Abnormal Uterine Bleeding Treatment

• You get your period more often than every 21 days or farther apart than 35 days. A normal adult menstrual cycle is 21 to 35 days long. A normal teen cycle is 21 to 45 days.
• Your period lasts longer than seven days (normally four to six days).
• Your bleeding is heavier than normal. If you are passing blood clots and soaking through your usual pads or tampons each hour for two or more hours, your bleeding is considered severe and you should call your doctor.
• You have bleeding after menopause.
• You have bleeding or spotting after sex.
• You have bleeding or spotting between periods.

• Problems with ovulation;
• Fibroids or polyps (common abnormal growths in the uterus or cervix);
• Bleeding disorders;
• A condition in which the endometrium grows into the wall of the uterus (adenomyosis)
• Problems linked to some birth control methods, such as an intrauterine device (IUD) or birth control pills
• Certain types of cancer, such as cancer of the uterus
• Abnormal pregnancy (miscarriage or ectopic pregnancy or normal pregnancy

The doctor will need to diagnose the cause of any abnormal bleeding: is it related to hormonal dysfunction, pregnancy or the uterus. Your doctor will ask how often, how long, and how much you have been bleeding. Your doctor may also conduct a pelvic exam, have you undergo a urine test for pregnancy, blood tests for hormone levels and possibly a pelvic ultrasound to evaluate the uterus and ovaries. These tests will help your doctor understand the cause of your abnormal bleeding. He or she may also take a tiny sample (biopsy) of tissue from your uterus for testing.

Once the doctor and you are able to discover the cause of your abnormal bleeding, treatments can be discussed. Typically, medications are the first course of action in treating AUB. Often, the medications that are prescribed include:

• Birth control pills— Birth control pills are often used to treat uterine bleeding due to hormonal changes or hormonal irregularities. Birth control pills may be used in women who do not ovulate regularly to establish regular bleeding cycles and prevent excessive growth of the endometrium. In women who do ovulate, they may be used to treat excessive menstrual bleeding. Abnormal bleeding from some abnormal uterine conditions can also be treated with birth control pills.
• Nonsteroidal anti-inflammatory drugs (NSAIDS) – These drugs (e.g. ibuprofen, naproxen sodium) may also be helpful in reducing blood loss and cramping in these women. During the menopausal transition, birth control pills or other hormonal therapy may be used to regulate the menstrual cycle and prevent excessive growth of the endometrium.
• Tranexamic acid – This medication taken during your menses reduces heavy menstrual bleeding.
• Gonadotropin-releasing hormone (GnRH) agonists – These drugs can stop the menstrual cycle and reduce the size of fibroids by inducing a temporary menopause.
• Progesterone— Progesterone is a hormone made naturally by the ovary that is effective in preventing or treating excessive bleeding in women who do not ovulate regularly. A synthetic form of progesterone, called progestin, may be recommended.
• Intrauterine device— An intrauterine contraceptive device (IUD) that secretes progestin (Mirena or Skyla) may be recommended for women who have abnormal uterine bleeding. Progestin-releasing IUDs decrease menstrual blood loss by more than 50 percent and decrease pain associated with periods. Some women completely stop having menstrual bleeding as a result of the IUD, which is reversible when the IUD is removed.

Sometimes, adenomyosis causes no signs or symptoms or only mild discomfort. However, adenomyosis can cause:

• Heavy or prolonged menstrual bleeding
• Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea)
• Chronic pelvic pain
• Painful intercourse (dyspareunia)

Your uterus might get bigger. Although you might not know if your uterus is bigger, you may notice tenderness or pressure in your lower abdomen.If you have prolonged, heavy bleeding or severe cramping during your periods that interferes with your regular activities, make an appointment to see your doctor.

• Invasive tissue growth. Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) might promote the direct invasion of the endometrial cells into the wall of the uterus.
• Developmental origins. Other experts suspect that endometrial tissue is deposited in the uterine muscle when the uterus is first formed in the fetus.
• Uterine inflammation related to childbirth. Another theory suggests a link between adenomyosis and childbirth. Inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.
• Stem cell origins. A recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis.

Risk factors for adenomyosis include:

• Prior uterine surgery, such as C-section, fibroid removal, or dilatation and curettage (D&C)
• Childbirth
• Middle age

Most cases of adenomyosis — which depends on estrogen — are found in women in their 40s and 50s. Adenomyosis in these women could relate to longer exposure to estrogen compared with that of younger women. However, current research suggests that the condition might also be common in younger women.

If you often have prolonged, heavy bleeding during your periods, you can develop chronic anemia, which causes fatigue and other health problems.

Although not harmful, the pain and excessive bleeding associated with adenomyosis can disrupt your lifestyle. You might avoid activities you've enjoyed in the past because you're in pain or you worry that you might start bleeding.

Symptoms of AVM vary based on where it's located. Often the first signs and symptoms appear after bleeding occurs. Besides bleeding, signs and symptoms can include:

• Progressive loss of neurological function
• Headaches
• Nausea and vomiting
• Seizures
• Loss of consciousness

Other possible signs and symptoms include:

• Weak muscles
• Paralysis in one part of the body
• Loss of coordination that can cause problems with gait
• Problems performing tasks that require planning
• Weakness in the lower extremities
• Back pain
• Dizziness
• Vision problems, including losing part of your field of vision, loss of control of eye movements, or swelling of part of the optic nerve
• Problems with speech or understanding language
• Unusual sensations including numbness, tingling or sudden pain Memory loss or dementia
• Hallucinations
• Confusion

Children and teens may have trouble with learning or behavior.

One type of AVM called a vein of Galen defect causes symptoms that appear at or shortly after birth. A vein of Galen defect is located deep inside the brain. Signs can include:

• A buildup of fluid in the brain (hydrocephalus) that causes enlargement of the head
• Swollen veins on the scalp
• Seizures
• Failure to thrive
• Congestive heart failure

Seek medical attention if you have any of the signs and symptoms of an AVM, such as headaches, dizziness, vision problems, seizures and changes in thinking or neurological function. Many AVMs are currently discovered incidentally, often after a CT scan or an MRI is obtained for reasons not directly related to the AVM.

AVMs result from development of abnormal direct connections between arteries and veins, but experts don't understand why this happens. Certain genetic changes might play a role, but most types are not usually inherited.

Rarely, having a family history of AVMs can increase your risk. But most types of AVMs aren't inherited.

Certain hereditary conditions may increase your risk of AVM. These include hereditary hemorrhagic telangiectasia (HHT), also called Osler-Weber-Rendu syndrome

The most common complications of an AVM are bleeding and seizures. If left untreated, the bleeding can cause significant neurological damage and be fatal.