Abnormal uterine bleeding terminology is used interchangeably with dysfunctional uterine bleeding. Unexplained uterine bleeding is called dysfunctional or abnormal uterine bleeding. In these cases the gynecological examination is normal. Painless uterine bleeding usually occurs in dysfunctional uterine bleeding. Abnormal uterine bleeding/dysfunctional uterine bleeding is another diagnosis, that is not explained here.
Irregular Uterine Bleeding
If you have excessive or iregular uterine bleeding, the causes of uterine bleeding needs to be explored. Uterine wall bleeding can be heavy or prolonged. The irregular, frequent and/or heavy bleeding or light bleeding in between the cycles need to be evaluated by a gynecologist.
Uterine haemorrhage is a medical and social problem affecting women’s daily activities. Severe uterine bleeding can cause anemia and other health problems. Endometrial bleeding can be a serious problem. Endometrial bleeding after menopause is an important symptom.
Types of uterine bleeding can be categorized as acute bleeding and chronic bleeding. Acute heavy bleeding needs to be treated immediately. Uterine hemorrhage causes anemia. Chronic uterine bleeding can also cause anemia and other health issues if left untreated. Uterine hemorrhage symptoms in chronic bleeding are fatigue, palpitation, malaise.
Differential Diagnosis of Uterine Bleeding
Differential diagnosis of uterine bleeding is composed of gynecological examination in combination with transvajinal ultrasound. Abnormal uterine and vaginal bleeding by gynecologist includes a transvaginal examination at all times. The irregular menstruation or irregular uterine bleeding in reproductive age women is evaluated with a pregnancy test, at initial step. When pregnancy is excluded other causes can be evaluated. The exclusion of pregnancy is follwed by endometrial biopsy in most cases. Please visit my article for endometrial biopsy details :
The causes of uterine bleeding can be catogorized as:
Gynecological problems related with the uterus: polyps, fibroids, adenomyosis, endometrial cancer and endometrial hyperplasia, endometritis, endometrial atrophy. These are uterine bleeding causes related with the diseases of the uterus itself.
Endometrial pathologies can be endometrial cancer, endometrial hyperplasia or endometrial tumors. Endometrial cyst are usually observed by hysteroscopy in cases with adenomyosis. Adenomyosis also cause bleeding. Excessive uterine bleeding occurring during the menses can indicate adenomyosis. In cases with adenomyosis, severe pain is the major symptom accompanying heavy uterine bleeding. Adenomyosis might necessiate laparoscopy.
Endometrial hyperplasia bleeding can be heavy and prolonged bleeding. Endometrial hyperplasia without bleeding is not possible. Endometrial hyperplasia is diagnosed with endometrial biopsy. Hysteroscopy can be performed prior to biopsy. Irregular uterine lining at ultrasound indicates fibroids or endometrial polyps. Endometrial polyps bleed. Endometrial polyp bleeding is usually irregular uterine bleeding, like spotting at midcycle. Uterine bleeding after period might be an indicator of an endometrial polyp. Uterine spotting is usually observed in uterine polyps. Endometrial polyp after menopause can be diagnosed at ultrasound.
Uterine fibroids bleeding is usually heavy uterine bleeding and prolonged menstruation. Endometrial fibroids and subendometrial fibroids cause heavy and prolonged bleeding. Endometritis can also cause irreguler uterine bleeding. Endometritis is diagnosed by hysteroscopy and biopsy. Endometrial atrophy does not cause any symptoms usually but in postmenopausal cases endometrial atrophy might cause uterine bleeding. Endometrial atrophy bleeding is light bleeding.
Other causes: coagulation disorders, ovulatory problems, medications, etc.
Different bleeding patterns can be observed in thyroid dysfunctions. Hypothyroidism is cause of uterine bleeding. Cases with uterine bleeding more often suffer from anovulation. Ovulatory abnormal uterine bleeding is much rare. Juvenile uterine bleeding have different causes like coagulation disorders. Abnormal uterine bleeding in perimenopause is quite common problem. Endometrial biopsy is mandatory for DUB/AUB diagnosis.
Treatment of Uterine Bleeding
Uterine hemorrhage treatment depends on the pathology detected. Uterine bleeding treatment can be by medical or surgical intervention. In order to stop uterine bleeding, medical treatment options are first line whenever possible.
- Endometrial hyperplasia when detected as a cause of postmenopausal bleeding is treated with hysterectomy. In premenopausal women medical treatment can be used.
- Endometrial polyp removal is performed by hysteroscopy. Hysteroscopic endometrial polypectomy is a daily basis surgery. Endometrial polyp removal by hysteroscopy do not require hospital stay. The patient can be discharged on the same day.
- Endometrial ablation is performed in some cases with heavy uterine bleeding. Endometrial ablation for menorrhagia is a common procedure. Hysteroscopy is used for endometrial ablation.
- Endometrial atrophy also causes bleeding in women after menopause. Endometrial atrophy bleeding does not require treatment.
- Endometrial myomas are removed by hysteroscopy.
- Uterine hemorrhage due to other causes like coagulation disorders, medications can be consulted with a hematologist or internal medicine specialist.