Abnormal uterine bleeding (sometimes referred to as dysfunctional uterine bleeding – DUB) is categorized as irregular uterine bleeding that occurs devoid of recognizable pelvic pathology, general medical disease, or pregnancy. The condition is symptomatic of a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining of the uterine wall lining.
Experts largely point to hormonal disturbances as the major precipitator: where reduced levels of progesterone engender low levels of prostaglandin F2alpha and cause menorrhagia (abnormally heavy flow); while increased levels of tissue plasminogen activator (TPA) (a fibrinolytic enzyme) lead to more fibrinolysis.
In Australian, the statistics reveal interesting facts. Up to 20 percent of Australian women in the reproductive age bracket complain of menstrual loss. As much as 1 in every 25 women in the country consults a doctor or another specialist on Abnormal Uterine Bleeding and other related issues. Surveys also reveal that over 50 percent of the cases of reported cases of Abnormal Uterine Bleeding usually end up being normal blood loss upon deeper examination.
Normal vs Abnormal Bleeding
Determining acceptable levels of bleeding is dependent on a number of factors including the physiology and physiopathology of the menstrual cycle. A good number of girls in Australia begin their ovulation cycles on or before the age of 13. Note that dysfunctional bleeding might be common in the first 2 to 3 years following the first ovulation cycle as a consequence of many anovulatory cycles resulting in irregular periods and heavy menses.
Once a regular pattern for ovulation and menstruation has been established (every 28 days or so), the woman is able to predict the duration/occurrence with a certain level of precision. Any deviation from this computed structure can be considered Abnormal Uterine Bleeding.
Types of Abnormal Uterine Bleeding
Ovulatory Abnormal Uterine Bleeding
Under this class of bleeding, progesterone secretion is prolonged because estrogen levels are low or depleted. This depletion precipitates the irregular shedding of the uterine lining, resulting in breakout bleeding. Such bleeding is also associated with tender blood vessels in the uterus.
Anovulatory Abnormal Uterine Bleeding
This class of AUB is more prevalent with rates of incidence reaching as high as 90 percent in women, Australia inclusive. In this case, ovulation is not occurring. This is common in reproductive ages such as early puberty and menopause. For the former, ladies who have not developed fully may see the release of a mature egg. This release precipitates the non-formation of the corpus luteum. As a result of this non-formation, estrogen is produced in copious amounts, leading to an overgrowth in the lining of the uterus, which leads to Abnormal Uterine Bleeding.
Management and Treatment
Usually, the age of the patient, causative factors as well as future plans for conception will determine the appropriate treatment/management route for each individual case. Depending on the age of the woman, the following treatment paths are suggested for the following groups:
At this age, doctors will recommend watching and ascertaining the regularity of your ovulation cycle, as maturity sets in. For unusual cases, progestin or birth control pills may be recommended to regularize your cycle.
In this scenario, doctors may opt for hormonal therapy such as a hormonal IUD to regularize your monthly cycle.
Under this class, medical experts recommend administering birth control pills. In more profound cases, the woman may decide to undergo an endometrial ablation or hysterectomy, if there are no future plans for conception.
You can make an appointment with Dr Kaur on (07) 3839 0552
This article is written to be informative and does not substitute seeking a professional consultation from a medical professional.
This post was written by Dr Anu Kaur