Normal uterine bleeding is regular (every 28-30 days) lasting no more than 7-8 days. The abnormal uterine bleeding meaning is uterine bleeding that is irregular and unexpected. The AUB medical term is interchangeably used with dysfunctional uterine bleeding (DUB).

Abnormal or dysfunctional uterine bleeding (AUB) is irregular uterine bleeding without any pathology like polyps, fibroids, adenomyosis any disease or pregnancy. AUB is a common problem in gynecology.

Abnormal or Dysfunctional Uterine Bleeding Symptoms

AUB is irregular menstruation with heavy or light bleeding which is unpredictable. The types of abnormal uterine bleeding are heavy bleeding, light bleeding, prolonged bleeding, and frequent bleeding or random uterine bleeding.

Some women with AUB have acute uterine bleeding and some women might have chronic irregular uterine bleeding as a repetitive problem.

 AUB is a disease of reproductive age women. Perimenopausal aub is more common. Perimenopausal dysfunctional uterine bleeding and the etiology of abnormal uterine bleeding is summarized in this article.

The pathophysiology of dysfunctional uterine bleeding is mostly unknown. AUB can occur in ovulatory and anovulatory cycles.

The aub diagnosis is made after many tests. The uterine bleeding needs differential diagnosis. Unexplained uterine bleeding can have many reasons. AUB (dysfunctional uterine bleeding) cases have irregular bleeding and normal pelvic examination findings. The blood count, thyroid function tests, prolactin levels, coagulation parameters, endometrial biopsy are performed.

Dysfunctional or Abnormal Uterine Bleeding Differential Diagnosis

The differential diagnosis of abnormal uterine bleeding requires many tests.

• The first test is to exclude pregnancy.
• To exclude cervix and endometrial cancer endometrial biopsy and servical smear test (PAP smear) is also performed. Endometrial biopsy is needed for diagnosis of AUB.
• The causes of anovulatory uterine bleeding can be listed as thyroid problems, high prolactin levels, polycystic ovaries. These all cause anovulatory bleeding. Anovulatory uterine bleeding treatment depends on the cause. Therefore, differential diagnosis is important. There are also ovulatory dysfunctional uterine bleeding cases.

Thyroid dysfunction and abnormal uterine bleeding : When the thyroid function tests are distorted, then regular cycles are lagging and in some cases uterine bleeding can be prolonged. In these cases, when the hypothyroidism is treated, then the patient can have regular cycles. No other treatment is required for abnormal uterine bleeding.

• Heavy abnormal uterine bleeding can be due to some medications like anticoagulants or liver disease, coagulation disorders.
• A transvajinal ultrasound is mandatory to document any uterine pathologies like polyps and fibrioids. In women over 35 years of age leiomyomas are common causes of abnormal uterine bleeding. AUB diagnosis also necessitates exclusion of uterine polyps. Uterine polyps bleeding are like spotting, usually light bleeding at midcycle. The uterine bleeding between periods is repetitive.

Transvaginal Ultrasound

The transvaginal ultrasound documents uterine lining. There are some cases with thin uterine lining and bleeding whereas some cases have heavy periods and thick uterine lining. In thick uterine lining and heavy bleeding cases, the underlying pathology can be polyp or fibrioids. These are called organic causes of abnormal uterine bleeding. The presence of such pathologies is detected by hysterosonography. The treatment is with hysteroscopy. Uterine bleeding treatment is performed based on the diagnosis. The fibroids or polyps causing irregular uterine bleeding need surgery.

• Abnormal uterine bleeding in perimenopause is usually associated with anovulatory cycles. After differential diagnosis, the patients can be treated with medical or surgical intervention.
• If the dysfunctional uterine haemorrhage is acute and heavy, endometrial curettage at initial step can lower the amount of bleeding. The histopathology of the specimen will also help for the diagnosis. In perimenopausal aub, this is important for exclusion of malignant disease.

Treatment of Dysfunctional Uterine Bleeding

Dysfunctional uterine hemorrhage affects a women’s daily life socially and medically. The abnormal uterine bleeding treatment is for long term. To stop uterine bleeding naturally is not possible.

When the diagnosis is dub uterine bleeding, then the patient can have medical treatment. The cases with anovulatory dysfunctional uterine bleeding usually have good results with medical treatment. The abnormal uterine bleeding and hormonal imbalance in perimenapouse can be treated with cyclic progesteron treatment.

Heavy uterine bleeding more often causes anemia in long-term if not treated. Acute uterine bleeding cases require quite fast diagnosis and treatment. These cases might be urgent.  Heavy uterine bleeding with clots can necessitate blood transfusion. If the patient has chronic anemia, iron supplementation will be required.

The Causes of Uterine Bleeding After Menopause

Postmenopausal uterine bleeding is another pathology, which has to be evaluated immediately. The most common cause of abnormal uterine bleeding after menopause is endometrial atrophy. In cases with uterine bleeding after menopause, endometrial cancer can be detected up to 10% of the cases. Any abnormal uterine bleeding in postmenopausal age would rather undergo an endometrial biopsy. Abnormal uterine bleeding in menopause is suspicious for malignancy, until proven otherwise.