AUB is the commonest menstrual problem in perimenopause - it can be acute or chronic.
At least one third of women will have AUB in their life. It has a significant impact on the physical and emotional quality of life of women. Higher incidence is seen around menarche and perimenopause.
The normal length of the menstrual cycle is typically between 24 days and 38 days. A normal menstrual period generally lasts from 4 to 8 days with 5 to 80 ml of blood loss
When to report to the doctor?
- Bleeding or spotting between periods
- Bleeding or spotting after sex
- Heavy bleeding during your period
- Menstrual cycles that are longer than 38 days or shorter than 24 days
- Duration more than 8–9 days
- Bleeding after menopause
Some of the common gynaecological causes of abnormal bleeding are
ACRONYM -PALM COEIN in the non pregnant women:
- L-LEIMYOMA .i.e fibroids
- M-MALIGNANCY and hyperplasia
- C- Bleeding disorders known as coagulopathy
- O-Ovulation Problems
- E-Endometrial problems
- I-Iatrogenic that is linked to exogenous therapy
- N -Not otherwise classified,
- Any abnormal bleeding which occurs more than once should be investigated
- However postmenopausal bleeding should be evaluated even if it occurs for the first time.
Common investigations which are done after a detailed history and examination are -
- Ultrasound TVS
- Pap Smear
- Blood Tests
- MRI pelvis (in some cases)
- Endometrial sampling in all women above 45 years and in select cases below 45 years
- Hysteroscopy and D&C when indicated
Increased availability of medical options has expanded the choice for women and many will not need surgery. Surgery is only done when medical management fails, is contraindicated or cannot be tolerated or there is a malignancy in an operable stage.
Treatment has to be individualized depending on symptoms ,desire for fertility ,age, parity and other co morbidities
Some of the treatment options include :
- Tranexamic acid and NSAIDS
- Hormonal tablets - low dose hormonal contraceptives are the mainstay of treatment for adolescents upto age 18 years
- Either low dose ocps or progesterone therapy is generally effective in women aged 19 to 39 years
- Mirena insertion e,g for simple hyperplasia of endometrium or for adenomyosis
- Mifepristone tablets or ulipristal as medical management of fibroids in select patients
- (GnRH) Analogues as short term therapy
- Lifestyle modifications for ovulatory dysfunctions like PCOS or obesity are first line therapy
- Interventional radiological services like uterine artey embolization or MRgFUS for select cases of fibroids
- Endometritis can be treated with antibiotics
- Polypectomy at the time of D&C and hysteroscopy