
In management of AUB, medications are often first choice.
- Oral contraceptive pills (OCP) / birth control pills: these pills will help in making your periods more regular.
- Gonadotropin-releasing hormone agonists (GnRH): these medications are sometimes prescribed to reduce menstrual cycle and this medication may be given to shrink your fibroids
- You may be advised to take tranexamic acid on monthly basis to decrease your flow of menstruation.
- Sometimes you may be given anti-inflammatory drugs which will control heavy bleeding
- If you have nay infection then you may be advised to take antibiotics
Surgery: if medical management doesn’t help in reducing bleeding surgery may be advised to treat the condition causing AUB.