Abnormal Uterine Bleeding in Women of Reproductive Age

Regular periods are no cause for concern, but women should not ignore an irregular period. Irregular periods can be a warning sign of abnormal uterine bleeding during the reproductive years. However, many women may not be familiar with the condition. 

Simply put, abnormal uterine bleeding is any bleeding from the uterus through the vagina. Abnormal symptoms include excessive menstrual flow that affects daily activities, requires extra sanitary pads or tampons, and necessitates sanitary protection be replaced frequently, bleeding between periods (before or after periods), or bleeding during sexual intercourse. Menstruation is a regular discharge of blood from the inner lining of the uterus through the vagina in women of reproductive age, usually between 12 and 52 years of age. The average menstrual cycle is 28 days long with a seven day deviation, so the actual range is from 21 to 35 days. Bleeding usually lasts no longer than seven days. If the monthly period falls within these parameters, it is considered regular.

Abnormal uterine bleeding is one of the most common gynecological conditions, accounting for about one-third of the patients who consult an OB/GYN. In these cases, the doctor obtains the patient’s medical history for evaluation and performs a physical examination so as to determine what part of the organ is causing the abnormal bleeding. The doctor then performs a pelvic examination to check internally whether there is any bleeding elsewhere or if it is through the vagina only. The examination begins with the inspection of the external genitalia, vagina, cervix, uterus, fallopian tubes and ovaries. The OB/GYN performs a separate inspection of the neighboring organs, such as the urethra and the anus. After the examination, if the doctor is confident that those organs are not causing the abnormal uterine bleeding, the search for the cause will be more focused on the uterine cavity in order to determine whether the bleeding is caused by abnormalities in the neck of the uterus or uterine cavity. If the bleeding is located in the uterine cavity, the doctor will evaluate whether it is due to polyps or a malfunction of the endometrium and muscle. Obviously, abnormal uterine bleeding can be caused by many different conditions.  

The diagnostic evaluation can be performed by using a camera to view the abnormalities of the uterine cavity. If the bleeding is caused by polyps in the uterine cavity, the doctor will find the abnormality and remove it by performing hysteroscopic surgery, a form of minimally invasive surgery (MIS). After this procedure, the patient will usually feel little or no pain. The doctor will remove the polyp(s) for lab testing. If the polyp is caused by a malfunction of the endometrium and muscle that results in a hormonal imbalance causing  abnormal uterine bleeding, the physician may prescribe hormone medications for three consecutive months.

If abnormal uterine bleeding is not treated early, it may result in cervical cancer or endometrial cancer for which the treatment is definitely more difficult. We recommend that all women consult an OB/GYN immediately if any abnormalities are observed because they may be indicative of abnormal uterine bleeding. Most importantly, women should not ignore having regular cervical cancer screenings and are encouraged to get the HPV vaccine prior to becoming pregnant, so as to prevent viral transmission from mother to infant. Take care of yourself properly and you will have the quality of life that you expect in this new era of medical advancements.