Dealing with abnormal uterine bleeding


Radhika Hegde from Bengaluru went through hell recently as she put up with abnormal uterine bleeding which lasted for 15 days. ''The bleeding got heavier and I also had blood clots,” recalls the 43-year-old who had to change sanitary pads every hour.

The problem persisted despite medication and lifestyle changes, and she eventually had to quit her job and undergo a hysterectomy. When she consulted Dr Jyothi Shenoy of Columbia Asia Hospital, she learnt that the causes of inter-menstrual bleeding could range from a benign polyp to an ovarian cyst to even something as ominous as cancer of the cervix or uterus.

After getting a pap smear, ultrasound, and some blood tests done, Radhika was diagnosed with estrogen dominance and was put on progesterone pills. She was also asked to reduce her weight and make some changes in her diet. Her bleeding stopped after a week.

Abnormal uterine bleeding, also known as dysfunctional uterine bleeding, is characterised by vaginal bleeding not associated with normal menstrual cycle, says Dr Bharati Kamoji, senior consultant—obstetrics and gynecology, Aster CMI Hospital, Bengaluru. “For instance, bleeding between periods, after sex, after menopause and spotting anytime during the cycle are considered as abnormal, as are menstrual cycles that are longer than 35 days or shorter than 21 days, she says. “There are six different types of dysfunctional uterine bleeding: menorrhagia (heavy and prolonged menstrual bleeding), polymenorrhoea (too frequent menstruation), metrorrhagia (irregular, on menstrual bleeding from the uterus or bleeding between menstrual periods), anovulatory bleeding (menstrual cycles in which ovaries do not release an egg), oligomenorrhoea (light or infrequent menstrual cycles) and postmenopausal bleeding (any bleeding that occurs more than one year after the last menstrual period at menopause),” she adds.

One of the most common causes of dysfunctional uterine bleeding is the hormonal imbalance. Hormonal intrauterine devices (IUD) such as Mirena can be a boon for women having persistent vaginal bleeding between periods due to hormonal variations. Mirena releases levonorgestrel, a type of progestin, at an initial rate of 20 micrograms per day. The amount of levonorgestrel released may go down to 14 micrograms per day after five years, but it could still be effective in preventing abnormal bleeding. Experts say that use of these devices can reduce the rate of hysterectomy by 40 per cent. Skyla, another IUD, releases 14 micrograms of levonorgestrel per day initially. The amount of levonorgestrel released reduces to five micrograms per day after three years. Hormonal IUDs can help stop heavy bleeding, allowing one to lead a normal life. Those who prefer indigenous products can go for similar devices from Emily.

Other conservative treatment options include tranexamic acid and oral contraceptive pills, says Dr Madhullika Sinha, senior consultant, obstetrician and gynecologist, Aakash Healthcare Super Speciality Hospital, New Delhi. Oral contraceptives contain as much as 150 micrograms of levonorgestrel. Non-hormonal medications including mefenamic acid, naproxen and progesterone pills are also often prescribed.