Abnormal Uterine Bleeding

What Counts As Abnormal Uterine Bleeding?

Any bleeding from the uterus that is unusual in amount or timing falls under this term. Signs that it is worth an assessment include:

• Soaking through a pad or tampon every one to two hours
• Periods lasting longer than seven days
• Passing clots larger than a R5 coin
• Bleeding between periods or after sex
• Cycles shorter than 21 days or longer than 35 days

Any bleeding after menopause should be checked promptly, even if it is light or happens only once.

What Causes Abnormal Bleeding?

Causes fall broadly into two groups. Structural causes include fibroids, polyps in the lining of the uterus, adenomyosis (where the lining grows into the muscle wall) and, less commonly, precancerous or cancerous changes.

Non-structural causes include hormonal changes that disrupt ovulation, such as polycystic ovary syndrome (PCOS) or thyroid conditions. Bleeding disorders and some forms of contraception can also play a part.

Over time, heavy bleeding can lead to iron deficiency, which may leave you feeling tired and short of breath.

How Is The Cause Found?

Your consultation starts with questions about your cycle and how the bleeding affects daily life. A diary of bleeding days kept for two or three months beforehand helps. A pelvic examination and ultrasound usually follow, along with blood tests to check your iron and hormone levels.

In some cases, a small sample of the uterine lining or a hysteroscopy, where a thin camera looks inside the uterus, gives a clearer answer.

What Treatment Options Are Available?

Treatment depends on the cause and on whether you hope to have children in future. Hormonal options that thin the lining include a hormone-releasing intrauterine device, while non-hormonal tablets taken during your period can reduce flow. When a polyp or fibroid is responsible, removing it is often possible.

For women who have completed their families, endometrial ablation or hysterectomy may be discussed as part of gynaecological surgery. Dr Makanda will explain the trade-offs of each approach.