Abnormal uterine bleeding (AUB) is a prevalent issue among women, and it accounts for up to 20 percent of visits to gynecologists over a two-year period, as stated by the American Academy of Family Physicians (AAFP). AUB refers to any changes in the frequency, duration, or amount of menstrual flow, as well as bleeding between periods, after intercourse, or more than 12 months after menopause. It’s important to note that bleeding during pregnancy is not considered abnormal uterine bleeding. There are various factors that can contribute to AUB, and it is a condition that most women will encounter at some point in their lives. Let’s explore the most common causes of AUB and the available treatments.
Understanding Hormone Imbalance
Hormones play a critical role in the female reproductive system, specifically in the processes of ovulation and menstruation. The monthly release of estrogen and progesterone is vital for these functions to occur at the right time in the menstrual cycle. However, when a woman’s hormones are not properly released, it can result in a condition known as hormone imbalance.
One of the common manifestations of hormone imbalance is anovulation, where a woman may experience a prolonged absence of menstruation or irregular bleeding patterns. Additionally, hormone fluctuations can lead to heavier bleeding than usual. This condition is often observed in adolescents, premenopausal women, and those who are either overweight or underweight.
Treatment options for hormone imbalance vary depending on the individual’s circumstances and reproductive goals. For women who are not planning to conceive, combination oral contraceptive pills are commonly prescribed. These pills help balance hormones and regulate the menstrual cycle. On the other hand, women with anovulatory dysfunctional uterine bleeding, a condition characterized by excessive estrogen release and insufficient progesterone, may be given progesterone to counterbalance the hormonal imbalance.
Thickening of the Uterine Wall or Lining
Thickening of the uterine wall or lining can occur due to hormonal imbalances or certain medical conditions that cause abnormal tissue growth. This can lead to heavy, prolonged, and irregular bleeding. There are two main conditions associated with this thickening:
Endometrial Hyperplasia
Endometrial hyperplasia is a condition in which the uterine lining, known as the endometrium, becomes excessively thick. According to The American College of Obstetricians and Gynecologists (ACOG), this condition is often caused by anovulatory cycles with high levels of estrogen and no progesterone. Estrogen stimulates the growth and thickening of the uterine lining in preparation for implantation. During ovulation, progesterone is released to prepare the body for pregnancy. If pregnancy does not occur, progesterone levels decrease, triggering menstruation and shedding of the uterine lining. However, without the release of progesterone, the uterine lining continues to grow, leading to the crowding of cells and the potential development of precancerous cells.
Adenomyosis
Adenomyosis is a condition characterized by the thickening of the uterus when endometrial tissue starts growing on the outer wall of the uterus. The cause of this condition is currently unknown, but it is most commonly observed in women between the ages of 40 and 50.
Treatment options vary for these conditions:
Treatment for Endometrial Hyperplasia
Most cases of endometrial hyperplasia can be effectively treated with progestin. This hormone can be administered orally, through injections, with an intrauterine device (IUD), or as a vaginal cream. Progestin triggers uterine bleeding similar to a regular period, which helps treat the condition.
Treatment for Adenomyosis
Adenomyosis can be managed with combination birth control pills or an IUD. In severe cases, especially if a woman no longer plans to conceive, a hysterectomy (removal of the uterus) may be recommended by a doctor.