Abnormal Bleeding
Dr. Kenneth Fortier is a gynecologist practicing in Raleigh, NC. Dr. Fortier specializes in women's health, particularly well-woman care and health screening and gynecologic conditions and needs including management of menopause and perimenopause symptoms, infertility evaluation and treatment, endometriosis, abnormal bleeding,... more
Abnormal Uterine Bleeding (AUB) is one of the most common reasons why women go to the gynecologist’s office, accounting for about one-third of all visits. There are numerous causes; the evaluation can be complicated and requires a thorough history and physical examination, sometimes lab tests and imaging studies, and the specialized expertise of a board-certified gynecologist.
AUB is concerning for several reasons. It can be a sign of a serious underlying problem including cancer, pre-cancer, or a disorder of hormones or the blood-clotting system. Untimely bleeding can be an inconvenience that significantly affects quality of life, and heavy bleeding can lead to iron deficiency anemia or can even be life-threatening.
The good news is that the great majority of the time, the root cause is benign and curable. Nevertheless, the cautionary word is that it is always paramount to exclude the relatively uncommon times when AUB can be due to a pre-cancerous or even cancerous disorder.
How is AUB defined?
Abnormal Uterine Bleeding (AUB) is menstrual flow that is outside of the normal volume, duration, regularity, or frequency. Menstrual flow originates from the endometrium, the tissue lining the cavity of the uterus. Occasionally bleeding from the uterine cervix or the vagina can be confused with AUB. This is usually readily apparent from a pelvic exam, which is one of the reasons why an examination is so important for the evaluation of abnormal bleeding.
What are the causes of AUB?
There are many causes. These can be primarily of the female organ system or from other systems such as malfunctions of the blood clotting system or the thyroid or pituitary glands.
The International Federation of Gynecology and Obstetrics (FIGO) has developed an acronym, PALM-COEIN, to help us remember the causes:
Polyps – Small tag-like growths of the uterine lining (endometrium).
Adenomyosis – A condition where the uterine lining grows into the uterine muscle.
Leiomyoma – Another name for fibroids, fibrous knots that grow into the uterine wall.
Malignancy – Cancer, especially of the uterine lining.
Coagulopathy – Abnormalities of the blood clotting system.
Ovulatory dysfunction – Disorders of ovulation that disrupt normal hormone function.
Endometrial – Primary disorders of the uterine lining (endometrium).
Iatrogenic – Medical interventions, such as hormonal medications or IUDs.
Not yet classified – Other causes not yet well understood.
What should I do if I have AUB?
It’s important to seek medical advice for several reasons. The root cause of each case must be understood to diagnose and treat the underlying abnormality. A thorough medical history and physical exam are necessary in most situations. Depending on the circumstances, other tests including blood tests, ultrasound, pap smear, or a sampling of the endometrium may be called for. Again, the good news is that the cause can usually be determined, and it is most often benign and curable. If you have questions or think you have a problem with AUB, please call to ask or to make an appointment: 919-233-8885.
