Abnormal uterine bleeding is a common condition that is defined as heavy menstrual flow, or unexpected or prolonged bleeding. The incidence of abnormal uterine bleeding increases as women grow older. Abnormal uterine bleeding may be caused by a variety of factors and, depending on the cause and nature of the bleeding, there are a variety of treatments available.

Causes of Abnormal Uterine Bleeding

The most common type of abnormal uterine bleeding is dysfunctional uterine bleeding. Normal menstruation occurs when there is a drop in the progesterone level, which usually occurs about 14 days after ovulation(release of the egg from the ovary). When you do not ovulate, your ovaries do not produce progesterone, so the lining of the uterus does not shed in an orderly fashion as it normally does. Because the lining of the uterus does not undergo this orderly shedding, it becomes thicker and breaks down in a very irregular fashion. As a result, virtually any type bleeding pattern may be encountered from prolonged heavy bleeding to intermittent irregular bleeding. This is dysfunctional uterine bleeding.Other causes of abnormal uterine bleeding include endometrial polyps, fibroids,infection, malignancy, and complications of pregnancy. Other less common causes may include certain medications, thyroid problems, or disturbances in blood clotting. Polyps are small growths of the uterus and are composed of soft uterine lining tissue. Polyps usually do not cause pain, but may cause bleeding, even when small. Fibroids are benign growths of smooth muscle in the lining or wall of the uterus. Complications of pregnancy, which may cause abnormal bleeding, include threatened miscarriage or tubal (ectopic) pregnancy. In order to make certain that these potential causes of abnormal bleeding are not present, a variety of approaches are used including: taking your history, a thorough examination, a pelvic examination, and laboratory tests. The laboratory tests might include a complete blood count, thyroid test, or pregnancy test. Depending on your age and condition, an ultrasound may be needed or a biopsy of the lining of the uterus may be helpful to determine the cause of the bleeding. In other circumstances, visualization of the inside of the uterus may provide information that would be beneficial. This procedure is called hysteroscopy.

Treatments for Uterine Bleeding

Treatments for abnormal uterine bleeding include medications, endometrial ablation, and hysterectomy.

Medical Prescriptions

Drug treatment is the first step your doctor will take to help you unless there is a contraindication to medication, or if it is felt that you will not benefit from this type of treatment. Drugs that are sometimes effective include birth control pills, non-steroidal anti-inflammatory drugs such as ibuprofen, or progestins such as Provera. Another group of drugs that are sometimes used are known as gonadotropin releasing hormone (GnRH) agonists. They temporarily block estrogen production from the ovaries. This group of drugs will cause your periods to stop, but they cannot be used for long-term treatment because of the expense and possible side effects associated with their use. When medical therapy fails or is contraindicated, surgical treatment options are available. They include methods that destroy the uterine lining, or hysterectomy (removal of the uterus).

Endometrial Abalation

Endometrial Ablation is another treatment option. It is a surgical, outpatient procedure. The uterus is expanded with fluid, and the surgeon inserts an instrument designed to remove the endometrial layer inside of the uterus. The endometrial layer bleeds during menstruation and bleeding is stopped or reduced when it is removed. The surgeon may also remove or partially remove fibroids and polyps during the procedure. Since Endometrial Ablation results in infertility, it is recommended only for women who do not want to bear additional children. Many women resume normal activities in 1 to 4 days.

Hysterectomy

Hysterectomy involves the surgical removal of the uterus. The procedure may be done through an abdominal procedure, through the vagina, or using laparoscopic techniques. The method chosen is dependent on the indication for the surgery and on other associated conditions. Because of the risk of major surgery, hysterectomy should not be considered lightly, and should only be used when other treatments have failed or are not medically appropriate. Recovery from a hysterectomy usually takes 4 to 6 weeks.

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