women s health issues
Abnormal Uterine Bleeding (AUB)
Introduction
Abnormal uterine bleeding in women of childbearing age is bleeding from the uterus that does not follow the normal pattern for menstrual cycles. That is, it occurs too frequently or irregularly or lasts longer or is heavier than normal menstrual periods. The most common type of abnormal bleeding results from problems that interfere with the release of the egg (ovulation). To diagnose abnormal uterine bleeding, doctors ask women questions about the pattern of bleeding (menstrual history) and do a pelvic examination, ultrasonography, and blood tests. A biopsy of the lining of the uterus may be done. Treatment depends on the cause and may include hormones or other medications, such as a combination birth control pill, or a procedure, such as hysteroscopy and dilation and curettage (D and C) If the biopsy detects abnormal cells, treatment involves high doses of a progestin and sometimes removal of the uterus. (See also Vaginal Bleeding .) Abnormal uterine bleeding is a common problem in women of childbearing age. It occurs most commonly at the beginning and end of the reproductive years: 20% of cases occur in adolescent girls, and more than 50% occur in women older than 45. In women of childbearing age, the most common cause of abnormal bleeding is ovulatory dysfunction. That is, the ovaries do not release an egg (ovulate) or do not regularly release an egg. Thus, pregnancy is less likely. However, because the ovaries may occasionally release an egg, these women should use contraception if they do not wish to become pregnant. Often, what causes the ovaries to malfunction is not known. Abnormal uterine bleeding commonly results when the level ofestrogenremains high instead of decreasing as it normally does after an egg is released and is not fertilized. The highestrogenlevel is not balanced by an appropriate level ofprogesterone. In women with this type of abnormal bleeding, no egg is released, and the lining of the uterus (endometrium) may continue to thicken (instead of breaking down and being shed normally as a menstrual period). This abnormal thickening is called endometrial hyperplasia. Periodically, the thickened lining is shed incompletely and irregularly, causing bleeding. Bleeding is irregular, prolonged, and sometimes heavy and may last many days. This type of abnormal uterine bleeding is called anovulatory uterine bleeding. In other women, an egg is released butprogesteroneproduction lasts longer than usual. As a result, the thickened lining of the uterus is shed irregularly. This type of abnormal uterine bleeding pattern is called ovulatory dysfunction. In women with obesity, this type can occur whenestrogenlevels are high. As a result, intervals with no periods alternate with intervals of prolonged bleeding. If this cycle of abnormal thickening and irregular shedding continues, precancerous cells may develop, increasing the risk of Cancer of the Uterus (endometrial cancer), even in young women. Abnormal uterine bleeding is often an early sign of Menopause (the several years before and the 1 year after the last menstrual period). 