The most common reason for women being referred to gynecologists is abnormal uterine bleeding (AUB), when there is a significant change in the frequency, duration, or amount of bleeding during or between periods in women, AUB is diagnosed. After a year, vaginal bleeding in women whose periods have stopped is abnormal and requires investigation.1

Patients typically first see their primary care physicians, who are equipped to handle most of the diagnostic and treatment processes.1

Medical History and Physical Examination:

Your healthcare provider will begin by taking a detailed medical history, including reasons for bleeding, other symptoms if any, and pregnancy history.3

A physical examination, including a pelvic exam, may be conducted to assess the reproductive organs and identify any visible abnormalities.3

Diagnostic Tests:

Blood tests– These may include a complete blood count (CBC), hormone level assessments, and pregnancy test.4,5

Imaging studies- Ultrasound imaging may be performed to evaluate the uterus, ovaries, and pelvic structures. Other imaging techniques, such as MRI may be required in specific cases.4,5

Endometrial biopsy- A procedure in which tissue samples from the lining of your uterus are taken and look for signs of cancer or cells that could turn into cancer.3

Thyroid screening– If your thyroid isn’t working right, it could be a sign that your ovaries aren’t working right, which could be the cause of your bleeding.

Hormone levels test– Hormone imbalances may be the cause of your unusual bleeding, or they may be a sign of a disease that is causing your bleeding.

What’s triggering your bleeding will determine how you are treated. Bleeding can be controlled medically, or the underlying cause can be addressed surgically.3

Medications:

Non-hormonal medications- Medications like Nonsteroidal anti-inflammatory drugs 

(NSAIDs) and Tranexamic can reduce abnormal uterine bleeding. These medications can be given occasionally to treat women who desire pregnancy or have heavy menstrual bleeding.5

Hormonal therapy: (eg, estrogen/progestin contraceptives) – Is often tried first in women who want contraception or who are perimenopausal (the time around which menstrual periods stop permanently). It suppresses endometrial (The layer of tissue that lines the uterus) development, reestablishes predictable bleeding patterns, and decreases menstrual flow.5

Surgical Procedures:

Hysteroscopy with dilation and curettage (D&C)- It is used for treating severe bleeding or in case of ineffective hormone therapy. It can identify structural causes and reduce bleeding.5

Endometrial ablation– It may control bleeding in 60 to 80% of patients. Ablation is less painful than having your uterus removed and the recovery time is shorter. Pregnancy rates may be high as it does not prevent pregnancy.5

You know your body best, therefore only you can determine what is typical for your period duration and bleeding intensity. Talk to your doctor if your periods are very heavy or prolonged, or if you experience any bleeding outside of your regular menstrual cycle. You should never keep your pain to yourself or feel ashamed. There are a variety of non-invasive treatments that can help stop your bleeding.3

References:

1. Telner DE, Jakubovicz D. Approach to diagnosis and management of abnormal uterine bleeding. Can Fam Physician. 2007;53(1):58-64.
2. Kumari P, Kundu J. Prevalence, socio-demographic determinants, and self-reported reasons for hysterectomy and choice of hospitalization in India. BMC Women’s Health. 2022;22(1).
3. Cleveland Clinic. Abnormal uterine bleeding. [Internet] [cited 2023 June 26]. Available from: https://my.clevelandclinic.org/health/diseases/15428-uterine-bleeding-abnormal-uterine-bleeding.
4. Davis E, Sparzak PB. Abnormal uterine bleeding. [Internet] 2022 Sep 9 [cited 2023 June 26]. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532913/
5. Pinkerton JV. Abnormal uterine bleeding. MSD Manual Professional Edition. [Internet] Published 2023 Jun 21 [cited 2023 June 26]. Available from: https://www.msdmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/abnormal-uterine-bleeding.