- 1What Is Abnormal Uterine Bleeding?
- 2Why Bleeding Happens in Endometrial Cancer?
- 3Risk Factors Linking AUB and Endometrial Cancer
- 4How Doctors Diagnose the Cause of Abnormal Uterine Bleeding?
- 5When Should Women With AUB Be Screened for Endometrial Cancer?
- 6When to See a Doctor for Abnormal Uterine Bleeding?
- 7Conclusion
- 8Key Takeaways
What Is Abnormal Uterine Bleeding?
Abnormal uterine bleeding refers to bleeding from the uterus that does not follow a typical menstrual cycle pattern. It can be heavier than your usual periods and can even cause bleeding between two menstrual cycles (periods), or there can be a prolonged or frequent period cycle that can extend for many days. Even bleeding after menopause is considered abnormal uterine bleeding (AUB). AUB is one of the common complaints across women of all ages, especially those around reproductive years, perimenopause (transitioning to menopause), and postmenopause.
Endometrium is the inner lining of the uterus that thickens and sheds during the menstrual cycle and is regulated by the hormones estrogen and progesterone. While estrogen helps the endometrium grow, progesterone helps in preparing it for pregnancy to receive the ovum. If pregnancy does not happen, then these hormone levels reduce and lead to shedding of the endometrial lining.
Why Bleeding Happens in Endometrial Cancer?
Endometrial cancer forms in the endometrium, causing cells to multiply rapidly and produce abnormal cells that will alter the normal endometrial structure. When the cancer grows further, the uterine lining may become fragile and unstable. Due to this fragility, blood vessels within the tissues break easily, causing bleeding.
The endometrium is therefore hormone-sensitive, and most endometrial cancers develop in an estrogen-rich environment. This is common, especially in type I endometrial cancer. Excess estrogen can cause uterine lining thickening without normal shedding, thereby increasing the chance of abnormal bleeding. So, uterine bleeding can be an early symptom of endometrial cancer and often appears before the disease starts to spread. Endometrial cancer, causing bleeding, can appear as:
Bleeding between periods.
Heavy periods.
Prolonged menstrual bleeding.
Spotting after menopause.
How Often Does Bleeding Indicate Cancer?
Most AUB cases are not linked to cancer. Common non-cancer causes for AUB include hormonal imbalance, thyroid problems, ovulatory disorders, fibroids (non-cancerous muscular tumors in the uterus), polyps (abnormal tissue growths), or infections that can cause abnormal uterine bleeding. If you experience abnormal uterine bleeding, it is important to talk to a healthcare professional when you have a known risk or if you are nearing menopause.
Based on a study, it was found that out of 972 women, only 5.3 % of women who had AUB were diagnosed with endometrial cancer. While not all AUB cases may indicate cancer, in certain scenarios, they require further evaluation.
Risk Factors Linking AUB and Endometrial Cancer
There are many risk factors, including hormonal variations in the LH/FSH (luteinizing hormone to follicle-stimulating hormone) ratio, prolactin levels, and thyroid-stimulating hormone (TSH), that are associated with abnormal endometrial thickness.
Important risk factors include:
Obesity:
As fat tissue increases estrogen levels, it is one of the strongest reasons for abnormal endometrial growth.
Menopause:
Perimenopause and menopause are risky because during that time, there can be hormonal fluctuations leading to AUB.
Increasing Age:
Women over 40 tend to be at risk for AUB as they are nearing menopause.
Diabetes Mellitus:
Women with diabetes mellitus and other metabolic issues can experience hormonal imbalance and irregular bleeding.
Hypertension:
Research suggests women with hypertension (high blood pressure) and those around reproductive age and menopause can experience AUB.
Hypothyroidism:
This condition causes an increase in TSH levels that further affects progesterone and estrogen levels, resulting in abnormal bleeding.
Nulliparity:
In nulliparous (never having been pregnant) women, there can be increased hormonal levels leading to AUB.
Polycystic Ovarian Syndrome (PCOS):
Women affected often have irregular ovulation, which leads to prolonged estrogen exposure.
Previous History of Cancer:
When there is hormone therapy, especially in cases of a history of breast cancer or other reproductive cancers, there is a risk for AUB.
Endometrial Thickening:
Endometrial thickening increases AUB risk in case of an irregular thickened endometrium.
How Doctors Diagnose the Cause of Abnormal Uterine Bleeding?
The doctors diagnose AUB by obtaining a thorough history and doing a physical examination. Doctors review personal and family history, past illnesses, pregnancy history, past surgery history, along with medication history, including those of birth control pills.
It is also important for you to keep a record of any abnormal bleeding pattern observed and the date and length of your usual periods. This information can help keep the doctors informed and arrive at a diagnosis. The doctor may also order additional tests along with a pelvic examination, such as:
Transvaginal ultrasound to check endometrial thickness and to have a picture of the pelvic organs.
An endometrial biopsy is performed when cancer is suspected.
Hysteroscopy (lighted scope inserted through the vagina) to see the inside of your uterus.
Magnetic resonance imaging (MRI) and computed tomography (CT) are used for more detailed imaging.
When Should Women With AUB Be Screened for Endometrial Cancer?
Not all women who have AUB should be screened for endometrial cancer. But certain women require prompt screening due to their risk factors, such as:
Postmenopausal Bleeding:
Any abnormal bleeding after menopause can increase cancer risk and require screening. Post menopause, the uterine lining should actually be thin and inactive. Bleeding at this stage may indicate something abnormal and require screening.
Women Over 45 With Abnormal Bleeding:
Women over 45 with abnormal bleeding (new heavy bleeding, prolonged bleeding, irregular cycles, or bleeding between periods) should be screened for endometrial cancer. Women over 45 who have abnormal uterine bleeding have a higher cancer risk due to hormonal fluctuations, and may hide underlying conditions.
Women Under 45 With High-Risk Conditions:
Young women with risk factors, especially obesity, PCOS, diabetes, chronic anovulation, and hypertension, should undergo endometrial assessment.
When to See a Doctor for Abnormal Uterine Bleeding?
You might require seeing a doctor for abnormal uterine bleeding, and it is important if:
It is heavier than usual.
Lasting longer than expected.
When it occurs between periods.
When there is bleeding after sex.
When there is repeated bleeding.
When there is bleeding after menopause.
When there is pelvic pain.
When there is fatigue, anemia, and unexplained weight loss.
Conclusion
Abnormal uterine bleeding may appear common, but not always. When you observe a change in pattern or notice bleeding after menopause, it requires medical assessment. In most women, the cause is hormone-related and can be corrected. As AUB is one of the earliest symptoms of endometrial cancer, careful evaluation by a gynecologist is important. If you see any abnormal bleeding, consult a women’s health specialist for further evaluation.
Key Takeaways
AUB includes heavy irregular bleeding, spotting, or postmenopausal bleeding.
Though most AUB can appear normal, it is important to report to the gynecologist about any drastic changes in the usual cycle.
Women who are at risk, especially need to be cautious about any abnormal bleeding that can occur.
