Abnormal Uterine Bleeding

Description

Abnormal uterine bleeding (AUB) is non-cyclic uterine bleeding that occurs in women of reproductive age in the absence of pregnancy or structural uterine pathology.

Common causes of abnormal uterine bleeding in reproductive-aged women include:

a) stress;

b) obesity;

c) polycystic ovary syndrome (PCOS);

d) hormone-secreting tumors;

e) the perimenopausal transition.

Symptoms

A normal menstrual cycle occurs every 24–35 days, with bleeding lasting 2–8 days and an average blood loss of up to 80 mL per menstrual period.

Abnormal uterine bleeding does not follow this pattern. Bleeding may last longer than 7 days or occur as heavy, irregular, or frequent episodes. Anovulatory bleeding is the most common pattern and is characterized by menstrual intervals longer than 35 days followed by episodes of heavy uterine bleeding.

Diagnosis

In women of reproductive age presenting with abnormal bleeding, it is important to determine:

a) whether the bleeding originates from the uterus;

b) whether it is related to the menstrual cycle or a menstrual disorder;

c) whether it is caused by structural uterine abnormalities, such as leiomyomas, pregnancy, endometrial polyps, or other pathology.

Abnormal uterine bleeding is diagnosed after excluding other potential causes of bleeding. These include genital tract trauma, vulvar varicosities, infectious or neoplastic lesions of the vaginal mucosa, cervicitis, cervical polyps, condylomas, gynecologic malignancies, and urinary tract disorders.

The evaluation includes a detailed history, gynecological examination, pelvic ultrasonography, and laboratory testing, including complete blood count and hormone assays. Ultrasonography is useful for assessing endometrial thickness and identifying ovarian pathology. Blood tests evaluate for anemia and coagulation disorders, while hormone testing helps identify endocrine disorders and the underlying cause of menstrual dysfunction.

Treatment

Treatment depends on the cause and pattern of bleeding and may include estrogen therapy, progesterone therapy, or hormonal contraceptives.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology