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More than 10 million women in the United States suffer from abnormal uterine bleeding. One third of all gynecological outpatient visits annually are for abnormal uterine bleeding.
The Menstrual Cycle
Menstruation (cyclic uterine bleeding) is usually established by age 13 and continues until the late 40’s to up to age 51. Once established, in most women menstrual cycles remain regular and predictable until menopause approaches, at which time some menstrual irregularity may be experienced.
Irregular menstrual cycles are common in the first few years following menarche (onset of first menses). However, most women ovulate regularly and menstrual periods become regular by 5-7 years after menarche. The normal menstrual cycle length ranges between 24-35 days (average 28), with bleeding occurring from 3-7 days (average 4 days), and an average menstrual loss of 35 ml (range 20-80 ml). Any bleeding pattern that falls outside this range is regarded as abnormal.
Abnormal bleeding is characterized by the following definitions:
Amenorrhea – absence of menstrual periods, and is classified as primary (absence by age 16) or secondary (absence for more than 3-6 months in a woman who previously had periods).
Oligomenorrhea – infrequent menstrual periods (cycle length of more than 35 days).
Menorrhagia – heavy menstrual flow (loss of more than 80 ml of blood) and/or increased duration of flow (greater than 7 days) at regular intervals. Menstrual loss of greater than 80 ml may result in anemia.
Metrorrhagia – bleeding at irregular intervals or bleeding between menstrual periods.
Menometrorrhagia – increased loss or duration of bleeding occurring at irregular intervals.
Polymenorrhea – menstrual bleeding occurring at less than 21 day intervals.
Hypomenorrhea – reduction in number of days or amount of menstrual flow.
Intermenstrual bleeding – bleeding between two regular menstrual periods.
Although some woman do not find irregular, infrequent or absent menstrual periods troubling, these changes can signal underlying medical conditions and can have long-term consequences.
Treatment can establish or restore normal menstrual periods and fertility, and can prevent long-term consequences. The goal of treatment of the above is to correct the underlying condition if possible, or to achieve fertility if a woman wishes to become pregnant.
Commonly used regimens to treat abnormal uterine bleeding include NSAIDS (non-steroidal anti-inflammatory agents like ibuprofen), combination estrogen and progesterone products (birth control pills, NuvaRing), progesterone agents (DepoProvera injections, progesterone), and iron supplements.
Persistent and unresponsive bleeding may require surgery.