Abnormal uterine bleeding: Beyond the basics

A lady buying sanitary pads in Kigali. A period more than once a month is sometimes a symptom of abnormal uterine bleeding File photo

Vaginal bleeding between periods, a period more than once a month, or extremely heavy bleeding during a woman’s period, could be symptoms of abnormal uterine bleeding.

Abnormal or dysfunctional uterine bleeding is when a woman has abnormal menses — this could be in form of regularity, frequency and duration.

WHEN IS BLEEDING ABNORMAL?

Dr Abdul Namugongo, a gynaecologist at Oshen King Faisal Hospital, explains that for one to fully understand what abnormal uterine bleeding is, they must know what normal bleeding is.

Normal uterine bleeding, or a normal menstrual cycle, he says, lasts for less than eight days. When it comes to frequency, it should be between 21 to 35 days.

If the bleeding is heavy enough to keep one away from daily activities, then it is considered abnormal because ideally, normal bleeding should not make one uncomfortable, he cautions.

Heavy bleeding during menstruation, an irregular period in which the cycle length varies by more than seven to nine days, bleeding after menopause, and bleeding between periods are some of the conditions considered as abnormal uterine bleeding.

CAUSES

Polyps are a health condition that can lead to abnormal uterine bleeding. These are tumours or swellings that grow inside the uterus, they can also grow from the endometrium (the inside wall of the uterus). They could grow within the uterus or within the cervix and that can cause abnormal uterine bleeding.

Namugongo also points out adenomyosis as another cause. With adenomyosis, the endometrial tissue exists within and grows into the uterine wall. If that happens, it will cause abnormal uterine bleeding.

Fibroids are another cause of this condition, he says. “These are also tumours that originate from the muscles of the uterus, they could come inside the uterus or stay within the uterus or outside the uterus. But those that cause abnormal uterine bleeding either grow inside the uterus or are within the muscle of the uterus.

“There is also hostilities; one could have cancer originating from the endometrium itself and this can surely lead to abnormal uterine bleeding.”

A bleeding disorder (coagulopathy) is a condition that affects the way the blood clots.

This too can cause abnormal uterine bleeding. For some reason, Namugongo says, a woman may have inadequate cells that prevent the blood from clotting once she has started bleeding, so if she has her menses and she doesn’t have those cells, she bleeds much longer than normal.

Namugongo says there are also endometrial causes, a condition within the endometrium that causes the bleeding — it could be infectious, like chlamydia.

“We have others that are erotogenic, whereby there is something one does that causes the bleeding, for example, women who take different medicines, or are on family planning methods.

According to the Family Doctor website, in most women, abnormal uterine bleeding is caused by a hormone imbalance. When hormones are the problem, doctors call the problem dysfunctional uterine bleeding, or DUB. Abnormal bleeding caused by hormone imbalance is more common in teenagers or in women who are approaching menopause.

HOW SERIOUS IS THE CONDITION?

It is a case of emergency depending on how heavy the bleeding is, however, there is no abnormal uterine bleeding that a woman should ignore, Namugongo warns.

“There are different causes, some are treatable and others are not, hence, irreversible unless it is dealt with early. For example, if a woman suffers with abnormal uterine bleeding for long and it’s a cancer-causing condition, she will go to the hospital when it’s too late,” he says.

The effects of such a condition, Namugongo says, depend on the causes.

“Because abnormal uterine bleeding is associated with excessive loss of blood, most of the time, one will end up with low blood concentration in the body, and that will prevent her from running her day-to-day activities, which is bad,” he says.

“If the cause is fibroids, it will be extremely painful and prolong the menstrual cycle, and sometimes, if pregnant, she could have a miscarriage. It can also cause total barrenness. If a woman takes too long to deal with this, it could even lead to death,” Namugongo adds.

DIAGNOSIS AND TREATMENT

Diagnosis is mainly done through blood tests to find out the effect of the bleeding on the body. It also helps to know the haemoglobin levels and the state of the clotting factors.

Imaging is also done through an ultrasound to see whether there are masses in the body.

Another test is a hysteroscopy. A thin tube with a tiny camera in it is put into the uterus. The camera lets the doctor see the inside of the uterus. If anything abnormal shows up, the doctor can suggest a biopsy.

Treatment depends on the cause; if it is curable and not harmful, for example, if it is non-cancerous, the doctor will try to stop it, if it is cancerous, treatment will involve surgical procedures, and that is if it is still in its early stages, Namugongo says.

“The medical treatment that we opt for is combined oral contraceptive pills, they are helpful; and ibuprofen, among others,” he says.

Prevention of abnormal uterine bleeding calls for regular screening.

editorial@newtimes.co.rw

 

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