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ABNORMAL UTERINE BLEEDING

Any bleeding from the uterus other than normal menses is considered as abnormal. Menses or menstruation is the regular occurrence of bleeding from the uterus which occurs as part of the menstrual cycle in a woman. It is the uterine lining or endometrium which is shed off. 

What is a menstrual cycle

  • The menstrual cycle involves the preparation of the ovaries for ovulation and the endometrium for implantation of the fertilized egg (ovum).
  • An average menstrual cycle lasts about 28 days, counting from the first day (day 1) of one period to the first day of the next.
  • Normal cycles can vary from 21 to 35 days.
  • Around day 5 in a normal cycle, the hormone estrogen (from the ovary) signals the endometrium to grow and thicken.
  • Around day 14, an egg is released from one of the ovaries. This is called ovulation.
  • The egg moves into one of the two fallopian tubes connected to the uterus.
  • After ovulation, the hormone progesterone (from the ovary) causes further changes in the endometrium in preparation to receive a fertilized egg.
  • If an egg meets with a sperm in the fallopian tube, it is fertilized. It travels down the tube to the uterus where it implants or burrows into the endometrium. The output of hormones from the ovaries increase, to support the growing embryo.
  • If a sperm does not fertilize the egg, the body absorbs it. Hormone levels decrease, and the endometrium then sheds with occurrence of bleeding (menstruation) around day 28. 

Features of abnormal Uterine bleeding

This may occur as one or more of the following:

  • Irregular periods i.e. periods coming after very long durations.
  • Periods coming too frequently
  • Bleeding between periods
  • Heavy bleeding during periods - the abnormality may be in either the amount of flow or the duration of flow.
  • Bleeding after sexual intercourse
  • Spotting only

Causes of Abnormal Uterine Bleeding

  • It is normal for menstrual periods to be irregular at certain times in the life of a woman. Soon after menarche i.e. attainment of first periods (between 9-16 years), for the first few years the periods are often irregular. As the woman approaches the age of 50 (menopause), the periods again may become irregular. 
  • Abnormal bleeding may be due to an imbalance in the hormones i.e. estrogens and progesterone (secreted by the ovary) or FSH/LH secreted by the pituitary gland in the brain. The imbalance may occur due to weight loss or gain, heavy exercise, stress, illness, or use of some medications. The most common result of a hormone imbalance is anovulation - when the ovaries do not release an egg. In such a case the endometrium grows too much.
  • Polycystic ovarian disease is a common cause for anovulation. In this condition the ovaries develop multiple small cysts. Symptoms of polycystic ovarian disease include:
    • Irregular uterine bleeding
    • Over-weight
    • Infertility
    • Acne
    • Excessive facial hair or hair on the abdomen or chest.

Other causes of abnormal uterine bleeding include:

  • Pregnancy
    • Normal
    • Miscarriage
    • Ectopic pregnancy
  • Problems linked to some birth control methods, such as intrauterine devices (IUDs) or birth control pills
  • Infection of the uterus or cervix
  • Uterine fibroids
  • Endometrioses
  • Problems with blood clotting
  • Cancer of the uterus, cervix, or vagina.
  • Chronic medical problems (e.g., hyperthyroidism and diabetes)


Uterine fibroids

Tackling the problem

  • A woman with an abnormal uterine bleeding needs to see a doctor to evaluate the cause. Self-medication with hormones is to be discouraged.
  • The woman is made to go through a routine clinical and pelvic examination. An ultrasound of the pelvis is done to evaluate the uterus and ovaries. Certain blood tests may be required.
  • Treatment is directed towards the cause. It may range from simple lifestyle measure such as exercise and diet, to hormonal medications or surgery.

 

  

 

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