Abnormal Uterine Bleeding: Causes and When to See a Gynaecologist

Introduction

Menstrual cycles can naturally vary from one woman to another, but significant changes in the timing, duration, or amount of bleeding should not always be ignored. Abnormal uterine bleeding (AUB) refers to bleeding from the uterus that differs from a woman's usual menstrual pattern. It may include unusually heavy periods, bleeding between periods, prolonged menstruation, irregular cycles, or bleeding after menopause.

AUB can occur at different stages of life and has many possible causes, ranging from temporary hormonal changes to conditions such as fibroids, polyps, or disorders affecting the uterine lining. An evaluation by the best gynaecologist in Ferozpur can help identify the underlying cause and determine the most appropriate treatment based on age, symptoms, medical history, and reproductive goals.

What Is Abnormal Uterine Bleeding?

Abnormal uterine bleeding is a broad term used for menstrual or uterine bleeding that is unusual in frequency, regularity, duration, or volume.

Examples can include:

• Unusually heavy periods
• Bleeding lasting longer than expected
• Bleeding or spotting between periods
• Menstrual cycles occurring unusually close together
• Very irregular menstrual cycles
• Bleeding after sexual intercourse
• Bleeding after menopause

An occasional change in the menstrual cycle may not necessarily indicate a serious condition. However, repeated or persistent changes should be medically evaluated.

Common Symptoms of Abnormal Uterine Bleeding

AUB can present differently depending on its cause. Some women experience changes gradually, while others notice sudden abnormal bleeding.

Heavy Menstrual Bleeding

Heavy menstrual bleeding may involve significantly increased blood loss, frequent changes of sanitary products, passing large blood clots, or bleeding that interferes with normal activities.

Prolonged Periods

Menstrual bleeding that continues considerably longer than a woman's usual period may be considered abnormal and should be evaluated if it happens repeatedly.

Bleeding Between Periods

Unexpected spotting or bleeding between regular menstrual cycles may occur because of hormonal changes, contraception, infections, polyps, or other conditions.

Irregular Menstrual Cycles

Periods that become unpredictable, unusually frequent, or widely spaced may indicate changes in normal ovulation or hormone levels.

Bleeding After Menopause

Any vaginal bleeding after menopause requires medical evaluation. Although there are several possible causes, doctors need to rule out conditions affecting the uterus, cervix, or endometrium.

Women experiencing persistent changes in their menstrual pattern can consult the best gynaecologist in Ferozpur for an appropriate examination and diagnostic assessment.

What Causes Abnormal Uterine Bleeding?

AUB is not a single disease. Instead, it can result from several structural and non-structural conditions.

1. Hormonal Imbalance

Hormonal changes are a common cause of irregular bleeding, particularly during adolescence and around perimenopause.

If ovulation does not occur regularly, the balance between oestrogen and progesterone can change. This may cause the uterine lining to become unstable and result in irregular or heavy bleeding.

2. Uterine Fibroids

Fibroids are non-cancerous growths that develop in or around the uterus. Depending on their size and location, they can cause heavy or prolonged periods, pelvic pressure, pain, or reproductive concerns.

3. Uterine Polyps

Endometrial polyps are growths arising from the inner lining of the uterus. They may cause irregular bleeding, spotting between periods, or bleeding after intercourse.

4. Adenomyosis

Adenomyosis occurs when tissue similar to the uterine lining grows into the muscular wall of the uterus. It may contribute to heavy menstrual bleeding, painful periods, and pelvic discomfort.

5. Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) can interfere with regular ovulation and result in irregular or absent menstrual periods. Some women may subsequently experience unpredictable or heavy bleeding.

6. Thyroid Disorders

Both an underactive and overactive thyroid can affect menstrual cycles. Thyroid testing may therefore be recommended when evaluating unexplained menstrual irregularities.

7. Medications and Contraception

Hormonal contraceptives, intrauterine devices, anticoagulants, and certain other medications may alter menstrual bleeding patterns.

8. Pregnancy-Related Causes

Bleeding during pregnancy has different possible causes and should not automatically be considered a menstrual period. Pregnancy-related bleeding requires appropriate assessment, particularly if accompanied by pain, dizziness, or heavy blood loss.

9. Disorders of the Uterine Lining

Abnormal changes in the endometrium, including endometrial hyperplasia, can cause irregular bleeding. In a smaller proportion of cases, abnormal bleeding may be associated with endometrial cancer, particularly after menopause.

How Is Abnormal Uterine Bleeding Diagnosed?

Diagnosis begins with understanding the pattern of bleeding. Your doctor may ask about cycle frequency, duration, blood flow, pregnancy possibility, medications, contraception, and other symptoms.

Pelvic Examination

A physical and pelvic examination may help identify abnormalities involving the reproductive organs.

Blood Tests

Blood tests may be used to check for anaemia, pregnancy, thyroid problems, or other conditions depending on the patient's symptoms.

Pelvic Ultrasound

Ultrasound provides images of the uterus and ovaries and can help detect fibroids, polyps, ovarian abnormalities, or changes in the uterine lining.

Hysteroscopy

During hysteroscopy, a thin viewing instrument is passed through the cervix to examine the inside of the uterus. It may be recommended when polyps or other abnormalities inside the uterine cavity are suspected.

Endometrial Biopsy

A small sample of the uterine lining may be collected for laboratory examination in selected patients. Whether a biopsy is necessary depends on factors such as age, risk factors, bleeding pattern, and ultrasound findings.

An individualized assessment by the best gynaecologist in Ferozpur can help determine which investigations are appropriate rather than performing unnecessary tests.

Treatment Options for Abnormal Uterine Bleeding

Treatment depends on the underlying cause, severity of bleeding, age, general health, and whether future pregnancy is desired.

Medications

Depending on the diagnosis, doctors may recommend medicines to reduce bleeding or regulate menstrual cycles. Options can include hormonal treatment, non-hormonal medicines, or treatment for an underlying medical condition.

Iron supplements may also be prescribed when prolonged blood loss has resulted in iron-deficiency anaemia.

Hormonal Contraception

Certain hormonal contraceptive methods can help regulate menstrual cycles and reduce heavy bleeding in appropriately selected patients.

Treatment for Fibroids or Polyps

If structural abnormalities are responsible for bleeding, procedures may be considered. Polyps can often be removed hysteroscopically, while fibroid treatment depends on their number, size, location, symptoms, and fertility goals.

Endometrial Ablation

In selected women who do not wish to become pregnant in the future, endometrial ablation may be considered to reduce heavy menstrual bleeding by treating the uterine lining.

Hysterectomy

Hysterectomy involves surgical removal of the uterus and permanently stops uterine bleeding. It is generally considered when symptoms are severe, other treatments are unsuitable or unsuccessful, and future pregnancy is not desired.

Can Abnormal Bleeding Cause Anaemia?

Yes. Repeated heavy or prolonged menstrual bleeding can gradually reduce the body's iron stores and lead to iron-deficiency anaemia.

Possible symptoms include:

• Persistent tiredness
• Weakness
• Dizziness
• Headaches
• Pale skin
• Shortness of breath
• Rapid heartbeat

Treating the bleeding as well as correcting iron deficiency is important for long-term management.

When Should You See a Gynaecologist?

Schedule a medical evaluation if menstrual bleeding becomes repeatedly heavier than usual, periods become significantly irregular, bleeding occurs between periods or after intercourse, or periods consistently last much longer than normal.

Bleeding after menopause should always be evaluated.

Seek urgent medical attention for extremely heavy bleeding, particularly when accompanied by fainting, severe dizziness, breathing difficulty, significant weakness, severe abdominal or pelvic pain, or possible pregnancy.

Early assessment by the best gynaecologist in Ferozpur can help identify the cause of abnormal bleeding and prevent complications such as severe anaemia while ensuring that conditions requiring treatment are detected appropriately.

Frequently Asked Questions (FAQs)

1. Is abnormal uterine bleeding always serious?

No. It can result from temporary hormonal changes, but persistent or unusual bleeding should be evaluated.

2. Can fibroids cause heavy menstrual bleeding?

Yes. Fibroids, particularly those affecting the uterine cavity, can contribute to heavy or prolonged periods.

3. Can hormonal imbalance cause irregular periods?

Yes. Changes in ovulation and hormone levels are common causes of irregular menstrual bleeding.

4. Should bleeding after menopause be checked?

Yes. Any bleeding after menopause should be evaluated by a healthcare professional.

5. Can heavy periods cause anaemia?

Yes. Repeated heavy blood loss can lead to iron-deficiency anaemia and symptoms such as fatigue, weakness, and dizziness.