Abnormal Uterine Bleeding (AUB)

A normal menstrual cycle is 28 days. A variation of 7 days (ie 21-35days) is considered normal. A cycle that is longer than 35 days or shorter than 21 days is abnormal.

Amenorrhea is a lack of periods.  If there is amenorrhea for more than 3 months in someone who has been menstruating normally previously, it is considered abnormal.

What is AUB?

  • Heavier than normal periods or bleeding longer than the usual cycle
  • Bleeding in between periods
  • Bleeding after intercourse
  • Bleeding after the onset of menopause 

 Reasons for AUB

  • Pregnancy and miscarriage
  • Endometrial polyps
  • Fibroids in the uterus
  • Infections of the uterus or cervix (which can include some sexually transmitted diseases like chlamydia)
  • Ectopic pregnancy
  • Polycystic ovarian disease
  • Abnormal thickening of the uterine lining (endometrial hyperplasia)
  • Cancers of the cervix, uterus or vagina
  • Dysfunctional uterine bleeding (DUB) – common at extremes of age (ie when menstruation first starts or before the onset of menopause)

Investigating AUB

In addition to history taking and clinical examination, this may include :

  • pap smear
  • Vaginal swabs and chlamydial swabs (or urine chlamydia testing)
  • Imaging which may include pelvic ultrasound (including 3D ultrasound) and possibly MRI 
  • Blood test to exclude anaemia, iron deficiency and blood clotting problems
  • Operative methods – hysteroscopy and endometrial sampling. 

Treating AUB

Factors that are taken into consideration when planning your treatment include your age, the cause of the bleeding and your desire to have children. 

Most women can be managed with medicines, and a small group will need an operation.

Medical management of AUB

  • Non-steroidal anti inflammatories like Nurofen or Ponstan. In addition to controlling bleeding, they help with menstrual cramps. This usually provides temporary relief only.
  • Antibiotics if there is an infection.
  • Tranexamic acid is a medication used to improve blood clotting and reduce heavy blood loss
  • Hormonal preparations:
    • The contraceptive pill
    • Injectable hormones like Depot Provera
    • Implants – Implanon NXT 
    • Intrauterine device – Mirena 

Surgical treatment of AUB

Again, this depends on the reason for the AUB and your desire for future childbearing. Options include:

  • Dilatation and curettage
  • Polypectomy
  • Hysteroscopic removal of fibroids (resection or morcellation using the MyoSure device
  • Endometrial ablation – rollerball, cavatherm of radiofrequency (NovaSure)
  • Hysterectomy