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Abnormal Uterine Bleeding

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Abnormal uttering bleeding is any bleeding that occurs between a woman’s menstrual period. Additionally, if a woman experiences excessive bleeding during her period, that is considered abnormal uterine bleeding, heavy menstrual bleeding or irregular periods. After the childbearing years are past and a woman enters menopause, the menstrual cycles end. However, any bleeding, other than the small amounts that can occur in women on hormone replacement therapy, is also considered abnormal.

Symptoms of Abnormal Uterine Bleeding

The symptoms of abnormal uterine bleeding, heavy menstrual bleeding and irregular menstrual bleeding can vary woman to woman, but presence of the following could indicate the existence of such a condition:

  • Bleeding between menstrual periods
  • Heavy menstrual bleeding
  • Irregular periods
  • Bleeding after menopause

Causes and Risk Factors of Abnormal Uterine Bleeding

The particular causes of abnormal uterine bleeding tend to occur at certain times throughout a woman’s life. For example, a hormone imbalance can cause bleeding—such as too much estrogen, or not enough progesterone. On the other hand, uterine polyps or uterine fibroids can also cause bleeding. Additionally, uterine cancer, a cervical infection and thyroid problems can all cause bleeding. The aforementioned problems can occur at any age, however, the most likely causes of abnormal uterine bleeding depends on a woman’s age.

The following lists of potential causes of abnormal uterine bleeding are broken down by a woman’s life stage. It is important to keep in mind that these are only potential causes.

Childhood to Adulthood

  • Bleeding before beginning to menstruate
  • Irritation of the genital area
  • Urinary tract infection
  • Sexual abuse
  • Ongoing irregular menstrual periods
  • Persistent breakthrough bleeding between periods
  • Pregnancy
  • Bleeding disorders
  • Medical illnesses
  • Infection

Adult Women up through their 30s

  • Pregnancy
  • Birth control pills
  • Lack of ovulation (release of egg) during menstrual cycle,
  • Light spotting between periods

Premenopausal Women

  • Abrupt changes in hormone levels at ovulation
  • Breakthrough bleeding due to use of oral contraceptives
  • Anovulation
  • Irregular changes in hormone levels
  • Uterine fibroids
  • Uterine polyps
  • Irregular growths
  • Benign tumors

Other causes of abnormal uterine bleeding in premenopausal women include:

  • Cancer of the endometrium (lining of the uterus)
  • Benign precancerous endometrial lesions
  • Endometritis or inflammation of the endometrium
  • Pelvic or vaginal infection
  • Clotting disorders such as von Willebrand's disease, platelet abnormalities or problems with clotting factors
  • Some systemic illnesses such as hypothyroidism, liver disease or chronic renal disease

Women in their 40s and early 50s

  • Decline of progesterone secretion
  • Proliferation of endometrium
  • Uterine polyps or fibroids
  • Cancer
  • Infection
  • Systemic illnesses
  • Pregnancy
  • Oral contraceptive agents
  • Lack of ovulation
  • Thickening of the lining of the uterus
  • Endometrial cancer

During and after menopause

  • Hormone replacement therapy
  • Thickened endometrium
  • Uterine cancer

Some of the most common causes of abnormal bleeding during menopause include:

  • Atrophy or thinning of the tissue lining the vagina and uterus
  • Cancer of the uterine lining or endometrium
  • Polyps or fibroids
  • Endometrial hyperplasia or the rapid growth of extra endometrial tissue
  • Infection of the uterus
  • Use of blood thinners or anticoagulants
  • Side effects of radiation therapy

Tests to Diagnose Abnormal Uterine Bleeding

Initially, a thorough medical and gynecologic history and physical examination will be conducted. Additional laboratory tests and diagnostic procedures may be used to identify the cause of abnormal bleeding, such as the following:

  • Pregnancy test
  • Check blood count for anemia (low iron) from the blood loss.

Depending on your age, the following tests could be ordered:

  • Ultrasound
  • Cervical culture
  • Lab tests
  • Ovulation tests
  • Endometrial biopsy
  • MRI (Magnetic Resonance Imaging)
  • Hysteroscopy
  • Dilation and curettage (D&C)

Treatments and Procedures for Abnormal Uterine Bleeding

As with many medical conditions, the specific treatment depends on the exact cause of abnormal uterine bleeding. For example, if the cause is a hormone imbalance, the best treatment might be to prescribe birth control pills or progesterone. On the other hand, if the cause of abnormal uterine bleeding is cancer, surgery might be the best treatment option. The following are all potential treatment options for abnormal uterine bleeding:

  • Birth control pills (oral contraceptive)
  • Intrauterine contraceptive
  • Altering the amount of estrogen prescribed (in hormone replacement therapy)
  • Treating a thyroid problem
  • Surgery
  • Nonsteroidal anti-inflammatory drugs (NSAIDS)
  • Hormonal therapy

To learn more about abnormal uterine bleeding, review the McCarus Surgical Specialists for Women Abnormal Uterine Bleeding FAQ Sheet.

If you are experiencing abnormal uterine bleeding, call McCarus Surgical Specialist for Women at 407.303.4190 to request an appointment at our Celebration or Winter Park location.