Abnormal uterine bleeding

Causes of abnormal uterine bleeding

Many different things can cause abnormal uterine bleeding. Pregnancy, fibroids or polyps (small and large growths) in the uterus, cervical infection or cancer of the uterus as well as thyroid problems can cause abnormal bleeding. In most women, abnormal uterine bleeding is caused by a hormonal imbalance. During a normal menstrual cycle, different levels of female hormones made by your body to go up and down. Estrogen and progesterone are two very important hormones.

Ovulation

Ovulation is the part of the normal menstrual cycle when an egg is released from the ovaries. The most common cause of a dysfunctional uterine bleeding is when the ovaries releases an egg. When this happens, the levels of hormone in your body are not the same thing, causing your period to be later or earlier and heavier than normal. Abnormal bleeding caused by hormonal imbalance is most common in teenagers or in women approaching menopause.

Common causes

These are just some of the problems that can cause abnormal uterine bleeding. These problems may occur at any age, but the most likely cause of abnormal uterine bleeding usually depends on your age:

A woman in her early teens, 20s and 30s – a common cause of abnormal bleeding in adolescents and young women is pregnancy. Some birth control pills and intrauterine device can also cause abnormal bleeding. Some young women who have an abnormal uterine bleeding does not release an egg from the ovary (ovulation) during their period, causing a hormonal imbalance where estrogen in your body makes the lining of your uterus too thick. This is common for teenagers who have just started to receive their periods. During the menstrual cycle, the bleeding will be very heavy. Hormonal imbalances can also cause your body doesn't know when to shed the lining. This can cause irregular bleeding ("spotting") between periods.
A woman in her 40s and early 50s – in the years before menopause starts and when the menopause, women have months when they ovulate causing abnormal uterine bleeding. Thickening of the lining of the uterus is another cause of abnormal bleeding. In some cases, this warning is a thickening of the uterine cancer. If you have an abnormal uterine bleeding and you are in this age group, talk with your doctor to rule out uterine cancer.
Women after menopause, hormone replacement therapy is a common cause of uterine bleeding after menopause. Other causes include cancer of the endometrium and uterus. These tumors are more common in older women, but are not always the cause of abnormal uterine bleeding. Talk with your doctor if you have any bleeding after menopause.

Dysfunctional uterine bleeding: symptoms

A woman with dysfunctional uterine bleeding, bleeding as a result of a hormonal imbalance – may notice the following changes in your menstrual cycle:

Bleeding or spotting from the vagina occurs between periods
Menstrual periods may be less than 28 days or more than 35 days away
Irregular menstruation cycles
Bleeding is heavier, including: passing large clots, needing to change protection during the night and soaking through a pad or tampon every hour for 2-3 hours in a row
Bleeding lasts for more days than normal or for more than 7 days

Other symptoms are caused by changes in hormone levels are:

Excessive hair growth on the body into a male model
Hot flashes
Mood swings
Tenderness and dryness of the vagina
A woman may feel fatigue or tiredness, if she is losing too much blood in time and becomes anemic

Diagnostic Test &

OB/GYN doctor will do a gynaecological and may recommend a test laboratory, including:

Complete blood count (CBC)
Blood clotting profile
Hormone tests
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH)
Levels of male hormones (androgens)
Prolactin
Progesterone
Serum or urine HCG (to exclude pregnancy)
Thyroid function tests
Culture in search of infection

Common procedures

In addition to the pelvic examination and test lab, the provider may recommend the following procedures to diagnose the problem, including:

Endometrial biopsy to infection, oral precancer or cancer, or to help you decide on an appropriate hormonal treatment.
Hysteroscopy is a procedure for the Office in which the doctor inserts a tube with a light and a tiny camera on the end into the uterus through the vagina.
Transvaginal ultrasound can be done to look for abnormalities in the uterus or pelvis.

Treatment

Non-surgical options

Adolescents are often not treated unless symptoms are very serious, as the heavy blood loss causing anemia. In other women, the goal of treatment is to control the menstrual cycle. Some treatment options include:

Birth control pills or progesterone only pills oral
An intrauterine device (IUD) that releases progestin hormone

Surgical options

If a woman is trying to get pregnant, it can be given medication to stimulate ovulation. For those whose symptoms are severe and do not respond to other therapies, OB/GYN physicians may offer alternative treatments, including surgery. Surgical treatment options include:

Endometrial ablation or resection (Cauterization) – by destroying or removing the lining of the uterus will often stop or reduce the amount of menstrual bleeding
Hysterectomy performed less often than in the past
D and C – for the diagnosis and to remove polyps