Abnormal Uterine Bleeding: Causes and Treatment

Let me explain an instance with you. As soon as we think our period is over and stop using sanitary napkins, we notice spots of blood in our underwear.

Have you gone through something similar? If you are thinking that this is something out of the way, then let me put all your assumptions to rest by stating some facts.

Abnormal Uterine Bleeding, earlier known as dysfunctional uterine bleeding, occurs in almost 9 to 14% of women between menarche (when a girl of 9-14 years of age starts having periods) and menopause (when menstruations stop permanently). In 2017, the prevalence of this condition was reported at a striking 17.9% in India

You’ll be surprised to know that the condition of abnormal vaginal bleeding can lead to loss of productivity. But how will you be able to distinguish ‘abnormal’ bleeding from the normal one? Read along as we discuss underlying factors behind this condition as well as a treatment option you should opt for!

Abnormal Vs Normal Uterine Bleeding

Your normal menstrual period generally lasts up to 8 days. Any heavy or unusual bleeding from the uterus through your vagina is defined as abnormal uterine bleeding. The bleeding that occurs other than your normal monthly cycle of menstruation is defined as abnormal uterine bleeding.

Abnormal uterine bleeding can entail any of the following-

●      Bleeding or spotting between periods

●      Heavy bleeding during period

●      A menstrual cycle that lasts over 38 days or not more than 24 days

●      Irregular periods in which cycle length varies more than 7-9 days

●      Spotting or bleeding even after sex

●      Spotting or bleeding after menopause

Why Abnormal Bleeding?

Now that you know how to differentiate between abnormal and normal bleeding, a logical question comes into mind “Why do this unusual bleeding occur?”. There are a number of factors that can cause this condition. But the most common ones discussed below-

Endometriosis

In this condition, the tissue which is similar to the uterine lining grows on other parts of the body such as fallopian tubes, ovaries, bladder, bowel, vagina or rectum. According to the Endometriosis Society of India, an estimated 25 million Indian women suffer from this condition. The most visible symptom of endometriosis is pelvic pain. Other symptoms of endometriosis are-

●      pain during sex

●      pain with ovulation

●      fatigue

●      painful cramps

●      frequent urination

●      low back pain

●      painful bowel movements

●      constipation or diarrhea

Fibroids

Fibroids are non- cancerous tumors that develop on the inner lining of the uterus. Generally, fibroids are not cancerous and very few of them are malignant. Although there most don’t show any symptoms some of them are lower backache, constipation, excessive or painful uterine bleeding to anemia. These can cause pain or heavy bleeding. Laparoscopy is recommended by gynecologists to remove them. Fibroids make it harder for the fertilized egg to attach itself to the lining of the womb as a submucosal fibroid changes the shape of the womb, making conception difficult.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is defined as a disorder caused by hormonal changes.  This is a disorder that is common among women of reproductive age. Women suffering from PCOS tend to have irregular or prolonged menstrual periods. The male hormone (androgen) levels are high in them. This condition occurs when your ovaries develop several small collections of fluid known as follicles and fail to release eggs regularly. Similarly, polycystic ovary disorder (PCOD) is another hormonal disorder that occurs in women of reproductive age.

Now that you know about various disorders that can contribute to abnormal uterine bleeding, it is recommended that you visit the gynecologist in order to get a proper diagnosis.

Diagnosing Abnormal Uterine Bleeding

After you have reached the clinic, the doctor will recommend several tests. The tests depend on your age. The doctor can recommend a pregnancy test after asking several questions. If you are having heavy bleeding then the doctor might recommend a test to check your blood count, iron deficiency and anemia. Furthermore, he might even recommend an ultrasound to check the uterus and ovaries. Other tests could be-

●      Endometrial biopsy- To check the uterine lining, this test is performed. In this test, a catheter is inserted into your uterus and removes a tiny piece of the uterine tissue and it is tested.

●      Hysteroscopy- In this procedure, a thin slender rod with a camera mounted on the top is inserted into the uterus to check for any inflammation or polyps.

Getting Cure For Abnormal Uterine Bleeding

A hysterectomy is the removal of the uterus. It can also involve the removal of the cervix, fallopian tubes and other reproductive organs. Depending on the diagnosis of the disease combined with the physiology of the patient, doctors can recommend any one of the following-

●     Abdominal hysterectomy- An abdominal hysterectomy is open surgery. In this surgery, a surgeon makes a 5- to 7-inch incision, around the belly. The surgeon then takes out the uterus through this incision. After an abdominal hysterectomy, a woman generally spends 2-3 days in the hospital. These are not opted by women because there is a visible scar at the location of the incision.

●     Vaginal hysterectomy- A cut is made in the vagina and the uterus is removed through this incision.

Scarless Treatment For Abnormal Uterine Bleeding

Out of all the advanced surgeries, doctors recommend patients for laparoscopic hysterectomy. This surgery is performed using a tube with a lighted camera, known as a  laparoscope which is inserted through several small cuts made in the belly. In the case of a single site laparoscopic procedure, one small cut is made in the belly button. The surgeon controls the equipment from outside the body by viewing the operation on a video screen.

●     Laparoscopic-assisted vaginal hysterectomy- To remove the uterus, the surgeon makes an incision in the vagina using laparoscopic tools.

●     Robot-assisted laparoscopic hysterectomy-  Similar to a laparoscopic hysterectomy, but the surgeon uses a sophisticated robotic system of surgical tools.

Choose only laparoscopy over others!

●      Reduced risk of bleeding- During laparoscopic surgery, the surgeon makes one or more small incisions in your abdomen. These allow the surgeon to insert the laparoscope, small surgical tools, and a tube used to pump gas into the abdomen. This is done so that the doctor can look inside and operate easily. The size of the incision size is so small than the large incision made for open surgery reduces the risk of bleeding.

●      Less painful healing process- In the case of conservative methods, patients take a longer time to recover as one large incision is made. After laparoscopic surgery, the post-surgical wound is much smaller and it is properly bandaged with abdominal sutures. This ensures that you have a less painful recovery process.

●      Reduced chances of scarring- Traditionally, before the emergence of this treatment, a surgeon had to cut a patient’s belly that was 6-12 inches long. This allowed doctors to see inside the abdominal or pelvic cavity and operate accordingly.

●      Reduced risk of infection- The risk of post-operation infection is significantly reduced to a minimal in laparoscopic surgery as there is minimum exposure of internal organs to external contaminants. Particularly in overweight and obese patients, there is a high risk of infection in the scar tissue, specifically if the surgical wound is larger.

●      Same-day procedures- As laparoscopic surgeries are day-care procedures, you will be generally discharged the same day. They can return to their daily activities much more quickly.

Patients who suffer from a lung or heart disease, laparoscopic treatment is carried out without general anesthesia. Surgeons guide their patients for traditional or laparoscopic surgery, accordingly after thorough diagnosis. Now that you have learned everything about abnormal vaginal bleeding, it will be evident for you that abnormal vaginal bleeding is completely ‘normal’!