Abnormal uterine bleeding (AUB) means any change from a person’s usual menstrual pattern — heavier or lighter bleeding, bleeding that lasts too long, bleeding too often, or bleeding between periods (not caused by pregnancy). Clinicians group causes using the PALM–COEIN system (structural: Polyps, Adenomyosis, Leiomyoma(fibroids), Malignancy; non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified).
Main causes (short list) of ABNORMAL UTERINE BLEEDING (AUB)
• Structural: uterine fibroids, polyps, adenomyosis, endometrial hyperplasia or cancer.
• Hormonal/ovulatory: anovulation (teenagers, perimenopause, PCOS).
• Bleeding disorders/medical: Von Willebrand disease, clotting problems, thyroid disease.
• Iatrogenic: contraceptives, anticoagulants, intrauterine devices.
• Other: infection, pregnancy complications (ruled out first).
How common is it? (brief regional snapshot) – ABNORMAL UTERINE BLEEDING (AUB)
• United Kingdom (NICE / RCOG): AUB/HMB is very common; up to ~1 in 3 women will have significant AUB in their life and HMB is a common reason for referral.
• United States (ACOG / UpToDate): Population studies report ~14–25% of reproductive-age women affected by clinically significant AUB/HMB.
• Europe: Similar ranges to UK/US (studies report ~15–40% depending on definition and age).
• Asia & Africa: Reported prevalence varies widely (from low single digits to >30% in some community studies) — under-reporting, cultural factors and study methods make comparisons hard. Systematic reviews highlight major regional heterogeneity.
(Overall: up to one third of women experience some AUB in their lifetime; heavy bleeding and clinically important AUB are common but reported estimates vary by study.)
Typical symptoms people report about ABNORMAL UTERINE BLEEDING (AUB)
• Very heavy menstrual bleeding (soaking through pad/tampon, needing to change at night)
• Periods lasting >7 days or very frequent bleeding
• Bleeding between periods or after sex
• Passing large clots, tiredness from anaemia, dizziness with heavy loss
Long-term consequences of ABNORMAL UTERINE BLEEDING (AUB) (if untreated)
• Iron-deficiency anaemia (fatigue, breathlessness).
• Reduced quality of life: work/school absence, social restriction, sexual dysfunction.
• Possible fertility impact if structural disease present.
• Increased healthcare use and possible progression to hysterectomy if refractory to treatment.
• Risk of endometrial hyperplasia or cancer if abnormal bleeding is ignored — needs investigation.
Investigations on ABNORMAL UTERINE BLEEDING (AUB) (practical stepwise approach)
1. Immediate: pregnancy test; assess haemodynamic status and treat severe blood loss.
2. Office tests: history of bleeding pattern and impact, 3-day bladder/bleeding record, full blood count (check anaemia), urine dip, STI screen if indicated.
3. Targeted bloods: TSH, prolactin, coagulation tests if bleeding history suggests, HbA1c if metabolic concerns.
4. Imaging: transvaginal ultrasound (first line for pelvic pathology).
5. Endometrial assessment: hysteroscopy ± biopsy if persistent abnormal bleeding, thickened endometrium or post-menopausal bleeding.
6. Specialist tests: MRI or targeted scans and specialist referral when needed. (NICE recommends a focused approach so tests change management.)
Treatment options for ABNORMAL UTERINE BLEEDING (AUB)
Choice depends on cause, severity, age and fertility plans. Shared decision-making is essential.
First-line / medical
• Tranexamic acid during heavy days — reduces bleeding.
• NSAIDs for pain and modest bleeding reduction.
• Combined oral contraceptive pill (continuous or cyclical) — regulates flow.
• Levonorgestrel IUS (Mirena®) — highly effective long-term for heavy bleeding.
Other medical / targeted
• Oral progestogens, GnRH agonists/antagonists (short-term or pre-op), new oral agents for fibroids (e.g., linzagolix recently approved in NHS pathways for fibroid symptoms).
Procedural / surgical (if structural cause or medical therapy fails)
• Hysteroscopic polypectomy / myomectomy for intracavitary pathology.
• Endometrial ablation (for those who do not want future fertility).
• Uterine artery embolisation for fibroids (selected cases).
• Hysterectomy — definitive when other treatments fail or not desired fertility.
When to seek help / red flags
• Soaking through clothes or night-time bleeding, fainting, chest pain or breathlessness → seek urgent care.
• Any post-menopausal bleeding, persistent intermenstrual bleeding, or failure of first-line treatment → refer for gynaecology assessment and endometrial sampling.
Key takeaways of ABNORMAL UTERINE BLEEDING (AUB)
• AUB is common and treatable; it ranges from mild nuisance to severe, life-disrupting bleeding.
• Start by ruling out pregnancy and treating anaemia, then use focused tests (TVUS, bloods) as guided by NICE/RCOG/UpToDate.
• Many women improve with tranexamic acid, hormonal therapy or IUS; surgery is reserved for persistent or structural problems.
Remember, ALWAYS consult with your GP and/or your gynecologist for your specific treatment options. Every woman is different!
Read also: Subfertility