Dysfunctional uterine bleeding

Abnormal uterine bleeding (AUB) is vaginal bleeding from the uterus that is abnormally frequent, last excessively long, is more than normal, or is irregular. Vaginal bleeding during pregnancy is excluded. Iron deficiency anemia may occur and quality of life may be negatively effected. Abnormal uterine bleeding (AUB) is vaginal bleeding from the uterus that is abnormally frequent, last excessively long, is more than normal, or is irregular. Vaginal bleeding during pregnancy is excluded. Iron deficiency anemia may occur and quality of life may be negatively effected. The underlying causes may include ovulation problems, fibroids, the lining of the uterus growing into the uterine wall, uterine polyps, underlying bleeding problems, side effects from birth control, or cancer. More than one category of causes may apply in an individual case. The first step in work-up is to rule out a tumor or pregnancy. Medical imaging or hysteroscopy may help with the diagnosis. Treatment depends on the underlying cause. Options may include hormonal birth control, gonadotropin-releasing hormone (GnRH) agonists, tranexamic acid, NSAIDs, and surgery such as endometrial ablation or hysterectomy. AUB affects about 20% of reproductive aged women. Symptoms include vaginal bleeding that occurs irregular, at abnormal frequency, last excessively long, or is more than normal. Normal frequency of periods is 22 to 38 days. Variation in the length of time between cycles is typically less than 21 days. Bleeding typically last less than 9 days and blood loss is less than 80 mL. Excessive blood loss may also be defined as that which negatively affects a person's quality of life. Bleeding more than six month after menopause is also a concern. The causes of AUB is divided into nine groups which includes: uterine polyps, fibroids, adenomyosis, cancer, blood clotting disorders, problems with ovulation, endometrial problems, healthcare induced, and not yet classified. More than one category of causes may apply in an individual case. Healthcare induced causes may include side effects of birth control. The underlying mechanism is often a hormonal disturbances: reduced levels of progesterone cause high levels of prostaglandin F2-alpha and cause abnormally heavy flow as progesterone stabilizes the endometrium and inhibits synthesis of prostaglandin F2-alpha; increased levels of tissue plasminogen activator (t-PA), a fibrinolytic enzyme, lead to more fibrinolysis.