Abnormal uterine bleeding (AUB) is a condition that affects many women and can have a significant impact on their health and quality of life.¹ It refers to period flow that deviates from normal patterns in terms of frequency, regularity, duration, or volume.² This article discusses the symptoms and causes of AUB to help raise awareness about the condition.

One of the most common signs of AUB is irregular bleeding or spotting. This means that a woman may experience bleeding or spotting between her regular periods or after sexual intercourse.^3,4

Another sign is heavy bleeding during periods. Some women with AUB may experience heavy bleeding that they need to change their pads or tampons every hour, and the bleeding may persist for more than 7 days.^3,4

Frequent or late cycles are also indicative of AUB. Menstrual cycles that are longer than 35 days or shorter than 21 days can be considered irregular. Additionally, irregular and prolonged menstrual cycles, where the bleeding days vary by more than 7-9 days, are also associated with AUB.⁴

No periods for an extended duration (3-6 months) can be another sign of AUB. Lastly, post-menopausal bleeding can also be a sign of AUB. It refers to any bleeding that occurs after menopause, which is the permanent cessation of periods.⁴

Some of the causes of AUB are as follows:

Hormonal changes: Abnormal uterine bleeding is commonly caused due to hormonal changes. In teenagers and women approaching menopause, there can be an excess build-up of the inner lining of the uterus. This can lead to spotting between periods, irregular or heavy periods.³

Cancer: Sometimes, abnormal uterine bleeding can be caused due to cancer of the uterus, cervix, or endometrium.³

Fibroids and polyps: Fibroids are small, noncancerous growth in the uterus, while polyps are another kind of noncancerous growth that can be found inside the uterus or on the cervix. Both fibroids and polyps can cause irregular or heavy bleeding.⁴

Problems with ovulation: When you don’t ovulate (release an egg) during your menstrual cycle, it can lead to irregular and sometimes heavy bleeding. If this happens for several cycles, the lining of the uterus can become thick. This can occur when you first start having periods or during the time leading up to menopause (perimenopause).⁴

Bleeding disorders: When blood doesn’t clot properly, it can lead to heavy bleeding. If you have had heavy periods since your first menstruation, you may have a bleeding disorder. Other signs include easy bruising, heavy bleeding after childbirth or surgery, frequent nosebleeds, and gum bleeding after dental work.⁴

Medications: Hormonal birth control methods can affect your bleeding pattern, causing bleeding at unexpected times called breakthrough bleeding. Certain medications like blood thinners and aspirin can lead to heavy bleeding. The copper intrauterine device (IUD) may also cause heavy menstrual bleeding, especially in the first year of using it.⁴

Stress/anxiety and lifestyle: Pressure situations can lead to increased psychosocial stressors like stress, anxiety, and depression which causes hormonal imbalance and can lead to AUB.⁵

AUB can impact the quality of life of the women affected.¹ Hence, it is advisable to consult a healthcare professional if you experience any symptoms of AUB. They can help conduct a thorough evaluation, including medical history, physical examination, and appropriate tests to determine the underlying cause and develop an individualised treatment plan.

References:

1. Levy-Zauberman Y, Pourcelot AG, Capmas P, et al. Update on the management of abnormal uterine bleeding. J Gynecol Obstet Hum Reprod. 2017 Oct;46(8):613-22.
2. Livingstone M, Fraser IS. Mechanisms of abnormal uterine bleeding. Hum Reprod Update. 2002;8(1):60-7.
3. WebMD. Abnormal uterine bleeding. [Internet] 2022 Sep 07 [cited 2023 May 22]. Available from: https://www.webmd.com/women/abnormal-uterine-bleeding.
4. American College of Obstetricians and Gynecologists. Abnormal uterine bleeding. [Internet] 2021 Dec [cited 2023 May 22]. Available from: https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding.
5. Preethi L, Mylanikunathil Saji A, Chandran L, et al. Pandemic-induced stress and obesity leading to abnormal uterine bleeding: A prospective study. Health Sci Rep. 2022;5(2):e508.