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Abnormal Uterine Bleed (AUB) & Menorrhagia

A normal menstrual cycle occurs every 28 days, and each lasts approximately 5 days. An average menstrual flow consists of 30-40ml of blood loss.
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What is Abnormal Uterine Bleed (AUB) & Menorrhagia?

A normal menstrual cycle occurs every 28 days, and each lasts approximately 5 days. An average menstrual flow consists of 30-40ml of blood loss.

A lady can exhibit a few forms of abnormal uterine bleeding:

  1. Heavy menstrual bleeding (HMB)
  2. Too-frequent menstrual periods – – Bleeding in between a clearly defined and predictable menstrual cycle
  3. Inter-menstrual bleeding (IUB)
  4. Post-menopausal bleeding (PMB) – Bleeding after menopause
  5. Post-coital bleeding (PCB) – Bleeding shortly after sexual intercourse

Heavy Menstrual Bleeding (HMB)

Heavy menstrual bleeding (HMB), also known as menorrhagia, occurs when there is excessive blood loss leading to the interference with a woman’s physical, emotional, and social well-being. It is characterized and quantified by excessive total menstrual blood loss of more than 80ml or a menstrual duration of more than seven days.

Causes of heavy menstrual bleeding

In a normal monthly menstrual cycle, there is an equilibrium between the hormone estrogen and progesterone to guide the thickness and shredding of the uterine lining. In heavy menstrual bleed, there may be an imbalance between the two hormones, leading to a thickened uterine lining. When menstruation occurs, the thicker abnormal uterine wall shreds, causing excessive heavy bleeding. This can occur commonly during adolescence period when the reproductive hormonal system has yet to be fully established. It can also occur when a woman is approaching menopause.

There are other common causes that one should be aware of as well.

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Signs and symptoms of heavy menstrual bleed

  • Need to change sanitary pads every hour as the menstrual flow soaks through
  • Need for double sanitary protection
  • Period that lasts more than 7 days
  • Period with large blood clots

One may experience symptoms related to anemia such as:

  • Pale appearance
  • Lethargy
  • Chest pain
  • Breathlessness
  • Palpitation

When should I consult a doctor, and what happens next?

Speak to your trusted doctor when you have:

  • Periods that last more than 7 days
  • Periods cycles that are less than 21 days apart
  • Or other symptoms discussed above

Your doctor will take a thorough, relevant history, and perform an abdominal and pelvic examination. Depending on the individual, your doctor may offer further tests to assess the womb and ovaries structures.

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Can it be treated?

Oral medications such as NSAIDS (mefenamic acids) and antifibrinolytic agents (tranexamic acid) may be used for alleviating symptoms. You are encouraged to consider a diet with high iron stores and iron tablets supplements.

Hormonal treatment in various forms ranging from contraceptive pills, and injections and intrauterine devices, may be used to regulate the cycle and menstrual flow amount.

Any other underlying conditions need to be managed. Those with structural lesions, surgical options, endometrial (uterine) ablation may need to be discussed and considered with the gynecologist.

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