Abnormal Uterine Bleeding

Abnormal uterine bleeding refers to excessive menstrual bleeding or bleeding in between periods. Women with abnormal bleeding require through assessment and investigations to rule out important pathology such as cancer.  Some women may have irregular menses as their ovaries are not releasing eggs (ovulation) regularly. The condition can also be associated with painful period (dysmenorrhoea), abdominal bloating or heaviness, iron deficiency anaemia due to excessive blood loss, painful sex (dyspareunia) or bladder / bowel symptoms. The condition can be treated once the specific cause been identified.

• Uterine – endometrial hyperplasia/cancer, fibroid uterus, endometrial polyp

• Cervix – cervical dysplasia/cancer, cervical or endocervical polyp, ectropion

• Vagina – vaginal atrophy, vaginal intraepithelial neoplasia (VIN)

• Urinary tract – UTI, bladder or renal stones

• Bowel – haemorrhoids

1. Imaging – pelvic ultrasound is commonly used, occasionally may require CT or pelvic MRI to rule out malignancy

2.  Ensure cervical screening test (CST) is up to date, some women may require colposcopy examination ± cervical biopsy if abnormal CST

3.  Consider hysteroscopy D&C if thickened or abnormal endometrium

4.  Baseline blood test including full blood count, iron studies to check baseline reserve

Education and clear communication of the underlying causes.

After excluding important causes listed above, women have the option of using:

• Non hormonal – NSAIDS, tranexamic acid

• Hormonal therapy

  • Oral contraceptive pills

  • Mirena intrauterine device – can be inserted during hysteroscopy or in the clinic

  • Injectable

• Surgical management (depending on the cause) as final resort if symptoms failed to improve after conservative therapies

 Please contact Dr Yong’s room if further information is required