Abnormal Uterine Bleeding: Causes and Concerns for Women Over 40

Abnormal heavy bleeding?

Hello, I would like to ask about my mother, who is approaching 49 years old this year.
Recently, she experienced uterine bleeding that lasted for about a month.
After being prescribed medication by a doctor, her condition improved, but once she stopped the medication, the bleeding resumed.
The amount of bleeding is several times more than a normal menstrual period.
Additionally, previous imaging showed that she has a tumor in her uterus.
I would like to know if this could be benign or malignant, and what types of uterine conditions are more likely in this situation?

luili, 10~19 year old female. Ask Date: 2001/09/10

Dr. Xu Junzheng reply Obstetrics and Gynecology

Uterine fibroids, endometrial hyperplasia, cervical cancer, and endometrial cancer can all cause heavy bleeding.
A thorough examination is necessary to confirm the diagnosis, as it cannot be determined solely based on symptoms.
Thank you.

Reply Date: 2001/09/10

More Info

Abnormal uterine bleeding (AUB) is a significant concern for women, especially as they approach perimenopause and menopause, typically occurring in their late 40s to early 50s. In your mother's case, at nearly 49 years old, experiencing prolonged and heavy uterine bleeding raises several important considerations.

Firstly, it’s essential to understand that AUB can have various causes, ranging from hormonal imbalances to structural abnormalities in the uterus. Given your mother's age and the presence of a uterine tumor, it is crucial to differentiate between benign and malignant conditions. Common benign causes of AUB include uterine fibroids, polyps, and adenomyosis. Fibroids are non-cancerous growths of the uterus that can cause heavy bleeding, especially during menstruation. Polyps are small growths on the lining of the uterus that can also lead to irregular bleeding. Adenomyosis occurs when the endometrial tissue grows into the muscular wall of the uterus, leading to heavy and painful periods.

On the other hand, the risk of endometrial cancer increases with age, particularly in women over 45 who experience abnormal bleeding. The presence of a uterine tumor, as noted in your mother's case, necessitates careful evaluation. While many tumors are benign, the possibility of malignancy cannot be overlooked, especially if the bleeding is heavy and persistent.

The fact that your mother’s bleeding improved with medication but resumed after stopping treatment suggests that the underlying issue may not have been fully addressed. Hormonal treatments, such as progestins or hormonal contraceptives, can help regulate the menstrual cycle and reduce bleeding. However, if the bleeding returns upon discontinuation, further investigation is warranted.

It is advisable for your mother to undergo a thorough evaluation, including a pelvic ultrasound or hysteroscopy, to assess the nature of the uterine tumor and the endometrial lining. A biopsy may also be necessary to rule out cancer. These diagnostic tools can provide valuable information about the structure of the uterus and help determine the appropriate course of action.

In summary, while there are several potential causes of abnormal uterine bleeding in women over 40, the presence of a uterine tumor and the characteristics of the bleeding necessitate a careful and comprehensive evaluation. It is crucial to work closely with a healthcare provider to determine the underlying cause and develop an appropriate treatment plan. Regular follow-ups and monitoring are essential to ensure your mother's health and well-being during this time.

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