What is abnormal uterine bleeding?
During a woman’s reproductive years, regular menstruation is expected. Exceptions are cases of taking hormones which suppress it, such as continuous progestogens. Abnormal uterine bleeding is any bleeding that occurs outside a woman’s normal period, either spontaneous or provoked, such as after sexual intercourse. Prolonged menstrual bleeding for a longer period than usual or with increased flow (menorrhagia) is also considered abnormal uterine bleeding.
The classification, risks for underlying sinister pathology and treatment for abnormal uterine bleeding depend on:
- the severity of bleeding
- the medical history of the woman
- the ultrasound scan findings
- menopausal status (before, about or after menopause)
- the effect the symptoms have to the woman’s every day life
Gynaecologist Surgeon Dr. Christina Founta has extensive experience in investigating and managing women with abnormal uterine bleeding. She is accredited in Diagnostic Colposcopy and Treatment, and she has been trained and worked as clinical lead in Diagnostic Gynaecological Oncology in major hospitals in Great Britain.
What possible causes lead to abnormal uterine bleeding?
The presence of benign pathology of the endometrium may or may not be accompanied by abnormal uterine bleeding of varying severity. Such cases may include:
- uterine fibroids
- endometrial hyperplasia
In cases of pathological findings, the absence of vaginal bleeding is particularly reassuring and significantly reduces the likelihood of precancerous lesions or endometrial cancer. However, it does not completely rule out this possibility.
Atypical endometrial hyperplasia (precancer) and endometrial cancer are almost always accompanied by abnormal uterine bleeding. It is important that in such cases, bleeding usually appears early in the course of the disease and is commonly curable.
Abnormal uterine bleeding per reproductive stage:
- Young women: The vast majority of menstrual disorders are the result of hormonal dysfunction. However, it is extremely important abnormal uterine bleeding is investigated by an expert Gynaecologist to confidently excpude the presence of sinister lesions. In addition, the Gynecologist will discuss with the patient the possible options and the appropriate treatment.
- Peri-menopause: Dysfunctional uterine bleeding is common. In women over 50 with abnormal uterine bleeding, the chance of atypical hyperplasia or endometrial cancer is 3%.
- After menopause (12 months or more without a period): Women with vaginal bleeding of any severity or over 55 years with irregular bleeding, have a 10% risk of endometrial cancer. This percentage is 20% for obese women.
What factors increase the risk of endometrial cancer?
The risk of endometrial cancer increases significantly in the following cases:
- polycystic ovarian syndrome
- Gene mutations – Lynch syndrome
Women who have a strong family history of endometrial and colon cancers in higher risk of having Lynch syndrome.
What should I do if I notice abnormal uterine bleeding?
Women with unexpected vaginal bleeding of any age should have:
- Their full gynaecological history taken
- gynaecological examination
- Ultrasound Scan of the pelvis
- An Investigation of their cervical smears and colposcopy history
If the bleeding occurs after sexual intercourse, a colposcopy must be performed by an expert Gynaecologist. In any case, if you notice unusual vaginal bleeding, contact your Gynaecologist immediately and book your appointment for further investigations.