Abnormal uterine bleeding (AUB) is a common but often distressing condition that can significantly affect a woman’s life, particularly for those who are trying to conceive. Understanding AUB and its implications is crucial for fertility patients seeking to navigate this challenging aspect of their reproductive health, so we asked Dr. Nicole Marchetto, board certified Reproductive Endocrinologist with Shady Grove Fertility, Pennsylvania and Delaware, to help break it down.
AUB refers to any variation from the normal menstrual cycle, which usually occurs every 21 to 35 days and lasts between 2 and 7 days. This condition encompasses a wide range of bleeding patterns, such as heavy menstrual bleeding that interferes with daily activities, irregular bleeding outside the expected menstrual periods, frequent periods occurring shorter than 21 days apart, infrequent periods longer than 35 days apart, and the complete absence of menstrual bleeding for three or more months.
Causes of abnormal uterine bleeding
The causes of AUB can be categorized into structural and non-structural origins. Structural causes include polyps, which are benign growths on the inner lining of the uterus or cervix, adenomyosis where the uterine lining grows into the muscular wall of the uterus, fibroids which are non-cancerous tumors within the uterine wall, and cancer or precancerous conditions in the uterus. On the other hand, non-structural causes encompass blood clotting disorders, hormonal imbalances that lead to irregular ovulation, issues within the lining of the uterus, certain medications that induce abnormal bleeding, and various other factors.
AUB can complicate the journey to parenthood by disrupting the regular menstrual cycle, which is vital for ovulation and conception. Women with irregular or absent periods may struggle to predict their fertile windows, making conception more challenging. Additionally, conditions like fibroids and polyps can impede embryo implantation or increase the risk of miscarriage, further complicating efforts to conceive.
Abnormal uterine bleeding diagnosis
Diagnosing AUB involves a thorough evaluation to identify the underlying cause. This process typically includes taking a detailed medical history and conducting a physical examination, followed by laboratory tests to assess hormonal levels, thyroid function, and blood clotting ability. Imaging studies such as ultrasound, hysteroscopy, or MRI are used to visualize the uterus and detect structural abnormalities, and an endometrial biopsy may be performed to check for cancerous or precancerous changes.
Treatment options for abnormal uterine bleeding
The treatment for AUB depends on its cause, the severity of the symptoms, and the patient’s fertility goals. Options include medical management and surgical interventions. Medical treatments might involve hormonal therapies such as birth control pills, progesterone, or hormone-releasing intrauterine devices (IUDs) to regulate cycles and reduce bleeding. Non-hormonal treatments like NSAIDs and tranexamic acid can manage bleeding, and underlying conditions such as thyroid disorders or blood clotting issues may need to be addressed. Surgical interventions include hysteroscopy, a minimally invasive procedure to remove polyps or small fibroids; endometrial ablation, which destroys the uterine lining to reduce bleeding; myomectomy, the surgical removal of fibroids while preserving the uterus; and, as a last resort for severe cases, hysterectomy, which involves the removal of the uterus.
Abnormal uterine bleeding is a complex condition with diverse causes and significant implications for those trying to conceive. Early diagnosis and appropriate treatment are essential for managing AUB effectively and enhancing the chances of a successful pregnancy. Infertility patients experiencing abnormal bleeding should seek prompt medical evaluation to address the underlying causes and improve their reproductive outcomes.