Abnormal Uterine Bleeding: What You Need to Know
Abnormal uterine bleeding (AUB) is any bleeding that’s excessive, bothersome or outside what a woman would consider normal during menstruation, or any bleeding between periods. That’s the concise definition provided by Dr. Denise Howard, Chief of Obstetrics and Gynecology at NewYork-Presbyterian Brooklyn Methodist Hospital and Associate Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medicine.
AUB accounts for 18 to 30 percent of gynecological visits, Dr. Howard says. However, heavy menstrual bleeding may affect about 50 percent of women during their reproductive years.
Read on for her answers to your FAQs and her advice regarding when to seek care for this common yet troublesome condition.
What is meant by the term “abnormal”?
A patient may have menstrual bleeding that becomes excessive. She may also have spotting between periods, which could be a sign of one or more of the following:
- Fibroids
- Polyps
- Hormonal issues
- Uterine or cervical cancer
“If you have heavy periods that interfere with your quality of life,” she says, “you don’t need to suffer. The term ‘abnormal’ can mean what’s abnormal for you. Be aware that there are numerous ways to control abnormal uterine bleeding, so don’t hesitate to make an appointment with your gynecologist to explore these.”
Who is at risk for AUB?
Any girl or woman of reproductive age is at risk for the condition.
Are menopausal women also at risk?
Women approaching menopause may experience heavy, irregular periods. If you go 12 months without a period, you’re officially “in” menopause, Dr. Howard explains.
“If you’re menopausal and you experience any bleeding, see your gynecologist immediately. Post-menopausal bleeding may be a sign of cancer, so make sure to be evaluated as soon as possible.”
How do you evaluate a patient who comes to you for help with her AUB?
“We begin with a thorough medical history which also includes menstrual, pregnancy, gynecologic, family and surgical history,” she says, “followed by indicated tests such as blood work to see whether you’re anemic; hormonal abnormalities, such as thyroid issues or abnormal prolactin levels; and/or imaging to visualize the uterus and ovaries. We note any family history of reproductive cancer. Depending on our findings, we may order a biopsy to confirm or rule out cancer.”
What methods are available for managing the condition?
A wide range of methods are available, she says, explaining that the approach to treatment will depend on the patient’s age, risk factors, quality of life concerns and desire for future fertility.
Sometimes, she says, there can be a very simple solution to abnormal uterine bleeding. “If you’re a 25-year-old who is sexually active, a hormonal contraceptive can resolve the problem. And even if you’re young and not sexually active, that can be an effective option.
“If you’re a competitive athlete, it may be inconvenient for you to have a period during a competitive event,” she continues. “Or if you’re traveling, you might prefer to avoid having one. A hormonal contraceptive can deliver lighter periods or even no period at all,” and that allows a woman to plan and predict her menses.
Hormonal contraceptives come in several forms: an oral formula (the birth control pill), a patch, a vaginal ring or a hormonal IUD.
Additionally, Dr. Howard points to surgery, should that be needed to remove polyps or fibroids—non-cancerous tumors in the uterus. In the case of uterine cancer, a hysterectomy made need to be performed—but for women who want to retain their fertility, that option is only used in a worst-case context.
When should I see a gynecologist?
“Every woman over age 21 should be screened for cervical cancer, and any girl or woman who is sexually active, has menstrual problems or wants to be checked should have a regular gynecological exam,” she says.
“Abnormal bleeding can range from annoying, inconvenient or bothersome all the way to medically significant. Whatever its cause, and whatever your level of concern, discussing the issue with your gynecologist will open the door to a conversation about its impact on your quality of life.
“You don’t need to suffer,” Dr. Howard reiterates. “Together, we can find the right option to manage your abnormal bleeding.”
Make an appointment with a gynecologist at Weill Cornell Medicine here.