Abnormal Uterine Bleeding

Abnormal uterine bleeding means bleeding from the womb that is heavier, longer, more frequent or more irregular than normal, or that occurs between periods, after sex or after menopause. Heavy menstrual bleeding is the commonest form and is defined in practice as blood loss that interferes with your physical, social or emotional life.

It is a symptom with many causes, grouped by doctors into structural ones, such as polyps, adenomyosis, fibroids and cancer or precancer, and non-structural ones, such as clotting disorders, ovulation problems and medicines. Most causes are benign and treatable, often without surgery. Any bleeding after menopause must be investigated.

Symptome

• Soaking a pad or tampon every 1 to 2 hours, or needing double protection
• Passing clots larger than a small coin, or flooding through clothes
• Periods lasting more than 7 to 8 days
• Bleeding between periods or after sex
• Cycles shorter than 24 days or longer than 38 days, or unpredictable
• Any bleeding 12 months or more after the last period
• Tiredness, breathlessness and paleness from iron deficiency

Ursachen und Risikofaktoren

Structural causes are endometrial and cervical polyps, adenomyosis, fibroids, especially those bulging into the cavity, and endometrial hyperplasia or cancer, for which obesity, diabetes, PCOS, tamoxifen and age over 45 are risk factors. Non-structural causes include irregular or absent ovulation around puberty, in PCOS and approaching menopause; bleeding disorders, of which von Willebrand disease is present in a notable share of teenagers with very heavy periods; thyroid disease; anticoagulants; copper coils and hormonal contraception; and infection of the cervix or womb lining. Pregnancy complications must always be considered first.

Wie es diagnostiziert wird

• History, examination and pregnancy test: Pattern and volume of bleeding, cervical inspection with a smear or HPV test if due, and a pregnancy test in anyone who could be pregnant.
• Blood tests: Full blood count and ferritin. Thyroid function and a clotting screen when the history suggests them.
• Transvaginal ultrasound: Measures the lining and detects polyps, fibroids and adenomyosis. After menopause, a lining of 4 mm or less makes cancer very unlikely.
• Endometrial biopsy: A thin suction tube takes a sample of the lining in the clinic within a minute or two. Advised for women over 45, those with risk factors, bleeding after menopause or failed treatment.
• Hysteroscopy: A fine camera passed through the cervix inspects the cavity and allows polyps and small fibroids to be removed at the same time, often without general anaesthetic.

Behandlungsmöglichkeiten

• Iron replacement: Tablets or an intravenous infusion to correct deficiency, regardless of the cause of bleeding.
• Tranexamic acid and anti-inflammatory drugs: Non-hormonal tablets taken only during the period. Tranexamic acid reduces loss by about a third to a half.
• Levonorgestrel intrauterine system: The most effective medical treatment for heavy periods, reducing loss by up to nine tenths over several months, and lasting years.
• Other hormonal options: Combined pill, cyclical or continuous progestogens, or injections to regulate or stop bleeding.
• Hysteroscopic removal of polyps and submucous fibroids: A short day-case procedure that often resolves the bleeding entirely.
• Endometrial ablation: Destroys the womb lining with heat or radiofrequency energy in about 10 to 30 minutes. For women who have completed their family. Contraception is still needed afterwards.
• Uterine artery embolisation, myomectomy or hysterectomy: For fibroid-related bleeding or when other treatments fail. Hysterectomy is the only option that stops periods for certain.

Wenn es dringend ist

Go to a local emergency department if you are soaking more than one pad an hour for 2 hours or more, feel faint, dizzy or breathless, have a racing heart, or bleed heavily with a positive pregnancy test or severe abdominal pain. Bleeding after menopause is not an emergency but should be assessed by a doctor within about 2 weeks.

Reisen nach Türkiye zur Behandlung

A visit can complete the work-up rapidly: ultrasound, biopsy and hysteroscopy with polyp or fibroid removal can often be done within 2 to 4 days, with pathology a few days later. Planned procedures such as ablation, myomectomy or hysterectomy fit stays of roughly 5 to 14 days depending on the operation. Do not fly with active heavy bleeding or untreated severe anaemia, and arrange for your own doctor to continue any hormonal treatment.

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