How do we know if we’re experiencing AUB?
We look at the definition – what is the quantity, the average duration of menstruation and the frequency.
Then we look at what is normal? The average is that a woman will get her period every 28 days but normal could be anything between 24-38 days, lasting up to 4-7 days, and consisting of 5-80 mls of blood; but – also heavy menses are generally defined as soaking a pad or tampon more than every two hours or as a volume of bleeding that interferes with daily activities.
Excessive blood loss is defined as a volume that interferes with the patient’s physical, emotional, social, and/or material quality of life.
Our favourite fact:
25% of women who think their period is heavy, it is normal. 40% of those who think it is normal, it is actually heavy.
1 in 3 presentations to gynaecologist is in regards to AUB.
The importance of AUB relates to its major impact on a person’s quality of life, productivity, and utilisation of health care services
There are many possible causes, including ovulatory dysfunction, bleeding disorders, cancer and pre-cancer, iatrogenic (caused by medical treatment), inflammation and infection. Structural problems can include polyps, fibroids, adenomyosis.
The causes are different in different age groups – in women over 45 years precancer and cancer are more of a concern.
A thorough examination with a gynaecologist is required to determine cause and appropriate treatment.
At the initial evaluation the source of bleeding is defined – most bleeding is from the uterus, but a systematic assessment is essential to exclude other sources; assessment will include tests to the causes and the consequences. Pelvic imaging and hormonal blood test will help with identifying the cause, while a blood count and iron studies will look for iron deficiency as a consequence.
If suspecting a structural problem – hysteroscopy and a dilation and curettage (D&C) would be the next step.
Management depends on the cause.
Some abnormal bleeding can be managed by hormonal interventions (the pill, Mirena or other IUD), taking anti-inflammatories (ponstan etc.) and tranexamic acid can also help and are non-hormonal. In some cases surgical treatment will be required to correct structural anomalies (fibroids/polyps), endometrial ablation or hysterectomy.
For more information on Abnormal Uterine Bleeding, heavy periods or uterine bleeding outside of regular menses listen to Dr Tzippi on the Knocked Up Podcast.
Written by Dr Tzippora Ben-Harim, our lead Gynaecologist.
If you think you have Abnormal Uterine Bleeding or another gynaecological concern and would like to see Dr Tzippi, click here to make an appointment.