Abnormal Uterine Bleeding

Abnormal uterine bleeding is a medical condition that occurs when there is bleeding from the uterus through the vagina apart from the normal monthly menstrual cycle. In such a condition, some patients may experience very heavy bleeding during or in between their period.

Abnormal uterine bleeding can occur at any stage of a woman’s reproductive life, from puberty to menopause.

WHAT ARE THE CAUSES OF ABNORMAL UTERINE BLEEDING?

Various ovarian and uterus-related diseases, such as the growth of polyps or fibroids in the uterus, can be a cause of abnormal bleeding.

In females, this condition can also be caused by a hormonal imbalance. It is most common in teenagers or women who are approaching menopause. Postmenopausal bleeding refers to the abnormal bleeding that occurs in a woman who is in menopause. It may need further evaluation.

 

PALM-COEIN is a classification system used to identify the underlying causes of abnormal uterine bleeding.

PALM stands for:

  • Polyps
  • Adenomyosis
  • Leiomyoma
  • Malignancy and hyperplasia

COEIN stands for:

  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic
  • Not otherwise classified

Polyps are growths that can occur inside the uterus and cause abnormal bleeding. Adenomyosis is a condition where the lining of the uterus grows into the muscle layer, leading to heavy and painful periods. Leiomyoma, also known as fibroids, are non-cancerous growths in the uterus that can cause heavy bleeding.

Malignancy and hyperplasia are conditions where there is abnormal growth of cells in the uterus. These conditions can be cancerous or pre-cancerous, and require prompt evaluation and treatment.

Coagulopathy refers to bleeding disorders that can cause abnormal uterine bleeding. Ovulatory dysfunction occurs when there is a disruption in the normal hormonal balance that regulates menstrual cycles, leading to irregular or heavy bleeding.

Endometrial refers to conditions related to the lining of the uterus, such as endometrial hyperplasia or cancer. Iatrogenic refers to bleeding caused by medical treatments or procedures, such as the use of certain medications or intrauterine devices.

Not otherwise classified refers to cases where the underlying cause of abnormal uterine bleeding cannot be identified using the PALM-COEIN classification system.

It is important to evaluate and diagnose the underlying cause of abnormal uterine bleeding in order to provide appropriate treatment. Treatment may involve medication, surgery, or other interventions depending on the underlying cause.

WHAT ARE THE SYMPTOMS OF ABNORMAL UTERINE BLEEDING?

A few common symptoms of abnormal uterine bleeding are:

    • Bleeding between menstruation cycles
    • Heavy menstrual flow
    • Large clots in menstrual blood
    • Menstrual flow lasting longer than seven days
    • Any bleeding after menopause
    • Any bleeding after intercourse
    • An interval between periods lasting greater than 35 days
    • Only having four to nine periods in a year

HOW IS ABNORMAL UTERINE BLEEDING DIAGNOSED?

A range of tests are needed to diagnose this condition considering the patient’s age. Some examples of these tests include a pregnancy test, a hormonal profile, a pregnancy ultrasound, etc.
A hysteroscopy may even be performed to diagnose this condition. During this procedure, a lens with a camera and a light source (called a hysteroscope) is inserted in the uterus. This camera produces an image of the inside of the uterus for the doctor to see. This further helps to look directly inside the uterus, while taking a biopsy. A hysteroscope can also be used to remove fibroids or polyps inside the uterus.

HOW IS ABNORMAL UTERINE BLEEDING TREATED?

Two methods can be used to treat this condition effectively.

Non-surgical options:

NSAIDs, Tranexamic acid, Birth control pills and hormonal pills constitute non-surgical options that may be taken after consulting with your doctor. Such pills prevent the lining of the uterus from getting too thick, which helps reduce bleeding. They may also lead to a regular menstrual cycle and reduced period cramps.

Surgical options:

Several minimally invasive treatment options are available to help with heavy bleeding.

Hysteroscopy
Hysteroscopy is an effective method for both the diagnosis and treatment of abnormalities like polyps and fibroids, which can cause heavy bleeding.

Endometrial Ablation
In this procedure, doctors surgically ablates the lining of the uterus. Only those patients who do not wish to have kids in the future or do not desire fertility are suitable for this procedure. This procedure can be very effective in selected patients. After the surgery is done, patients may either stop getting their periods completely or have lighter periods. Hysterectomy may be recommended for a small proportion of patients who do not get the expected relief from this procedure.

Hormonal IUDs
In some patients, placement of hormonal IUDs like Mirena, Liletta, or Kyleena can help reduce bleeding.

Hysterectomy
The uterus is completely removed during a hysterectomy to stop the bleeding. In younger patients, the ovaries are often preserved because they produce estrogen, which prevents women from getting menopausal symptoms such as hot flashes or vaginal dryness. If a patient opts for a hysterectomy, their uterus is removed, so they won’t be able to have periods or bear children.