Management of Abnormal Uterine Bleeding

Service Overview

What Is Abnormal Uterine Bleeding?

Abnormal uterine bleeding is bleeding from the uterus that is unusual in its timing, duration, regularity, or amount.

It may include:

• Menstrual bleeding that is unusually heavy
• Periods that last longer than usual
• Bleeding between periods
• Bleeding after sexual intercourse
• Irregular or unpredictable menstrual cycles
• Frequent menstrual bleeding
• Bleeding after menopause

Abnormal bleeding can have many causes. Some are related to hormonal or reproductive changes, while others may result from structural conditions affecting the uterus.

Persistent, heavy, or unexplained bleeding should be evaluated by a gynaecologist.

What Causes Abnormal Uterine Bleeding in Women?

Abnormal uterine bleeding can occur for a number of reasons. Common causes include:

• Uterine fibroids
• Endometrial polyps
• Adenomyosis
• Hormonal or ovulatory disturbances
• Thyroid disorders
• Polycystic ovary syndrome (PCOS)
• Certain medications
• Bleeding or clotting disorders
• Changes associated with perimenopause
• Pregnancy-related conditions
• Endometrial abnormalities

In some women, no single cause is identified initially.

A detailed medical history, examination, and appropriate investigations can help determine the likely cause.

Heavy Menstrual Bleeding

Heavy menstrual bleeding is one of the common presentations of abnormal uterine bleeding.

A woman may notice:

• Bleeding that interferes with daily activities
• Frequent changing of sanitary products
• Passing large blood clots
• Menstrual bleeding lasting longer than expected
• Fatigue or weakness associated with blood loss
• Symptoms of iron-deficiency anaemia

The amount of menstrual bleeding can be difficult to estimate accurately. A change from your normal menstrual pattern can be an important reason to seek medical evaluation.

Symptoms of Abnormal Uterine Bleeding

AUB symptoms can vary depending on the underlying cause.

Possible symptoms include:

• Heavy periods
• Prolonged periods
• Irregular periods
• Bleeding between periods
• Spotting
• Bleeding after intercourse
• Pelvic discomfort or cramping
• Passing blood clots
• Fatigue
• Dizziness or weakness associated with significant blood loss
• Anaemia

Bleeding patterns can also change during adolescence, the reproductive years, and the perimenopausal period.

When Should Heavy Period Bleeding Be Evaluated?

You should consider consulting a gynaecologist if menstrual bleeding:

• Becomes significantly heavier than your usual periods
• Lasts longer than usual
• Occurs between periods
• Occurs after sexual intercourse
• Causes significant pain or pelvic symptoms
• Leads to fatigue or suspected anaemia
• Interferes with work, sleep, exercise, or daily activities
• Develops after menopause

Very heavy bleeding accompanied by fainting, severe weakness, shortness of breath, severe abdominal pain, or other concerning symptoms may require urgent medical assessment.

How Is Abnormal Uterine Bleeding Diagnosed?

The evaluation of AUB is tailored to the individual patient.

Your gynaecologist may ask about:

• Menstrual cycle pattern
• Duration and amount of bleeding
• Presence of clots
• Pelvic pain
• Previous pregnancies
• Medications
• Medical conditions
• Contraceptive use
• Pregnancy possibility
• Fertility plans
• Family and personal medical history

A pelvic examination may also be recommended depending on the symptoms.

Tests for Abnormal Uterine Bleeding

Depending on the clinical situation, investigations may include:

Pregnancy Test

Pregnancy-related conditions can cause abnormal bleeding and may need to be ruled out in women who could be pregnant.

Blood Tests

Blood tests may be recommended to assess for anaemia or investigate other possible causes of abnormal bleeding.

Thyroid Testing

Thyroid disorders can affect menstrual patterns, so thyroid evaluation may be recommended when clinically appropriate.

Pelvic Ultrasound

Ultrasound can help evaluate the uterus and ovaries and identify structural causes such as:

• Fibroids
• Endometrial polyps
• Adenomyosis-related changes
• Ovarian abnormalities

Saline Infusion Sonography

In selected patients, saline may be introduced into the uterine cavity during ultrasound to provide a clearer assessment of the endometrium and possible intracavitary lesions.

Hysteroscopy

Hysteroscopy allows the doctor to directly examine the inside of the uterine cavity using a thin camera.

It may help identify conditions such as:

• Endometrial polyps
• Submucosal fibroids
• Certain endometrial abnormalities

Endometrial Sampling

In selected patients, a sample of the uterine lining may be recommended to evaluate the endometrium.

The need for this investigation depends on factors such as age, symptoms, risk factors, and clinical findings.

Common Structural Causes of Abnormal Uterine Bleeding

Fibroids

Fibroids are benign growths arising from the muscular tissue of the uterus.

Depending on their location, they may contribute to heavy or prolonged menstrual bleeding.

Submucosal fibroids, which project into the uterine cavity, can be particularly relevant when investigating heavy menstrual bleeding.

Endometrial Polyps

Endometrial polyps are growths arising from the lining of the uterus.

They can cause irregular bleeding, spotting, or bleeding between periods.

Some polyps can be removed hysteroscopically.

Adenomyosis

Adenomyosis occurs when tissue similar to the uterine lining grows within the muscular wall of the uterus.

It may be associated with:

• Heavy periods
• Painful periods
• Pelvic discomfort
• An enlarged or tender uterus

Treatment depends on symptoms, age, reproductive plans, and the severity of the condition.

Hormonal Causes of Abnormal Uterine Bleeding

Hormonal changes can affect ovulation and the normal development and shedding of the uterine lining.

Irregular ovulation may occur with:

• Polycystic ovary syndrome
• Perimenopause
• Adolescence
• Thyroid disorders
• Certain endocrine conditions
• Significant changes in weight or other health factors

When ovulation is irregular, menstrual bleeding may become unpredictable or prolonged.

Treatment focuses on identifying and addressing the underlying cause where possible.

Abnormal Uterine Bleeding and Anaemia

Repeated or heavy blood loss can lead to iron deficiency and anaemia.

Possible symptoms include:

• Fatigue
• Weakness
• Reduced exercise tolerance
• Dizziness
• Headaches
• Shortness of breath with exertion

If heavy menstrual bleeding is accompanied by these symptoms, your doctor may recommend blood tests to assess haemoglobin and iron status.

Treatment may involve managing the bleeding as well as correcting iron deficiency when present.

Treatment for Abnormal Uterine Bleeding

Treatment depends on the cause and may include medical, minimally invasive, or surgical approaches.

Medical Treatment

Depending on the patient's condition, medical treatment may include:

• Hormonal medications
• Combined hormonal contraceptives
• Progestin-based treatment
• Levonorgestrel-releasing intrauterine systems in appropriate patients
• Non-hormonal medicines for menstrual bleeding
• Iron supplementation when iron deficiency is present

The choice of treatment depends on the underlying cause, medical history, contraindications, and pregnancy plans.

Treatment of Fibroids

If fibroids are responsible for abnormal bleeding, treatment options depend on their size, number, location, symptoms, and reproductive plans.

Possible approaches include:

• Observation in selected cases
• Medication
• Hysteroscopic myomectomy for suitable submucosal fibroids
• Laparoscopic myomectomy
• Abdominal myomectomy
• Other fibroid-directed treatments in selected patients

Hysteroscopic Treatment

Hysteroscopy can be used to diagnose and treat selected conditions within the uterine cavity.

Depending on the findings, procedures may include removal of:

• Endometrial polyps
• Selected submucosal fibroids
• Certain intracavitary lesions

Hysteroscopic procedures are performed through the vagina and cervix and generally do not require a conventional abdominal incision.

What Is Hysteroscopic Ablation?

Endometrial ablation is a procedure designed to reduce or control heavy menstrual bleeding by treating the lining of the uterus.

It may be considered for selected women with heavy menstrual bleeding when appropriate medical treatment has not provided adequate relief and future pregnancy is not desired.

Different techniques may be used to treat the endometrium.

Endometrial ablation is not a contraceptive procedure, and pregnancy after ablation can be dangerous. Women considering this treatment should discuss contraception and future pregnancy plans carefully with their gynaecologist.

Endometrial ablation is not appropriate for every woman with AUB, particularly when the cause of bleeding requires another form of treatment.

Who May Be Suitable for Endometrial Ablation?

Endometrial ablation may be considered in selected women with heavy menstrual bleeding after appropriate evaluation.

The doctor may consider:

• Severity of menstrual bleeding
• Underlying cause
• Uterine anatomy
• Endometrial assessment
• Previous treatments
• Age
• Medical history
• Future pregnancy plans

The cause of abnormal bleeding should be evaluated before proceeding with ablation.

Can Abnormal Uterine Bleeding Be Treated Without Surgery?

Yes. Many causes of abnormal uterine bleeding can initially be managed with medication or observation, depending on the diagnosis.

For example, medical treatment may be appropriate for some women with:

• Hormonal or ovulatory bleeding
• Heavy menstrual bleeding without a major structural abnormality
• Certain fibroid-related symptoms
• Adenomyosis-related bleeding

However, structural causes such as polyps or certain submucosal fibroids may benefit from hysteroscopic treatment.

The appropriate approach depends on the individual diagnosis.

Abnormal Uterine Bleeding and Fertility

Can AUB Affect Fertility?

Abnormal bleeding itself does not always cause infertility, but some conditions associated with AUB may affect reproductive health.

For example:

• Submucosal fibroids can alter the uterine cavity.
• Endometrial polyps may be associated with reproductive concerns.
• PCOS can cause irregular ovulation.
• Adenomyosis may be associated with fertility-related concerns.
• Certain endocrine conditions can affect ovulation.

Women planning pregnancy should discuss both bleeding management and fertility goals with their gynaecologist before choosing treatment.

Abnormal Uterine Bleeding During Perimenopause

Menstrual cycles often become less predictable during perimenopause because hormonal and ovulatory patterns change.

Some women may experience:

• Heavier periods
• Longer or shorter cycles
• Irregular bleeding
• Spotting
• Changes in menstrual flow

Although hormonal changes can contribute to AUB during this stage, persistent or unusual bleeding should not automatically be attributed to perimenopause.

Appropriate evaluation may be recommended based on age, symptoms, risk factors, and clinical findings.

Abnormal Bleeding After Menopause

Any vaginal bleeding after menopause should be evaluated by a healthcare professional.

The causes can range from relatively common conditions such as vaginal or endometrial changes to more significant conditions affecting the uterus.

Evaluation may include ultrasound, examination, hysteroscopy, or endometrial sampling depending on the clinical situation.

Abnormal Uterine Bleeding Treatment in Dwarka

If you are experiencing heavy periods, prolonged bleeding, irregular menstrual cycles, or bleeding between periods, a gynaecological consultation can help identify the possible cause.

Evaluation may include:

• Menstrual history
• Gynaecological examination
• Blood tests
• Pelvic ultrasound
• Saline sonography when indicated
• Hysteroscopy when appropriate
• Endometrial assessment in selected patients

Treatment is then planned according to the cause and your individual needs.

CTA: Book Abnormal Uterine Bleeding Consultation in Dwarka

AUB Specialist in Dwarka Sector 6

If you are searching for an AUB specialist in Dwarka Sector 6, evaluation by a gynaecologist can help determine why your periods have become unusually heavy, prolonged, irregular, or unpredictable.

Women from Dwarka Sector 6, Sector 7, Sector 10, Sector 11, Sector 12, Sector 13, Sector 14, Sector 17, Sector 19, and surrounding Delhi NCR areas can seek evaluation for:

• Heavy menstrual bleeding
• Prolonged periods
• Irregular periods
• Bleeding between periods
• Fibroid-related bleeding
• Endometrial polyps
• Adenomyosis
• Anaemia associated with menstrual blood loss
• Perimenopausal bleeding
• Fertility-related concerns

Treatment should be based on the underlying cause, clinical findings, imaging results, medical history, and reproductive plans.

Personalised Abnormal Uterine Bleeding Care

Evaluation of Heavy Periods

A detailed assessment can help identify whether heavy bleeding is related to fibroids, polyps, adenomyosis, hormonal changes, or another condition.

Medical Treatment

Appropriate medicines may help manage bleeding when there is a suitable medical indication.

Hysteroscopic Treatment

Selected polyps and submucosal fibroids can be treated through hysteroscopy without conventional abdominal surgery.

Hysteroscopic Ablation

Endometrial ablation may be considered for selected women with heavy menstrual bleeding who do not desire future pregnancy.

Anaemia Management

Blood tests can help identify anaemia or iron deficiency associated with ongoing menstrual blood loss.

Fertility-Focused Planning

Treatment can take future pregnancy plans into account when selecting the most appropriate management approach.

Individualised Treatment

There is no single treatment for all cases of abnormal uterine bleeding. Management depends on the underlying cause, symptoms, uterine anatomy, age, medical history, and reproductive goals.