Abnormal Uterine Bleeding

Several abnormalities can occur in the menstrual cycle. Menses can be heavy, long, or occur infrequently or more frequently than desired. Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal. The lack of menses for 3–6 months is also abnormal. There are many reasons why menstrual changes occur. They may be related to problems with the uterus itself, for example fibroids or adenomyosis, or a hormonal imbalance that can be seen in conditions like polycystic ovarian syndrome. Treatment of these conditions is based on the cause of the condition.

The evaluation of abnormal uterine bleeding may first begin with an exam in the physician’s office. An ultrasound may be needed to evaluate the uterus and ovaries. The ultrasound may detect pathology such as fibroids, increased endometrial thickness, or an increased number of ovarian follicles which may help guide the physician’s management. Fibroids are benign growths within the uterus that may lead to heavy menstrual bleeding or menorrhagia. These growths are easily identifiable on ultrasound. In the case of increased endometrial thickness, additional testing may be indicated to rule out endometrial polpys, hyperplasia or cancer. Additional imaging such as sonohysterogram, endometrial biopsy and hysteroscopy with or without dilation and curettage may be indicated.

For further evaluation, the physician may also opt to obtain blood work which may help to diagnose anemia, thyroid dysfunction or additional hormonal imbalances which could lead to abnormalities in the menstrual cycle. In some cases, the patient may also be tested for diabetes mellitus or insulin resistance.

Once the source of the bleeding is identified, whether it is physical or hormonal, the patient and her physician will work together to decide the best treatment.

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