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Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) is among the commonest reasons why women consult Gynecologists. Fortunately for most women, symptoms can easily be controlled to achieve good quality of life.

Common symptoms include: heavy periods, irregular periods (too frequent or too scarce), painful periods, bleeding after the menopause and bleeding in pregnancy (bleeding in pregnancy will be published in a separate article).

Even though most causes of AUB are transient and have no long-term implications, please consult your Gynecologist if you experience abnormal bleeding to exclude rare but serious causes. Young women under 40 years rarely have any serious causes for their symptoms.

Older women above 40 years or in the menopause may rarely have potentially serious causes of their symptoms, and always warrant a thorough assessment.

The commonest cause is hormone imbalance for various reasons. A regular and predictable menstrual cycle is dictated by well synchronised hormone signals between glands in the brain and the ovaries. The uterus then responds in a predicable cyclical pattern. Other causes include: uterine fibroids, endometriosis, some medications, and diseases of the cervix or lining of the womb that may include cancer especially in older women. Rarer causes include bleeding disorders that your Gynecologist will look for.

For some women, the cause will be immediately apparent following a medical history and clinical examination. Specific tests may include: hormone tests, ultrasound imaging of the pelvis, taking a biopsy of the lining of the womb and in some case, further evaluation may include assessing the inside of the womb with a camera (called Hysteroscopy).

Some women will require no specific treatment, as the cause may be transient and self-resolving. However there is a broad range of choices of treatment depending on the cause found. Non-hormonal tablets can be taken during periods to reduce both the amount of bleeding and pain. Hormonal tablets or injections, especially if contraception is also desired, are especially good in controlling bleeding. An intra-uterine hormone device can also be inserted into the uterus to control symptoms.

Surgical procedures should be considered last as they have more risks, and affect future fertility. Endometrial Ablation is a minimally invasive procedure that uses heat energy to destroy the uterine lining and limit subsequent bleeding. Its simplicity means less expense, quick recovery and is done as a day procedure. Some women will require specific interventions like removal of large fibroids or surgical treatment of endometriosis. Hysterectomy is rarely required, but may be the appropriate choice if serious disease like cancer is the cause.

Certain causes like abnormal changes on the cells lining the inside of the womb, or cancer require long-term follow-up. Your Gynecologist will advise if any specific follow up is necessary.

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