Abnormal Uterine Bleeding: Causes and When to Seek Help - Obstetrics and Gynecology

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Abnormal uterine bleeding (AUB) is a common concern among women and can manifest in various forms, including irregular menstrual cycles, spotting between periods, or heavy menstrual bleeding. Understanding the causes of AUB is crucial for determining when to seek medical help and for effective management.


Causes of Abnormal Uterine Bleeding
1. Hormonal Imbalances: One of the most common causes of AUB is hormonal imbalance, particularly involving estrogen and progesterone. This can lead to irregularities in the menstrual cycle, causing either heavy bleeding or light spotting. Conditions such as polycystic ovary syndrome (PCOS) can also contribute to these imbalances.

2. Structural Abnormalities: Uterine fibroids, polyps, and adenomyosis can cause abnormal bleeding. Fibroids are non-cancerous growths in the uterus that can lead to heavy menstrual bleeding and prolonged periods. Polyps are similar but are usually smaller and can also cause irregular bleeding.

3. Medical Conditions: Conditions such as thyroid disorders, bleeding disorders (like von Willebrand disease), and endometriosis can lead to abnormal bleeding patterns. Endometriosis, in particular, can cause significant pain and irregular bleeding due to the presence of endometrial-like tissue outside the uterus.

4. Medications: Certain medications, especially hormonal contraceptives, can lead to changes in bleeding patterns. Anticoagulants and some psychiatric medications may also contribute to abnormal bleeding.

5. Infections: Pelvic inflammatory disease (PID) and sexually transmitted infections (STIs) can cause abnormal bleeding, often accompanied by other symptoms such as pelvic pain or unusual discharge.

6. Pregnancy-Related Issues: Early pregnancy complications, including miscarriage or ectopic pregnancy, can present with abnormal bleeding. If there is any chance of pregnancy, it is essential to take a pregnancy test.


When to Seek Help
It is essential to seek medical attention if you experience any of the following:
- Heavy Bleeding: Soaking through one or more sanitary pads or tampons every hour for several consecutive hours.

- Prolonged Bleeding: Bleeding that lasts longer than seven days.

- Severe Pain: Intense pelvic pain that is not relieved by over-the-counter medications.

- Signs of Anemia: Symptoms such as fatigue, weakness, or shortness of breath, which may indicate significant blood loss.

- Unexplained Changes: Any sudden changes in your menstrual cycle, especially if accompanied by other symptoms like fever or unusual discharge.


Diagnostic Approach
If you are experiencing abnormal bleeding, a healthcare provider may recommend several diagnostic tests, including:
- Pelvic Examination: To check for any physical abnormalities.

- Ultrasound: To visualize the uterus and ovaries for structural issues like fibroids or polyps.

- Blood Tests: To check hormone levels, thyroid function, and complete blood count (CBC) to assess for anemia.

- Endometrial Biopsy: If there is a concern for endometrial hyperplasia or cancer, a biopsy may be performed.


Conclusion
In your case, experiencing coffee-colored discharge and blood clots, along with irregular menstrual flow, warrants a thorough evaluation. While some causes of AUB can be benign, others may require treatment to prevent complications. It is advisable to consult with a healthcare provider who can perform the necessary evaluations and guide you toward appropriate management based on the underlying cause of your symptoms. Early intervention can help alleviate symptoms and improve your quality of life.