Abnormal uterine bleeding, one of the most common issues affecting women’s health, can negatively impact not only physical well-being but also psychological and social life. Dr. Şadıman Kıykaç Altınbaş, an obstetrician and gynecologist, emphasizes the importance of a conscious and informed approach to this condition. There can be many underlying causes of abnormal bleeding—some as simple as hormonal imbalances, while others may indicate more serious conditions.
In this article, we will cover the causes, symptoms, diagnostic methods, and treatment options for abnormal uterine bleeding.
Abnormal uterine bleeding (AUB) refers to deviations from the normal menstrual pattern and is frequently encountered among women of reproductive age. It typically presents in the following ways:
This condition may manifest as bleeding between periods, very heavy bleeding, prolonged menstruation, or irregular menstrual cycles. Such complaints—especially in women over the age of 40—should not be ignored, and medical consultation with a gynecologist should be sought without delay.
There can be various causes of abnormal uterine bleeding. In medical literature, these are typically examined under two major groups: structural and non-structural causes. The International Federation of Gynecology and Obstetrics (FIGO) classifies them under the acronym “PALM-COEIN.” While this terminology may seem complex, it can be explained simply:
This group includes visible or image-detectable changes within the uterus.
These are small, usually benign growths that originate from the uterine lining. They may lead to symptoms such as spotting between periods or bleeding after sexual intercourse. They are often diagnosed through a procedure called hysteroscopy and can be removed with minor intervention.
This occurs when endometrial cells grow into the muscular wall of the uterus. It may cause heavy and painful periods. Women may also experience bloating, pressure, and pelvic pain. It is more commonly seen in women over 35 who have previously given birth.
Fibroids are benign muscle tumors that grow in the uterine wall. They are very common. Some women may be asymptomatic, while others experience heavy and prolonged menstruation, pelvic pain, or frequent urination. The size, number, and location of the fibroids determine the severity of symptoms.
“Malignancy” refers to cancer in medical terminology. Endometrial cancer is the most frequently encountered type in this category. Hyperplasia refers to an abnormal thickening of the uterine lining, which can progress to cancer if left untreated. Any bleeding after menopause must be investigated for these possibilities.
This group includes bleeding without any physical abnormality in the uterus and is often related to hormonal disturbances, systemic conditions, or external factors.
Refers to conditions that prevent normal blood clotting. Some congenital disorders or side effects of medications can prolong bleeding time. Affected women may report prolonged bleeding during menstruation or after minor injuries.
Results from disrupted ovulation. It often occurs during adolescence or perimenopause. Even when estrogen levels are high, a lack of progesterone leads to irregular or prolonged shedding of the uterine lining.
When the endometrial lining fails to respond appropriately to hormonal signals, irregular bleeding can occur. This is typically diagnosed by exclusion in women who do ovulate but still experience abnormal bleeding.
Certain medications, especially hormonal contraceptives, can temporarily disrupt menstrual cycles. Birth control pills, hormonal injections, or intrauterine devices (IUDs) can cause abnormal bleeding. Medications used for other health conditions may also lead to bleeding as a side effect.
Sometimes, despite thorough testing, no specific cause is found. These rare cases are categorized only after all other possible causes are excluded.
One or more of these causes may be present in a given patient. Since every woman is different, evaluation should be performed by a specialist in gynecology. Early diagnosis and individualized treatment planning improve quality of life and help prevent potentially serious health problems.
The diagnostic process begins with a thorough medical history and physical examination. Additional evaluations may include:
Treatment depends on the patient’s age, fertility desires, general health, and the underlying cause of the bleeding.
Abnormal uterine bleeding is a common and potentially serious issue in women’s health. Irregular menstrual cycles, heavy or prolonged bleeding, and unexpected postmenopausal bleeding not only impair quality of life but may also indicate underlying conditions. Therefore, symptoms should not be ignored, and medical evaluation should be sought.
Causes such as uterine polyps, fibroids, hormonal imbalances, ovulatory dysfunction, or medication side effects may all contribute to the bleeding. With a comprehensive history, gynecologic examination, ultrasound, and biopsy if needed, the underlying cause can be accurately determined. Treatment should be tailored to the individual based on the cause, age, fertility plans, and overall health status. While some cases respond to medical treatment, others may require surgical intervention.
If you experience menstrual irregularities, intermenstrual bleeding, postcoital spotting, or bleeding after menopause, be sure to consult a gynecologist. Prof. Dr. Şadıman Kıykaç Altınbaş provides evidence-based and personalized care in this field. Remember: every symptom is a signal, and early intervention can be life-saving. For more information or to schedule an appointment, feel free to contact us.
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