Abnormal Uterine Bleeding
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I get a lot of calls from my female friends lately about how they're bothered by irregularities in their menstrual cycle. This inspired me to write on Abnormal Uterine Bleeding(AUB).
I usually start by calming them down, as long as there's a diagnosis, then the first problem has been solved... now I'll say the same to my readers, don't let the diagnosis scare you, there are measures that have been put in place to correct the disorder.
I'm gonna start by talking about the normal real briefly, then we talk about the abnormal. Normal uterine bleeding is synonymous to menstruation. Menstruation is the periodic or cyclical vaginally bleed in a reproductive human female.
It's a physiologic cycle occurring every 21-35 days with an average of 28 days. The flow duration considered normal ranges from 2-7 days. Anything outside of these statistics is termed abnormal.
The quantity of blood is variable and is in respect to each individual. This just means there's really no range, but the patient would know if she's bleeding more than usual. But there are some cases where the blood loss is objectively excessive.
In a nutshell, we can conveniently define AUB as vaginal bleeding that is abnormal in volume, regularity and/or timing. AUB is a broad term that consists of a number of signs. I'm going to try and explain some of them in simple terms.
Menorrhagia, this is usually a common presenting complaint and it means heavy menstrual bleeding. And as I said earlier, it is not an objective assessment but depends on the individual patient. If a lady says she's bleeding more, then she's bleeding more, irrespective of the quantity.
Intermentrual bleeding, this is quite troublesome. This is bleeding that occurs between clearly defined cyclic and predictable cycles. It may even develop a pattern and occur in a predictable fashion on the same day in each cycle. It may also be random.
Post costal bleeding may also be observed. This is vaginal bleeding after sexual intercorse. It may or may not be associated with painful sexual intercorse.
An unstable and irregular menstrual pattern may be the case. And it is futile to keep counts as there is no regular pattern.
AUB may be anovulatory or ovulatory. Simpler words, I know, it means the patient may have menstrual cycles with ovulation, which is the normal, or without ovulation. Ovulation is paramount for conception to take place.
Only about 10% of cases are ovulatory while the bulk of patients are anovulatory. Common causes of anovulatory AUB are endocrinopathies, meaning pathologies of the endocrine system.
Examples of endocrine causes of AUB are polycystic ovarian syndrome(PCOS), which has a rising incidence in Nigeria. Others are hypothyroidism, physical and emotional stress, weight gain or loss, birth control pills, extreme exercises.
Endometrial causes of AUB, that is, causes from the uterus, include sexually transmitted infections, infection of the cervix and endometrium and cancer of the cervix and uterus. More commonly, intrauterine growths, such as fibroid and polyps could result in AUB.
A diagnosis of AUB is made from patient's history and physical examination, as well as laboratory investigations. Investigations include a full blood count(FBC) has the patient must of had considerable blood loss and that should be corrected.
The investigations are guided by patient's history for optimal treatment. If intrauterine growths are suspected, then an ultrasound scan will be done. An hysterescopy may also be indicated. In the case of growths, a biopsy is taken to determine if the sample is neoplastic.
The treatment approach could be medical or surgical, depending on the cause and degree of progression of the cause. Also, one's family size and desire to have more pregnancy is taken into consideration.
Drugs are usually the first approach. Hormonal contraceptives, such as the combined oral contraceptives are mostly used.
Gonadotropin releasing hormone agonist is highly indicated and used in AUB caused by fibroid. They shrink the size of the mass while a more curative option is being considered.
NSAIDS, such as ibuprofen, when taken before the period starts, has shown to reduce menorrhagia. Other options are Tranaxemic acid and Intrauterine devices which release progestin which stops the menorrhagia.
Surgery is a more definitive approach and includes a variety of options, depending on the patient's age, degree of progression and severity.
Myomectomy is the surgical removal of fibroids, and is indicated when fibroids present with really bad menorrhagia.
Uterine artery embolization, is the cutting off of the blood supply to fibroid tissue.
The most definitive treatment for AUB is a hysterectomy. This is the removal of the uterus. It is done in severe cases and if patient's have completed their family size.
It is irreversible and there is absolutely no chance of pregnancy afterwards. It is the last line and only done when absolutely necessary.
Common complications of AUB are anaemia due to blood loss, which could be disabling affecting the patients day to day activities.
Subfertility is a common complication as 90% of patients with endocrinopathies have anovulatory cycles. Subfertility may be seen in some cases as some causes such as fibroid may result in subfertility.
Even the treatment option includes the use of contraceptives and would interfere with one's plans of getting pregnant.
Patient's with AUB are suspected to be at higher risk of endometrial cancers. This doesn't mean there is a progression of AUB to neoplasm, but AUB has been implicated.
The environment and treatment approach might increase the risk as patient's in my environment usually prefer to try out other treatment methods which are usually unorthodox and worsen the condition.
I usually start by calming them down, as long as there's a diagnosis, then the first problem has been solved... now I'll say the same to my readers, don't let the diagnosis scare you, there are measures that have been put in place to correct the disorder.
I'm gonna start by talking about the normal real briefly, then we talk about the abnormal. Normal uterine bleeding is synonymous to menstruation. Menstruation is the periodic or cyclical vaginally bleed in a reproductive human female.
It's a physiologic cycle occurring every 21-35 days with an average of 28 days. The flow duration considered normal ranges from 2-7 days. Anything outside of these statistics is termed abnormal.
The quantity of blood is variable and is in respect to each individual. This just means there's really no range, but the patient would know if she's bleeding more than usual. But there are some cases where the blood loss is objectively excessive.
In a nutshell, we can conveniently define AUB as vaginal bleeding that is abnormal in volume, regularity and/or timing. AUB is a broad term that consists of a number of signs. I'm going to try and explain some of them in simple terms.
Menorrhagia, this is usually a common presenting complaint and it means heavy menstrual bleeding. And as I said earlier, it is not an objective assessment but depends on the individual patient. If a lady says she's bleeding more, then she's bleeding more, irrespective of the quantity.
Intermentrual bleeding, this is quite troublesome. This is bleeding that occurs between clearly defined cyclic and predictable cycles. It may even develop a pattern and occur in a predictable fashion on the same day in each cycle. It may also be random.
Post costal bleeding may also be observed. This is vaginal bleeding after sexual intercorse. It may or may not be associated with painful sexual intercorse.
An unstable and irregular menstrual pattern may be the case. And it is futile to keep counts as there is no regular pattern.
AUB may be anovulatory or ovulatory. Simpler words, I know, it means the patient may have menstrual cycles with ovulation, which is the normal, or without ovulation. Ovulation is paramount for conception to take place.
Only about 10% of cases are ovulatory while the bulk of patients are anovulatory. Common causes of anovulatory AUB are endocrinopathies, meaning pathologies of the endocrine system.
Examples of endocrine causes of AUB are polycystic ovarian syndrome(PCOS), which has a rising incidence in Nigeria. Others are hypothyroidism, physical and emotional stress, weight gain or loss, birth control pills, extreme exercises.
Endometrial causes of AUB, that is, causes from the uterus, include sexually transmitted infections, infection of the cervix and endometrium and cancer of the cervix and uterus. More commonly, intrauterine growths, such as fibroid and polyps could result in AUB.
A diagnosis of AUB is made from patient's history and physical examination, as well as laboratory investigations. Investigations include a full blood count(FBC) has the patient must of had considerable blood loss and that should be corrected.
The investigations are guided by patient's history for optimal treatment. If intrauterine growths are suspected, then an ultrasound scan will be done. An hysterescopy may also be indicated. In the case of growths, a biopsy is taken to determine if the sample is neoplastic.
The treatment approach could be medical or surgical, depending on the cause and degree of progression of the cause. Also, one's family size and desire to have more pregnancy is taken into consideration.
Drugs are usually the first approach. Hormonal contraceptives, such as the combined oral contraceptives are mostly used.
Gonadotropin releasing hormone agonist is highly indicated and used in AUB caused by fibroid. They shrink the size of the mass while a more curative option is being considered.
NSAIDS, such as ibuprofen, when taken before the period starts, has shown to reduce menorrhagia. Other options are Tranaxemic acid and Intrauterine devices which release progestin which stops the menorrhagia.
Surgery is a more definitive approach and includes a variety of options, depending on the patient's age, degree of progression and severity.
Myomectomy is the surgical removal of fibroids, and is indicated when fibroids present with really bad menorrhagia.
Uterine artery embolization, is the cutting off of the blood supply to fibroid tissue.
The most definitive treatment for AUB is a hysterectomy. This is the removal of the uterus. It is done in severe cases and if patient's have completed their family size.
It is irreversible and there is absolutely no chance of pregnancy afterwards. It is the last line and only done when absolutely necessary.
Common complications of AUB are anaemia due to blood loss, which could be disabling affecting the patients day to day activities.
Subfertility is a common complication as 90% of patients with endocrinopathies have anovulatory cycles. Subfertility may be seen in some cases as some causes such as fibroid may result in subfertility.
Even the treatment option includes the use of contraceptives and would interfere with one's plans of getting pregnant.
Patient's with AUB are suspected to be at higher risk of endometrial cancers. This doesn't mean there is a progression of AUB to neoplasm, but AUB has been implicated.
The environment and treatment approach might increase the risk as patient's in my environment usually prefer to try out other treatment methods which are usually unorthodox and worsen the condition.
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Ladies have a lot of problems.
Sadly
Well, ladies also have a lot of doctors. 🤗
Lol, I say ifs the price for owning the world.
Fibroids can be really terrible... Nice one baba.
So they do uterine artery embolization in your center?
Lol, no, just myomectomy.
For some reason, I have issues with this topic though I've read it multiple times before this post. Actually, the reason is because it feels so broad
But with this read, it's gotten a bit clearer, and I think it won continue to do so. Thanks chief
Happy it was helpful.