Abnormal Uterine Bleeding

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This blog is for educational purposes only and does not replace professional medical advice or diagnosis. If you have health concerns, consult an AHPRA-registered telehealth doctor or request a medical certificate online if clinically appropriate. Please note: Hola Health does not currently offer Mental Health Care Plans.

Overview

Abnormal uterine bleeding (AUB) is vaginal bleeding that differs from your usual menstrual cycle in terms of timing, frequency, length, or quantity. It can develop at any age, from puberty to menopause. While some changes in menstrual bleeding may be temporary, persistent or unusual bleeding should be evaluated by a healthcare professional.

AUB can have a range of causes, including hormonal changes, pregnancy-related illnesses, uterine abnormalities, and underlying medical conditions. Although many of the causes are not serious, some require prompt diagnosis and clinical management. This article covers abnormal uterine bleeding, its potential causes, how it is identified, available management options, and when to seek medical attention.

What is abnormal uterine bleeding?

Abnormal uterine bleeding refers to vaginal bleeding that differs from your usual monthly cycle. This includes changes in the amount of bleeding, how often periods occur, how long they continue, or bleeding outside of your normal menstrual cycle.

Most individuals experience a regular menstrual cycle every 21 to 35 days, with bleeding lasting up to 7 days. However, cycle duration and flow might differ across individuals.

There are several types of abnormal uterine bleeding, including:

• Heavy menstrual bleeding
• Bleeding between periods
• Irregular menstrual periods
• Frequent menstruation (cycles less than 21 days)
• Infrequent periods (cycles lasting more than 35 days)
• Bleeding following sexual intercourse
• Bleeding following menopause

Common causes of abnormal uterine bleeding

Signs and Symptoms

Symptoms depend on the underlying cause, but may include:

• Heavy menstrual bleeding
• Bleeding between periods
• Periods lasting more than 7 days
• Passing large blood clots.
• Bleeding following sexual intercourse
• Bleeding following menopause
• Pelvic discomfort or cramps
• Fatigue, weakness, dizziness, or other signs of anaemia

How is abnormal uterine bleeding diagnosed?

Your doctor will analyse your symptoms to figure out the underlying cause and the best management pathway.

1. Medical history: Your doctor will enquire about your current health, medications, previous pregnancies, medical issues, and family history.
2. Menstrual history: You will be asked questions about your menstrual cycle, including when the bleeding began, how heavy it is, how long it lasts, and if it occurs between periods or after intercourse.
3. Pregnancy test: A pregnancy test is routinely used in women of reproductive age to rule out pregnancy-related causes of bleeding.
4. Blood tests: Blood tests can assess:
   • Iron levels and symptoms of anaemia
   • Thyroid function
   • Hormone levels
   • Blood clotting where appropriate
5. Pelvic ultrasound: Pelvic ultrasounds can detect fibroids, polyps, ovarian cysts, adenomyosis, and other structural problems.
6. Cervical screening (if applicable): Your doctor may recommend cervical screening in accordance with current guidelines if you show symptoms relating to cervical illness.
7. Endometrial biopsy (in specific situations): A small sample of the uterine lining may be collected to check for abnormal cells, particularly in women who experience chronic bleeding or bleeding after menopause.
8. Hysteroscopy (if recommended): A hysteroscopy allows a doctor to examine the inside of the uterus using a thin camera and may be recommended if further assessment is needed.

Note: Diagnostic imaging and surgical investigations (such as ultrasounds or hysteroscopies) are not provided directly by Hola Health and are included for informational purposes only.

Management options

Treatment depends on the cause of the bleeding, your age, whether you are planning pregnancy, and how severe your symptoms are.

Mandatory Disclaimer: This information is for educational purposes only. You should consult a medical practitioner before attempting new wellness programs or lifestyle changes to ensure they are safe for your specific condition.

Can lifestyle changes help?

Lifestyle changes improve your general health and manage certain symptoms, but they cannot replace clinical management for underlying medical conditions causing irregular uterine bleeding. Here are some helpful strategies:

• Maintain a healthy weight, as weight fluctuations can disrupt hormonal equilibrium.
• If you are bleeding heavily, you need an iron-rich diet to lower your risk of iron deficiency. Good sources include lean meat, lentils, leafy green vegetables, and iron-fortified cereals.
• Stay hydrated.
• Monitor your menstrual cycle and symptoms using a journal or app.
• Take medicines exactly as prescribed by your doctor.
• Attend regular follow-up sessions to assess your condition and modify treatment as required.

When should you see a doctor?

Arrange a medical evaluation if you encounter any of the following:

• Heavy bleeding that interrupts your regular activities
• Bleeding between periods
• Bleeding following menopause
• Bleeding following sexual intercourse
• Periods lasting more than seven days
• Anaemia symptoms include weariness, dizziness, and weakness
• Chronic pelvic pain or severe cramps
• Irregular bleeding that lasts for months

When is it an emergency?

Seek urgent medical attention immediately if you experience:

• Excessive bleeding, such as soaking through a pad or tampon every hour for several hours
• Severe abdominal or pelvic pain
• Fainting, collapse, or loss of consciousness
• Heavy bleeding during pregnancy or suspected pregnancy
• Symptoms of severe anaemia include shortness of breath, chest discomfort, disorientation, and significant weakness.

If you experience severe, worsening, or life-threatening symptoms, call 000 immediately or attend your nearest Emergency Department (ED). Examples include excessive bleeding (soaking a pad every hour), severe pelvic pain, or loss of consciousness.

Can telehealth help?

Telehealth is a convenient option for appropriate healthcare needs and can complement in-person healthcare. It is not a replacement for face-to-face care. Some health concerns, such as those requiring a physical examination, pregnancy-related complications, or severe bleeding, require an in-person assessment or emergency care.

An online doctor might help with:

• Reviewing your menstruation symptoms and bleeding pattern.
• Assessing potential causes based on your medical history.
• Recommending blood tests or imaging referrals when clinically indicated.
• Prescribing medications where clinically appropriate.
• Referring you to a gynaecologist if additional evaluation is needed.
• Monitoring your symptoms and ongoing treatment through follow-up consultations.

Severe bleeding, potential pregnancy problems, or symptoms needing a physical examination will require a quick in-person evaluation.

How Hola Health can help

Hola Health offers secure telehealth consultations with AHPRA-registered doctors.

Doctors can:

• Assess abnormal uterine bleeding.
• Provide women's health advice.
• Arrange pathology and imaging referrals where clinically appropriate.
• Prescribe suitable medications if clinically appropriate.
• Refer you to a gynaecologist for further assessment.
• Provide medical certificates if clinically appropriate.

Key takeaways

• Abnormal uterine bleeding refers to vaginal bleeding that differs from your usual monthly cycle.
• It can be caused by hormonal changes, pregnancy-related issues, uterine abnormalities, medications, infections, or other medical diseases.
• Early evaluation identifies the underlying problem and guides proper management.
• Heavy, chronic, irregular, or postmenopausal bleeding should not be overlooked.

FAQs

What is considered abnormal uterine bleeding?

Abnormal uterine bleeding refers to any vaginal bleeding that differs from your regular menstrual cycle in terms of timing, frequency, duration, or quantity. This includes heavy periods, bleeding between periods, bleeding during intercourse, and bleeding after menopause.

What are the most common causes of abnormal uterine bleeding?

Common causes include hormonal imbalances, PCOS, uterine fibroids, endometrial polyps, pregnancy-related conditions, thyroid disorders, certain medications, infections, and, less commonly, precancerous or cancerous changes.

When should I see a doctor about abnormal menstrual bleeding?

Consult a doctor if you experience heavy or lengthy periods, bleeding between cycles, bleeding after menopause, bleeding after sex, chronic pelvic discomfort, or irregular bleeding that lasts for several months.

Can a hormonal imbalance cause abnormal uterine bleeding?

Yes. Hormonal imbalances are one of the most common causes of irregular uterine bleeding and can be associated with illnesses like PCOS, thyroid problems, puberty, or perimenopause.

How is abnormal uterine bleeding diagnosed?

A review of your medical and menstrual history, a physical examination, pregnancy testing, blood tests, pelvic ultrasound, cervical screening, and, in certain cases, an endometrial biopsy or hysteroscopy may be performed.

What management are available for abnormal uterine bleeding?

Treatment depends on the underlying cause and may involve hormonal or non-hormonal medications, iron supplements, minimally invasive treatments, or surgery in certain cases.

Can an online doctor help assess abnormal uterine bleeding?

Yes. A telehealth doctor can evaluate your symptoms, offer relevant investigations, prescribe medication when clinically indicated, organise referrals, and advise whether you need urgent in-person care.

Is abnormal uterine bleeding a sign of cancer?

Most cases of abnormal uterine bleeding are not caused by cancer. However, bleeding after menopause, persistent abnormal bleeding, or bleeding associated with other concerning symptoms like unintentional weight loss should always be assessed promptly to rule out serious conditions, including cancer.