Treatments for Abnormal Uterine Bleeding (AUB)

 Treatments for Abnormal Uterine Bleeding (AUB)

Drugs used to treat Abnormal Uterine Bleeding

1- Tri-Previfem

2- Tri-Estarylla

3- Myzilra 

4- Kelnor 1/50

5- Kelnor 1/35

6- Ethinyl Estradiol / Etonogestrel

7- Elinest 

8- Chateal 

9- Amethia Lo

10- Zovia 1/50E

11- Trivora 

12- Tri-Lo-Sprintec

13- Tri-Lo-Marzia

14- Tri-Linyah

15- Sronyx 

16- Portia 

17- Orsythia 

18- LoSeasonique

19- Lessina 

20- Kurvelo 

21- Falmina

22- Ethinyl Estradiol / Norgestrel

23- Ethinyl Estradiol / Ethynodiol

24- Enpresse

25- CamreseLo 

26- Zovia 1/35E

27- Premarin Intravenous

28- Seasonale 

29- Previfem

30- Lutera 

31- Levora 

32- Levlen 

33- Conjugated Estrogens

34- Mono-Linyah

35- Low-Ogestrel-28

36- Jolessa 

37- Estarylla

38- Tri-Sprintec

39- Gallifrey

40- Ethinyl Estradiol / Norethindrone

41- Desogestrel / Ethinyl Estradiol

42- Ethinyl Estradiol / Norgestimate

43- Seasonique

44- Cryselle 

45- Ethinyl Estradiol / Levonorgestrel

46- Aviane 

47- Premarin

48- Sprintec

49- Megestrol

50- Provera

51- Norethindrone

52- Medroxyprogesterone

What is Abnormal Uterine Bleeding (AUB)?

Abnormal Uterine Bleeding (AUB) is an umbrella term for any bleeding from the uterus that varies in frequency, duration, or volume from typical menstrual bleeding. It can affect women at any stage of their reproductive life and is particularly common around puberty and perimenopause. Here's a thorough look at what AUB is, its causes, symptoms, diagnosis, and treatment options.

 

1. Definition and Classification

   - Definition: AUB refers to uterine bleeding that deviates from the normal pattern of menstrual bleeding. This can mean bleeding that is heavier, lighter, prolonged, irregular, or more frequent than the regular cycle.

   - Classification: The International Federation of Gynecology and Obstetrics (FIGO) classifies AUB based on the PALM-COEIN system, where each letter stands for a specific cause:

     - PALM: Structural causes (Polyps, Adenomyosis, Leiomyoma (fibroids), Malignancy/Hyperplasia).

     - COEIN: Non-structural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified).

 

2. Types of Abnormal Uterine Bleeding

   - Menorrhagia: Excessive bleeding during regular menstruation periods, often lasting more than seven days or involving blood loss over 80 mL.

   - Metrorrhagia: Irregular bleeding between menstrual cycles.

   - Menometrorrhagia: Heavy, irregular bleeding that doesn’t follow a set menstrual pattern.

   - Oligomenorrhea: Infrequent menstrual periods, typically with cycles longer than 35 days.

   - Polymenorrhea: Frequent menstrual periods with cycles shorter than 21 days.

   - Postmenopausal Bleeding: Bleeding occurring after menopause, which is often concerning as it can indicate malignancy.

 

3. Causes of Abnormal Uterine Bleeding

   - Hormonal Imbalances: Common in adolescents and women nearing menopause, these imbalances can affect ovulation, leading to irregular bleeding.

   - Structural Issues: Conditions like uterine polyps, fibroids, or adenomyosis can lead to AUB. For example:

     - Fibroids are benign tumors that grow within the uterine wall, often causing heavy or prolonged bleeding.

     - Adenomyosis occurs when the endometrial tissue grows into the muscular wall of the uterus.

   - Endometrial Issues: Disorders like endometritis (inflammation of the uterine lining) can cause irregular bleeding.

   - Coagulation Disorders: Blood clotting disorders, such as von Willebrand disease, can result in prolonged bleeding.

   - Iatrogenic Causes: Medications like anticoagulants, hormonal contraceptives, or certain medical devices (e.g., IUDs) can alter bleeding patterns.

   - Malignancies: Cancers of the uterus, cervix, or endometrium can cause bleeding, especially in postmenopausal women.

 

4. Symptoms

   - Irregular Menstrual Cycles: Women may experience variations in cycle length, frequency, and bleeding duration.

   - Heavy or Prolonged Bleeding: Increased blood loss that may require frequent tampon or pad changes.

   - Pain or Cramping: Sometimes, AUB is accompanied by pelvic pain or cramps.

   - Fatigue and Anemia: Prolonged heavy bleeding can lead to iron deficiency anemia, causing fatigue, weakness, and shortness of breath.

   - Bleeding Post-Menopause: Any bleeding after menopause should be considered abnormal and investigated.

 

5. Diagnosis

   - Medical History and Physical Exam: A detailed history about menstrual patterns, family history, medications, and any recent stress or weight changes can be revealing.

   - Pelvic Exam: Helps detect abnormalities in the cervix, uterus, or surrounding structures.

   - Laboratory Tests: Blood tests to assess hormonal levels, pregnancy, and check for anemia or coagulation issues.

   - Imaging:

     - Ultrasound is often the first-line imaging tool, providing a detailed view of the uterus and ovaries.

     - Hysteroscopy involves inserting a thin scope through the cervix to directly visualize the inside of the uterus, aiding in detecting polyps, fibroids, or other abnormalities.

   - Endometrial Biopsy: Especially important for women over 35 or those at risk of endometrial cancer, this test involves taking a small tissue sample from the uterus lining.

 

6. Treatment Options

   - Hormonal Therapy: Often the first line of treatment, particularly for women whose AUB is due to hormonal imbalances. Options include:

     - Oral Contraceptives: Regulate menstrual cycles and reduce bleeding.

     - Progestin Therapy: Given either orally, as an injection, or through an intrauterine device (IUD) to help control bleeding.

   - Non-Hormonal Medication:

     - NSAIDs (e.g., ibuprofen): Help reduce menstrual blood flow and relieve pain.

     - Tranexamic Acid: A medication that helps reduce bleeding by stabilizing blood clots.

   - Surgical Options:

     - Dilation and Curettage (D&C): Scraping the uterine lining to reduce bleeding.

     - Endometrial Ablation: Removes or destroys the endometrial lining to reduce or stop bleeding, typically for women who no longer wish to have children.

     - Myomectomy: Surgical removal of fibroids while preserving the uterus.

     - Hysterectomy: Complete removal of the uterus; considered the last option, particularly in cases of severe AUB or malignancy.

   - Treatment for Underlying Causes: If AUB is due to a specific condition like polycystic ovary syndrome (PCOS) or thyroid disease, treating the underlying condition can help stabilize menstrual cycles.

 

7. Risk Factors and Prevention

   - Age: Teenagers and women near menopause are at higher risk due to hormonal shifts.

   - Lifestyle Factors: Obesity, stress, excessive exercise, or poor diet can contribute to hormonal imbalances.

   - Medical History: Women with clotting disorders or those on certain medications are more susceptible.

   - Prevention: While not all AUB can be prevented, maintaining a healthy lifestyle, managing stress, and regular medical check-ups can help identify and manage any irregularities early.

 

8. When to Seek Medical Attention

   - Persistent heavy bleeding, bleeding lasting more than 7 days, or significant changes in menstrual cycle regularity.

   - Symptoms of anemia, such as fatigue, pale skin, or lightheadedness.

   - Bleeding after menopause, as this could indicate a more serious condition.

 

9. Prognosis

   - The outlook for AUB depends largely on the underlying cause. Many women find relief with medical or surgical treatments, but some may need ongoing management.

   - For those with conditions like fibroids or hormonal imbalances, treatment can often restore a more regular cycle, though symptoms may recur if the underlying issue isn’t permanently addressed.

 

Summary

AUB is a complex condition with a wide range of potential causes and treatment options. Diagnosis typically involves a combination of history, examination, lab tests, and imaging, while treatment may range from hormonal therapies to surgery, depending on severity and underlying factors.