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Information from Your Family Doctor
Abnormal Uterine Bleeding
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Am Fam Physician. 2004 Apr 15;69(8):1931-1932.
What is abnormal uterine bleeding?
Abnormal uterine bleeding (AUB) is any bleeding from the uterus other than your normal monthly period.
Who can have AUB?
AUB can happen in females of all ages. However, it means different things at different stages of your life.
Uterine bleeding is not normal in girls who are too young to have periods. Causes can include sexual abuse and cancer. Call your doctor right away if your little girl has this kind of bleeding.
Women of childbearing age have different menstrual patterns. Some women have longer periods than others. Some have periods less often than others. These differences are usually normal.
Here are some signs of AUB:
Periods that happen more often than usual (less than 21 days apart)
Periods that happen less often than usual (more than 35 days apart)
Heavier than normal bleeding during periods
Bleeding between periods
If you have any of these signs, you should see your doctor.
AUB also can happen after menopause (also called “change of life”). There are two signs of AUB at this stage of life:
Bleeding that occurs 12 months or more after periods stop
Unpredictable bleeding that occurs 12 months or more after starting to take hormones
AUB can be a sign of a serious health problem such as cancer of the uterus. You should call your doctor if your menstrual cycle changes or if you have any vaginal bleeding when you should not have it.
If I have AUB, what will my doctor do?
Your doctor will ask you to describe the bleeding—when it happens, how often it happens, how much you bleed. Your doctor also will ask you about any illnesses that you have, and any medicines or herbal products that you take. You might have a pelvic exam and maybe a general physical exam, and a Pap test.
AUB can have many causes. It may take several visits to find the reason for your bleeding.
If you are of childbearing age, vaginal bleeding can be a side effect of pregnancy. Certain medicines and herbs also can cause AUB.
Some illnesses can cause AUB. You might not even know that you are sick. Your doctor will ask questions about certain illnesses, and you might have some tests.
Injury, infection, and growths (sometimes even cancer) can cause AUB. The pelvic exam and Pap test may identify these conditions.
Depending on the cause of your AUB, your doctor might have you take medicine to control the bleeding. It will take some time for the medicine to work. You may need to see your doctor again after you have taken the medicine for several weeks or months.
Will I need other tests?
Some women are at higher risk for serious illness such as cancer of the uterus. You might need more tests if you:
Are older than 35 years
Are overweight or obese
Have more than 35 days between your periods
Have diabetes or high blood pressure
Take medicines such as tamoxifen (brand name: Nolvadex)
Have never been pregnant
Your doctor also will consider more tests if medicine does not stop your bleeding.
Your doctor may perform an endometrial biopsy (say: en-do-mee-tree-al bi-op-see). For this test, your doctor uses a special tool to take a tissue sample from the inside of your uterus. This test can make you have cramps. You may be given a medicine to help with the pain.
Your doctor may send you to a radiologist for a special ultrasound exam. For this exam, a slender tool is put in your vagina. The tool is connected by wires to a TV screen. It helps the radiologist see your uterus, fallopian tubes, and ovaries. To improve the view, your uterus may be filled with fluid. This test may find growths or changes that might not be found during a pelvic exam.
Your doctor could decide to perform hysteroscopy (say: hiss-tur-os-ko-pee). This test is another way to see if you have abnormal changes or growths in your uterus.
If you have gone through menopause and have AUB, your doctor may recommend that you have a procedure calleld a D&C. This is a surgery to remove a tissue sample from the inside of your uterus. The sample is larger than the one taken with an endometrial biopsy. For this surgery, you will have a general anesthetic. If a general anesthetic is too risky for you, your doctor may recommend endometrial biopsy and a transvaginal ultrasound exam.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 2004 by the American Academy of Family Physicians.
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