Abnormal Uterine Bleeding: Causes and Management

Abnormal bleeding and heavy menstrual bleeding?

Doctor, I have not engaged in sexual intercourse.
Since the end of my menstrual period in May this year, I have been experiencing a large amount of discharge, which has included blood.
After my menstrual period ended in June, I started having abnormal bleeding and orange-colored discharge, requiring regular use of pads.
I have been to the doctor, who said it was due to stress.
On August 30, my period started, and on September 4, I experienced heavy bleeding with large blood clots.
The amount of clots during this bleeding was more than a bowl of grass jelly, requiring me to change a night pad every hour, and it even overflowed.
Each time I went to the hospital, I took two hemostatic pills, but the bleeding wouldn't stop.
On September 14, I had another heavy bleeding episode and took one hemostatic pill along with one contraceptive pill.
It wasn't until September 21 that the bleeding stopped, but then my period returned on September 29 with heavy bleeding again.
On October 4, I experienced heavy bleeding again, filling a night pad in just 15 minutes, and the bleeding wouldn't stop, so I went to the emergency room for a hemostatic injection.
On October 5, the bleeding decreased, but on October 6, I had another heavy bleeding episode.
I took two hemostatic pills on my own, which stopped the heavy bleeding, but I am still experiencing some bleeding.
During this time, ultrasounds have indicated fibroids, but they should not be affecting me, and I have been unable to undergo a pelvic exam due to the continuous bleeding.
I would like to ask the doctor: 1.
Can I increase the dosage of the hemostatic pills to two each time? 2.
Besides a pelvic exam, are there other diagnostic methods or other causes for the heavy bleeding? 3.
Is there anything I need to pay attention to in my diet during this period? Thank you.

Niming, 40~49 year old female. Ask Date: 2021/10/12

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
"Abnormal vaginal bleeding" has numerous causes, including lifestyle habits, stress, age, vaginal infections, benign gynecological conditions, and malignant tumors, among others.
Therefore, it is recommended that you visit a professional obstetrician-gynecologist for examination and evaluation.
2.
If there is no improvement after medication or if bleeding recurs, it is necessary to rule out the possibility of malignant lesions in the uterus.
3.
Dietary factors have minimal impact.

Reply Date: 2021/10/12

More Info

Abnormal uterine bleeding (AUB) is a common issue that can significantly impact a woman's quality of life. It encompasses a variety of symptoms, including irregular menstrual cycles, heavy bleeding, and bleeding between periods. Understanding the causes and management of AUB is crucial for effective treatment and alleviating concerns.

Causes of Abnormal Uterine Bleeding
1. Hormonal Imbalances: Fluctuations in hormone levels, particularly estrogen and progesterone, can lead to irregularities in the menstrual cycle. Conditions such as polycystic ovary syndrome (PCOS) and thyroid disorders are common contributors.

2. Structural Abnormalities: Uterine fibroids, polyps, and adenomyosis can cause heavy bleeding and irregular cycles. These structural issues can lead to changes in the uterine lining, resulting in abnormal bleeding patterns.

3. Infections: Pelvic inflammatory disease (PID) or other infections can cause inflammation of the reproductive organs, leading to abnormal bleeding.

4. Coagulation Disorders: Conditions that affect blood clotting can lead to excessive bleeding. This includes inherited disorders like von Willebrand disease or acquired conditions due to medications.

5. Stress and Lifestyle Factors: High levels of stress, significant weight changes, and lifestyle factors can also disrupt hormonal balance, leading to AUB.

Management of Abnormal Uterine Bleeding
1. Medical Management:
- Hormonal Treatments: Birth control pills are often prescribed to regulate menstrual cycles and reduce bleeding. They work by stabilizing hormone levels and thinning the uterine lining.

- Tranexamic Acid: This medication is used to reduce heavy menstrual bleeding by helping the blood clot more effectively.

- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen can help reduce menstrual flow and alleviate pain.

2. Surgical Options: If medical management fails, surgical interventions may be necessary. Procedures such as endometrial ablation (to destroy the uterine lining) or myomectomy (to remove fibroids) can be effective.

3. Lifestyle Modifications: Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help manage stress and hormonal balance. Additionally, addressing any underlying health issues, such as thyroid disorders, is essential.

4. Monitoring and Follow-Up: Regular follow-up with a healthcare provider is crucial for monitoring symptoms and adjusting treatment as necessary. If bleeding persists or worsens, further evaluation may be needed, including imaging studies or endometrial biopsy.

Specific Concerns Addressed
1. Increasing Dosage of Medications: It is essential to follow the prescribed dosage of any medication, including hemostatic agents. Self-adjusting the dosage without medical guidance can lead to complications. Always consult your healthcare provider before making any changes to your medication regimen.

2. Alternative Diagnostic Methods: While a pelvic exam is a standard procedure, imaging techniques such as ultrasound or hysteroscopy can provide additional insights into the causes of AUB. These methods can help visualize structural abnormalities without the need for invasive procedures.

3. Dietary Considerations: A balanced diet rich in iron (to combat potential anemia from heavy bleeding) and vitamins can support overall health. Foods high in vitamin K, such as leafy greens, can help with blood clotting. Staying hydrated and maintaining a healthy weight are also beneficial.

Conclusion
Abnormal uterine bleeding can stem from various causes, and its management requires a comprehensive approach tailored to the individual's needs. It is vital to maintain open communication with healthcare providers, adhere to prescribed treatments, and seek further evaluation if symptoms persist or worsen. By understanding the underlying causes and available treatment options, women can take proactive steps toward managing their reproductive health effectively.

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