From Spotting to Hemorrhage: The Spectrum of Abnormal Uterine Bleeding

Abnormal period
Amy Guip/Getty images

If you are experiencing bleeding that it is different from your regular period you may be very worried.

Once you have become used to the pattern of your regular cycle any bleeding that happens outside of your normal period can be unsettling.

Irregular bleeding used to be called dysfunctional uterine bleeding. But with new diagnostic terminology in place, the experts recommend that the term dysfunctional uterine bleeding is changed to abnormal uterine bleeding.

What is Abnormal Uterine Bleeding?

Abnormal Uterine Bleeding is a menstrual cycle disorder.  Any bleeding that is outside of your regular cyclic menstruation is considered abnormal uterine bleeding. Any change in the amount or duration of your period is also considered abnormal uterine bleeding. Abnormal uterine bleeding can range from a random day of light spotting to 10 days of heavy bleeding replacing your normal menstrual flow.

During your reproductive years, it is likely that you will experience some type of abnormal uterine bleeding at least once. Abnormal uterine bleeding that occurs only once usually does not indicate any significant underlying problem. If you have 3 consecutive months of abnormal bleeding it is more likely that you have an underlying problem causing the bleeding.

If you are just starting to menstruate or if you are in the last few years of your regular menstrual cycles or  perimenopausal, you are at an increased risk of experiencing abnormal uterine bleeding.

 

Making the Diagnosis

The diagnosis of abnormal uterine bleeding is based on your complaints of changes to your menstruation. There are four main variables that describe menstruation:

How much you bleed?

How many days do you bleed?

How often you bleed?

How regular are the intervals between your periods?

What you report as changes in the amount, duration, frequency, and regularity of your periods is the information used by your healthcare provider to make the diagnosis of abnormal uterine bleeding.

Your list of complaints will help your healthcare provider begin to figure out what is causing your abnormal uterine bleeding. 

Types of Abnormal Uterine Bleeding

This is where things can get a little confusing. Up until recently, we would give a diagnosis based on the description of the bleeding alone. You may still see these terms used by your healthcare provider or in your internet searches. Before I explain the more recent recommended terminology I will review some of the once popular terms which the experts now recommend should be used only for research purposes.

Outdated Terminology

  • Menorrhagia- This term is used to describe a period with a heavier flow than normal. By definition more than 80 ml of menstrual blood loss during your period.
  • Metrorrhagia- This term describes any bleeding that happens in between your regular periods.
  • Menometrorrhagia- This term describes a combination of heavy periods and bleeding between periods.
  • Dysfunctional uterine bleeding- This term was used much more commonly than abnormal uterine bleeding as a diagnosis. The experts recommend that this term should no longer be used at all

    The following terms describe the frequency of your bleeding:

    • Polymenorrhea- This term describes a period that comes more frequently than every 21 days.
    • Oligomenorrhea- This term describes a period that comes at intervals greater than every 35 days. 

    Current Terminology

    A new classification system has been introduced that uses the umbrella diagnosis of abnormal uterine bleeding or AUB.

    Depending on the quality of the bleeding AUB it is then further defined as:

    • Abnormal uterine bleeding with heavy menstrual bleeding (AUB/HMB)
    • Abnormal uterine bleeding with bleeding between periods (AUB/IMB)

    Once you undergo additional testing and evaluation your healthcare provider will be able to determine a cause of your bleeding and can further classify you as abnormal bleeding due to:

    Structural causes (changes in your uterus)

    • Polyps (AUB-P)
    • Adenomyosis (AUB-A)
    • Leiomyoma (AUB-L)
    • Malignancy and hyperplasia (AUB-M)

    Nonstructural causes 

    • Coagulopathy (AUB-C) - abnormal bleeding due to an underlying bleeding condition
    • Ovulatory dysfunction (AUB-O)- abnormal bleeding because you are not ovulating regularly
    • Endometrial (AUB-E)- abnormal bleeding because of problem with the lining of your uterus like an infection
    • Iatrogenic (AUB-I)- abnormal bleeding because of a medication you are taking
    • Not yet specified (AUB-N)- your healthcare provider can't find an underlying reason for your abnormal bleeding

    As you can see, there are many causes of abnormal bleeding. If you are experiencing abnormal uterine bleeding you should discuss your symptoms and your concerns with your healthcare provider as changes in your menstruation are often a sign of an underlying condition.

    Abnormal uterine bleeding that is heavy and/or frequent can also cause you to become anemic. Anemia caused by chronic blood loss makes you tired and weak. With significant blood loss, you may experience shortness of breath and/or heart palpitations, fainting, or chest pain as your body tries to compensate for your anemia. This puts significant stress on your heart and can be very dangerous for you if you have underlying cardiovascular disease. 

     

    Updated by Andrea Chisholm M.D.

    Source:

    American Congress of Obstetricians and Gynecologists(2012)Diagnosis of Abnormal Uterine Bleeding in Reproductive Age Women (Practice Bulletin #128) accessed 2/21/2016 https://www.acog.org/-/media/Practice-Bulletins/Committee-on-Practice-Bulletins----Gynecology/pb128.pdf?dmc=1&ts=20160221T2213468711

    Continue Reading