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Abnormal Uterine Bleeding (AUB) Causes And TreatmentBy Dr. John F. McNamara Jr., MD, Randolph OB/GYNAbnormal uterine bleeding (AUB) is a concern for many women, with multiple causes and treatments. If you are experiencing AUB, please contact us at Randolph OB/GYN for assistance. Causes of AUB can be divided into the following: • Hormonal • Anatomical (fibroids, polyps, etc.) • Infectious • Malignancies and pre-malignant processes • Clotting disorders of the blood • Some chronic medical conditions such as hypothyroidism • Some drugs such as steroids Hormonal causes are the most common. Typically they are due to not ovulating or not producing enough progesterone hormone after ovulation. Anatomical causes are due to an abnormal mass inside the uterus or impinging upon the lining of the uterus (endometrium). Congenital deformities of the uterus such as septum can also cause AUB. Infections of the cervix or lining of the uterus can cause AUB. Malignancies or pre-malignant conditions usually occur in post-menopausal women, but can also occur before menopause. The diagnostic work-up consists of: • A history including recent medications • An exam to rule out infections of the cervix and uterus and obvious anatomical abnormalities • An ultrasound or saline-infused ultrasound to look for anatomical problems • Hormonal and/or clotting blood tests when appropriate • Endometrial biopsy if indicated - this can be done in the office. Treatment will depend upon the findings. If the work-up is completely negative, then one usually assumes a hormonal cause. Birth control pills or progesterone therapy are the usual treatments. If this fails, then a D&C (Dilatation and Curettage, or scraping the lining of the uterus) and hysteroscopy (examination of the uterus using a special interior viewing scope) is typically the next step. Endometrial ablation (removing the endometrial lining of the uterus) can also be done. If an anatomical cause is found, such as polyps or fibroids, then surgical options are available. This includes hysteroscopy with resection (cutting out) a polyp , fibroid, or septum. Endometrial ablation can usually also be done if desired. Sometimes hysterectomy (removal of uterus) is indicated. Endometrial ablation is done using hot water (Hydrothermal Ablation), electricity (Novasure) or a balloon device (Thermachoice). For patients with this problem, approximately 50% will have no bleeding at 3-5 years. An additional 35-45% will have normal or lighter than normal bleeding. A smaller percentage between 8-12% of procedures are considered a failure. NOTE: Many reports show much higher cure rates, but they are only looking at much shorter time intervals, such as 6 months. If your menses (periods) are more often than every 21 days, too heavy, lasting more than 7 days, or spotting between menses, then you should talk with your doctor, or contact Randolph OB/GYN if you do not have a current local obstetrician or gynecologist relationship. Learn More About Abnormal Uterine Bleeding |
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