MAY 2024

About a third of women will experience abnormal uterine bleeding (AUB) in their lifetime, which is considered normal during menarche, when young women start menstruating and again during perimenopause when the female body transitions to menopause.

However, any unexpected or irregular bleeding from the uterus that deviates from a woman’s typical menstrual pattern, shouldn’t be ignored, as it can sometimes be a symptom of more serious conditions like cancer or uterine fibroids.

Rene Schickerling, Women’s Health Category Manager for Pharma Dynamics says while occasional variations in menstrual cycles or bleeding patterns can be normal for some women, particularly during adolescence, perimenopause or in association with hormonal changes, persistent or recurrent abnormal uterine bleeding warrants evaluation by a healthcare provider to determine the underlying cause and appropriate management.

“There are multiple reasons that could lead to AUB, some of which include stress, rapid weight gain or loss, medications, fibroids, polyps, endometriosis, diabetes, kidney disease, polycystic ovary syndrome thyroid disease, sexually transmitted diseases (STDs), certain cancers, as well as certain oral contraceptives and intrauterine devices (IUDs).

“Additionally, factors such as age, overall health, and individual menstrual history may influence what is considered abnormal for a particular woman. Therefore, any changes or concerns regarding menstrual bleeding that is outside of the norm should be discussed with a doctor.”

She says abnormal uterine bleeding can manifest in various ways, which may include:

  1. Heavy menstrual bleeding (menorrhagia): Menstrual periods that are unusually heavy, with prolonged bleeding that lasts more than seven days or requires frequent changing of sanitary products.
  2. Bleeding between periods (metrorrhagia): Unexpected bleeding or spotting that occurs between menstrual periods.
  3. Irregular menstrual cycles: Menstrual cycles that are significantly shorter or longer than usual or menstrual periods that occur at irregular intervals.
  4. Intermenstrual spotting: Light bleeding or spotting that occurs intermittently between menstrual periods.
  5. Bleeding after menopause: Any vaginal bleeding that occurs after a woman has gone through menopause, which is defined as the absence of menstrual periods for 12 consecutive months in women over the age of 45-55.
  6. Bleeding after sexual intercourse (postcoital bleeding): Vaginal bleeding that occurs immediately or shortly after sexual activity.

The treatment of abnormal bleeding is based upon the underlying cause. However, Schickerling says that in cases of ovulatory dysfunction, AUB can in most instances be remedied with a low-dose combined oral contraceptive (COC) containing ethinylestradiol (estrogen) and levonorgestrel (progestin), “If not effective, minimally invasive procedures, such as endometrial ablation could be considered. Hysterectomy may also be an option, yet this depends on individual factors such as hormone levels, severity of symptoms, underlying health conditions, reproductive plans, age and personal preferences.

“Maintaining a healthy lifestyle and weight, which includes regular exercise and stress management may also help regulate menstrual cycles and reduce bleeding.

“Abnormal uterine bleeding can significantly impact multiple aspects of a woman’s life, affecting physical health, emotional well-being, social interactions and daily activities. Seeking timely medical evaluation and appropriate treatment can help alleviate symptoms, improve quality of life, and address any underlying health concerns,” advises Schickerling.

For more on these women’s health conditions, visit the MyDynamics platform (www.mydynamics.co.za).

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