Overview Of Abnormal Uterine Bleeding (AUB)
Abnormal uterine bleeding (AUB) is bleeding from the uterus that either occurs at an unexpected time or is longer than usual. The bleeding may be lighter or heavier than usual, and can occur randomly or often.
AUB can occur:
- After sex
- After menopause
- As bleeding or spotting between your normal periods
- Heavier than usual
- For a longer amount of time than normal
This type of bleeding does NOT occur during pregnancy. If bleeding during pregnancy occurs, the person should immediately contact their health care provider.
Commonly Associated With
Hormonal Abnormal uterine bleeding, Anovulatory bleeding, Polymenorrhea and dysfunctional uterine bleeding
Causes Of Abnormal Uterine Bleeding (AUB)
AUB sometimes occurs if the ovaries do not release an egg as expected. AUB is common in premenopausal people and teenagers. Those who are overweight are also more likely to experience AUB. Oftentimes changes in hormone levels can cause periods to be earlier or later than usual, and may also make the bleeding heavier than average.
Every person’s period/menstrual cycle is different, so AUB is defined differently depending on the person.
On average, periods occur every 28 days, and most cycles are between 24-34 days apart. The period itself typically lasts 4-7 days.
Younger people may get their periods anywhere from 21-45+ days apart.
Those in their 40’s and above may start to have the interval between their periods decrease, or the periods may occur less often.
For most, hormone levels change every month, and the hormones progesterone and estrogen release during the ovulation process. When ovulation occurs, an egg releases.
AUB is often caused by a hormone imbalance of some type. It can also occur due to the following:
- Uterine fibroids
- Cancers of the ovaries, vagina, cervix, or uterus
- Uterine polyps
- Thickening of the uterine lining or wall
- Infection of the cervix or uterus
- Bleeding disorders or issues with blood clotting
- Polycystic ovary syndrome
- Hormonal birth control, such as IUD’s (Intrauterine devices) or birth control pills
- Severe/sudden weight loss or gain (involves more than 10 pounds/4.5 kilograms)
Symptoms Of Abnormal Uterine Bleeding (AUB)
AUB can be unpredictable. The bleeding may be very light or heavy and can occur often/randomly.
Symptoms of AUB can include:
- Bleeding that lasts for more than 7 days, or lasts longer than is normal for the person
- Periods that occur more often than usual (less than 28 days apart) or less often than usual (more than 35 days apart)
- Bleeding or spotting between periods
- Heavier bleeding than usual, such as needing to change sanitary products during the night, passing large clots, or soaking through a tampon/pad every hour for 2 to 3 hours in a row
- The time between periods is unpredictable, and often changes from month to month
Other symptoms caused by changes in hormone levels can include:
- The person may feel fatigued or tired if they lose too much blood too quickly. These symptoms can suggest anemia
- Dryness and tenderness of the vagina
- Excessive growth of body hair (hirsutism)
- Mood swings
- Hot flashes
Exams & Tests
A provider can rule out other possible causes of irregular bleeding upon exam. A pelvic exam and Pap/HPV test will mostly likely be ordered to determine the possible causes of the AUB.
Other tests that may be done can include:
- A blood clotting profile
- A complete blood count (CBC)
- A liver function test (LFT)
- Hormone tests, including but not limited to LH, FSH, prolactin, androgen levels, and progesterone
- Thyroid function tests
- A fasting blood glucose test
- A pregnancy test
Your provider may also recommend the following:
- A culture test to check for an infection
- An ultrasound to search for abnormalities in the pelvis or uterus
- A hysteroscopy, which is a procedure a health care provider’s office performs to visualize the uterus through the vagina with a small scope
- A biopsy to check for cancer, precancerous areas, or to help determine if there is a need for hormone treatment
Treatment Of Abnormal Uterine Bleeding (AUB)
Treatment can include one or more of the following:
- Hormone therapy
- High-dose estrogen therapy for those with very heavy bleeding
- An intrauterine device (IUD) that releases progestin
- Surgery, if the bleeding is caused by a fibroid or polyp
- A prescription for nonsteroidal anti-inflammatory drugs (NSAIDs) that should be taken just before the period is expected to start
- Iron supplements, but only if the person has anemia.
- Low-dose birth control pills
- If you want to get pregnant, you may be given a medication to stimulate ovulation.
Those with severe symptoms that don’t improve with the other treatments listed above, or those who have a cancerous or precancerous diagnosis may require other procedures such as:
- A surgical procedure to remove or destroy the lining of the uterus
- A hysterectomy, which removes the uterus completely