Abnormal Uterine Bleeding AUB

Abnormal Uterine Bleeding (AUB): Information Abnormal uterine bleeding (AUB) is a term used to describe unusual bleeding that occurs during the menstrual cycle. This condition manifests itself as deviation from normal in terms of quantity, duration, or regularity of bleeding. AUB not only affects quality of life but can also sometimes be a sign of serious diseases.

What Is Normal Menstrual Bleeding Like? The menstrual cycle typically lasts 21–35 days. The bleeding duration is usually between 2–7 days. Total blood loss is less than 80 ml (approximately 4-5 pads/day). Bleeding beyond these limits is considered abnormal. Types of Abnormal Uterine Bleeding Menorrhagia: Excessive amount or prolonged bleeding (more than 7 days). Polymenorrhea: Frequent menstrual cycles (less than 21 days). Oligomenorrhea: Infrequent menstruation (longer than 35 days). Irregular or intermenstrual bleeding: Bleeding between periods or after sexual intercourse. Postmenopausal bleeding: Vaginal bleeding in a woman who has not had a period for at least 12 months. Causes 1. Structural (organic) causes: Intrauterine polyps Fibroids Adenomyosis Endometrial hyperplasia Cancer of the uterus or cervix 2. Functional (non-structural) causes: Hormonal irregularities (ovulation problems, thyroid disorders) Stress, excessive exercise, weight changes Misuse of birth control medications Bleeding and clotting disorders Certain medications (anticoagulants, hormone-containing medications)

When Can It Be Serious? Postmenopausal bleeding Heavy or clotted menstrual bleeding Bleeding between periods or after intercourse Irregular menstrual cycle Anemia (weakness, dizziness, pallor) Diagnostic Methods Anamnesis and gynecological examination Blood tests: Hormone levels, thyroid function, anemia check Ultrasound (transvaginal): Uterine wall thickness, presence of myoma/polyp Endometrial biopsy: Especially in women over 40 and postmenopausal Hysteroscopy: Direct visualization of the uterine cavity and treatment if necessary Treatment Methods 1. Medical (drug) treatment: Hormonal treatments (progesterone or combined birth control medications) Intrauterine hormonal spiral (Mirena etc.) Painkillers and antifibrinolytic drugs Iron supplementation (if anemia is present) 2. Surgical treatment: Polyp or fibroid removal (hysteroscopic resection) Endometrial ablation Hysterectomy (if other treatments fail to provide response and there are no plans for children) Prevention and Monitoring Weight control Regular exercise Stress management Using birth control medications as recommended by a doctor Regular gynecological check-ups

References:

• Munro MG, et al. FIGO Classification System (PALM-COEIN) for Causes of Abnormal Uterine Bleeding in Reproductive Age Women. Int J Gynaecol Obstet. 2011;113:1–12.

• American College of Obstetricians and Gynecologists (ACOG). Abnormal Uterine Bleeding in Reproductive-Aged Women. 2018

• Fraser IS, et al. Abnormal Uterine Bleeding. Best Pract Res Clin Obstet Gynaecol. 2007;21:891–908.

• Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of abnormal uterine bleeding in reproductive-aged women. Fertil Steril. 2012;98:1401–1410.

• Mayo Clinic. Abnormal uterine bleeding. 2023. https://www.mayoclinic.org