Abnormal Uterine Bleeding (AUB)
A good place to start is by defining what a normal period should look and fell like.
How do we know if we’re experiencing AUB?
A good place to start is by defining what a normal period should look and fell like.
What is a normal period like?
The average woman will get her period every 28 days, and the normal range is anything between 24-38 days.
The average period lasts between 4 to7 days, associated with 5-80 mls of blood loss.
What do gynaecologists call a heavy period
The definition of excessive uterine bleeding is greater than 80 ml blood loss. We don’t expect women to get out a measuring cup to define their own lived experience. Soaking a pad or tampon more than every two hours is not normal. Flooding through pads/tampons and clothing is not normal. Bleeding that majorly interferes with daily activities is not normal. Bleeding that causes anaemia and iron deficiency over time is not normal.
Excessive blood loss is defined as a volume that interferes with the patient’s physical, emotional, social, and/or material quality of life.
Confusing facts about your period
We don’t always perceive periods according to text book definitions. Studies have reported that 25% of women think their period is heavy, when by definition it is normal. Conversely, for 40% of women who think their period is normal, it is actually heavy.
Dealing with periods is our forte
1 in 3 presentations to see a gynaecologist is in regards to AUB.
The importance of AUB relates to its major impact on a person’s quality of life.
There are many possible causes of abnormal periods. Some of these include ovulation problems (ovulatory dysfunction), bleeding and clotting disorders, cancer and pre-cancer endometrial changes, iatrogenic problems (caused by medical treatment such as blood thinning medications), inflammation and infection. Structural problems of the uterus (the womb) itself can cause heavy periods, including polyps, fibroids and adenomyosis.
The common causes of heavy periods differ across age groups. It is very rare to detect a cancer or pre-cancer change causing heavy periods in women under 45 years. However womb cancers do sometimes occur in young patients and we always need to consider the possibility.
A thorough examination with a gynaecologist is required to determine the cause of AUB and to offer appropriate treatment.
What to expect when you see a gynaecologist about your period
At your first appointment, initial evaluations will be undertaken. The source of bleeding needs to be defined. Most bleeding is from the uterus, but a systematic assessment is essential to exclude other sources. Speculum examination, pelvic imaging and hormonal blood test will help with identifying the cause, while a blood count and iron studies will look for iron deficiency as a consequence.
If we suspect a structural problem – hysteroscopy (checking the inside of your uterus using a tiny camera) and a dilation and curettage (D&C) will be the next step. This is performed as a day procedure under a gentle anaesthetic for your comfort.
Management of AUB depends on the cause
Abnormal uterine bleeding can be managed by hormonal interventions , such as hormone regulating pills, or a progesterone infused intrauterine device (IUD). Non hormonal medical therapies can help too, like taking anti-inflammatory medications (to manage period associated discomfort) or tranexamic acid (an oral, non-hormonal agent that helps slow down uterine bleeding to make periods lighter). In some cases surgical treatment will be required to correct structural anomalies such as fibroids or polyps. Occasionally more significant surgical treatments need to be considered including permanent endometrial ablation or hysterectomy.
For more information on Abnormal Uterine Bleeding, heavy periods or uterine bleeding outside of regular menses listen to Dr Tzippi on Knocked Up Podcast.
If you think you have Abnormal Uterine Bleeding or another gynaecological concern and would like to see Dr Tzippi, click here to make an appointment.
Reviewed by Dr Tzippora Ben-Harim
RANZCOG Gynaecologist
Dr Tzippora Ben- Harim is a broadly trained specialist gynaecologist at Women’s Health Melbourne. Fluent in both Hebrew and English, Tzippi is known for her caring, compassionate approach, supporting women with gynaecological care through every life stage.